Why Do People With Social Anxiety Disorder Shake?

Why do people with social anxiety disorder shake?

Verywell / Nusha Ashjaee 

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Shaking or trembling of the hands or other parts of the body is a common physical symptom you may experience as part of social anxiety disorder (SAD). When your shaking is caused by anxiety, it is a result of your body's fight-or-flight response.

As much as you might feel terrible in the moment that you are shaking, and that the whole world can see just how nervous you are—remember that people don't really notice as much as you think they do.

Causes

When you shake because of anxiety, it is a result of the fight-or-flight response. This physiological response to threats in the environment increases your alertness and prepares your body for exertion.

In the absence of a real physical threat, your body becomes revved up to fight a lion or tiger, but more likely what you are facing is a stranger or an audience.

If you are in an anxiety-provoking social or performance situation, your body will release the hormone epinephrine (also known as adrenaline). Epinephrine directs blood to your skeletal muscles. You may also experience increased heart rate, blood pressure, and blood sugar.

A second hormone, norepinephrine, is also released and involved in many of these changes in your body. When your body starts to quiver, it is as a result of all of these complex internal processes.

Shaking can also result from a medical condition such as Parkinson's disease or be the side effect of some medications. When shaking is the result of a medical condition or medication, a medical doctor will determine the best course of treatment.

Triggering Situations

Common situations in which you might notice your hands or body shaking include when you are:

  • Holding papers during a presentation
  • Holding silverware
  • Pouring drinks
  • Raising a drink to your mouth
  • Signing a check
  • Writing in front of others

Shaking and Social Anxiety

If you struggle with social anxiety disorder, you may have problems with shaking in front of others. Have you ever had trouble raising a glass to your lips or holding notes during a speech without shaking? You might even notice your legs shaking or your lips quivering.

Often these symptoms are also kept going by a cycle of negative thinking: "Oh no, I'm starting to shake!" You think.

Guess what that causes? More shaking. Tense muscles. You trying to control your shaking, hiding your hands behind your back, and otherwise doing things to try and hide it from others.

Unfortunately, fighting against your anxiety and using avoidance strategies will tend to make your shaking worse. But don't worry—there are things you can do to shake less.

Treatment

According to the National Institute of Mental Health, approximately 19.1% of U.S. adults experience some type of anxiety disorder each year. While common, only around 20% of people affected seek treatment.

Because women are twice as likely as men to experience anxiety, the Women's Preventative Services Initiative (WPSI) now recommends that all women aged 13 and older be screened for anxiety disorders as part of routine preventative health care. Effective treatments are available and earlier interventions may result in better health outcomes.

People who shake because of anxiety may be treated with either medication or talk therapy.

Beta-blockers are sometimes used to cope with infrequent anxiety-provoking situations, such as speeches or performances. These medications treat the symptoms of anxiety by blocking the effect of adrenaline but do not address underlying psychological issues.

Talk therapies such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) can be helpful for changing your thought patterns that contribute to social anxiety symptoms.

If you are diagnosed with anxiety, contact a mental health professional (or get a referral from your doctor) to receive one of these therapies, or try them out as self-help methods on your own.

How to Cope

Things that may make your shaking worse (and that you can avoid), include:

  • Lack of sleep
  • Caffeine

Positive strategies that you can use to manage your shaking:

While you may never be fully free of shaking, by following a lifestyle that includes positive measures to combat stress and anxiety is a good first step. Remember: People probably notice a lot less than you think.

If you ever find yourself shaking in front of someone, don't try to control it. Instead, focus on something else and move your mind along with so that it doesn't become fixated on the physical symptom and degenerate into a panic attack.

A Word From Verywell

Everyone gets nervous from time to time. If you find that your anxiety-induced shaking is having a significant negative effect on your daily functioning, however, it is important to seek help. Shaking that results from social anxiety disorder can be treated with medication or therapy.

If you or a loved one are struggling with anxiety, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Article Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harvard Health Publishing. Understanding the Stress Response. Updated May 1, 2018.

  2. Chand SP, Marwaha R. Anxiety. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated April 23, 2020.

  3. National Institute of Mental Health. Any Anxiety Disorder. Updated November 2017. 

  4. Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: A recommendation from the Women's Preventive Services Initiative. Ann Intern Med. 2020. doi:10.7326/M20-0580

  5. Abboud H, Ahmed A, Fernandez HH. Essential tremor: Choosing the right management plan for your patient. Cleve Clin J Med. 2011;78(12):821-8. doi:10.3949/ccjm.78a.10178

Additional Reading
  • Columbia University, Go Ask Alice. Nervous Trembling.

  • Cordingley GE. Nervousness and Shaking: Are They the Same Thing?

  • University of Utah. How Cells Communicate During the Fight or Flight Response.

  • University of Michigan Health Service. Anxiety Disorders and Panic Attacks.