Khazan: Does everyone get socially anxious, or just certain people?

Hofmann: Well, it would be very abnormal not to be socially anxious. Social anxiety is a very normal stage that children go through, [along with] separation anxiety and stranger anxiety. These are actually very normal stages, and children who do not go through these stages, doctors do worry about those kids.

Later on, we obviously will still be uncomfortable in novel social situations, it’s quite normal. It becomes, obviously, a problem if we are too distressed. If it interferes with our lives and bothers us too much, then it becomes a problem, and then we would call it social anxiety disorder.

Khazan: How is social anxiety different from generalized anxiety? Is it more common than regular anxiety, or less severe? Where would you place social anxiety on the anxiety map?

Hofmann: In psychiatry we have a group of what we call anxiety disorders, and that includes social anxiety, generalized anxiety disorder, panic disorder, agoraphobia, specific phobias, and the like. Social anxiety disorder is the most common form among all the anxiety disorders. It actually is also ranked, in comparison to all the other mental disorders, as one of the most common disorders, next only to depression and substance use disorder. Thirteen out of 100 people meet criteria for social anxiety disorder [at some point in life].

Khazan: Is there any overlap between people who are generally anxious and people who have social anxiety?

Hofmann: Yeah, all the anxiety disorders are highly comorbid. Comorbidity means the coexistence of two or more problems in one individual. The most common problem for people with social anxiety disorder is actually depression. Then other forms of anxiety disorder, in particular generalized anxiety disorder and panic disorder. But this is true for almost all disorders—they are highly overlapping with each other. Which, by the way, causes problem for the psychiatric diagnosis, because we wouldn’t assume that there’s such a high overlap, but it does exist.

Khazan: How do you know if your level of social anxiety is considered disordered?

Hofmann: The definition of a mental disorder is that it causes either significant distress, and/or significant interference in one's life. So you might be able to perform normally during daily life, but you're terribly distressed around these social situations, such as meeting people, giving speeches, or doing things in front of people. It causes you such a level of distress that causes you to want to get help.

Or, there are people who kind of find their way around these problems, and they live lives that are fairly isolated. They might not marry, they might have very few friends, they might not go out for parties. In other words, they might not feel much distress because they’re living isolated lives, but at the same time they would like to be social. So they feel still an urgency to do something about it because they're not loners, but they just can't be around people because it's so distressing. Some people use substances like alcohol to medicate themselves.