Public Speaking, the Most Common Social Fear: What a National Survey of 9,282 Adults Found

By Noam Shemla · The Studies

TL;DR In a nationally representative survey of 9,282 American adults, public speaking was the most common social fear: 21.2% had felt it strongly enough to count, ahead of speaking up in a meeting or class (19.5%). About one person in eight (12.1%) met the criteria for social phobia at some point in their life. The more situations someone feared, the more likely the disorder and the more it disrupted their life, yet only about half of those who got help were treated for it.

• Paper: Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological Medicine, 38(1), 15–28.
• Survey: The National Comorbidity Survey Replication: face-to-face interviews in US households, 2001 to 2003, weighted to match the 2000 census.
• Sample: 9,282 adults aged 18 and over; response rate 70.9%.
• Interview: The WHO Composite International Diagnostic Interview (CIDI 3.0), asking about 14 social situations and the DSM-IV criteria for social phobia.
• Outcomes: Lifetime and 12-month prevalence, age at onset, recovery, other disorders, impairment at home, work, in relationships and social life, and treatment.

"People fear public speaking more than death" is one of the most repeated lines in the speaking business, and it comes from informal lists of fears rather than from anything this rigorous. This paper is the careful version. Amanda Ruscio, Ronald Kessler and colleagues used a national survey of American adults to measure how common each of 14 social fears is, and what happens to the people who have them.1

The most common social fear

Everyone in the survey was asked about 14 social situations: whether they had ever felt shy, afraid or uncomfortable in each, strongly enough that it was excessive and caused real distress or avoidance. Public speaking came first.

Having a fear is not the same as having the disorder. Social phobia, in the psychiatric definition, requires the fear to be persistent, out of proportion and disruptive. The survey's tables let you see both at once: of the 21.2% who feared public speaking, about half (50.6%) also met the criteria for social phobia.

One dimension, not two kinds

A long-running debate was whether fear of performing (a speech, an exam) and fear of interacting (a party, a stranger) are different conditions. The data said no. The 14 fears correlated very highly with one another (from .73 to .98), and a factor analysis found one strong factor and essentially no second one. What distinguished people was not which situations they feared but how many.

What it costs

The number of fears predicted almost everything else. People with more feared situations had their first fear earlier, were more likely to avoid situations (from 67.5% with 1 to 4 fears to 88.1% with 11 or more), were more likely to have another mental disorder (from 62.9% to 90.2%), and were more impaired in daily life.

Impairment among people with social phobia in the past year, by number of fears (%)

The course was long. First fears typically appeared between the ages of 10 and 13, and avoidance followed a year or two later. Recovery, defined as two years free of symptoms, usually took decades: only 20 to 40% of people had recovered within 20 years of onset.

And most people were not treated for it. Of those who had ever had social phobia, 68.9% had received some kind of mental health or medical treatment, but only 35.2% had received treatment for the social phobia itself: roughly half of the people who sought help were helped with something else. Among people with no other disorder, those with the most fears were the least likely to be treated for this one.

Has it held up?

A 2017 analysis of 28 surveys in the World Mental Health Survey Initiative, with 142,405 respondents in countries at every income level, found a lower lifetime prevalence across all countries combined (4.0%), highest in high-income countries and the Americas. But the pattern was the same everywhere: early onset, long persistence, impairment in several areas of life and the same associated disorders.2 The United States is at the high end; the shape of the problem is universal.

What this study cannot tell you

• It is about the United States. Prevalence varies a great deal between countries, as the later cross-national data show.
• Everything is recalled. Ages of first fear and past symptoms come from adults remembering, which is imprecise, especially about childhood.
• A fear is self-defined. The survey counts fears that were excessive and distressing in the respondent's own view; it does not observe anyone speaking.
• It does not say what helps. The paper documents how rarely social phobia is treated, not which treatments work; the next paper in this series does.

What a speaker can take from it

If speaking in front of people frightens you, you are in the largest single group in this survey. One adult in five has felt it strongly enough to count, and it is the fear that most often forms part of a diagnosable condition.

It also shows why practice matters early and specifically. The fears start young, they rarely fade on their own, and people who get help are often helped with something else. Speaking in front of others is a skill that responds to repeated, graded exposure, which is exactly what the rest of this series looks at.

This article summarises an open-access paper. Every percentage and odds ratio is the authors’ own, from the text and Tables 1 to 4. The confidence intervals are ours, computed from the standard errors the paper reports.

Measured

• Lifetime social fears and DSM-IV social phobia, from a structured diagnostic interview of a national household sample
• Age of onset, impairment and treatment, as reported by respondents

Inferred, not measured

• That the number of fears reflects severity along one dimension: the authors’ interpretation of their factor and latent-class analyses

References

1. Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological Medicine, 38(1), 15–28. https://doi.org/10.1017/S0033291707001699
2. Stein, D. J., Lim, C. C. W., Roest, A. M., et al. (2017). The cross-national epidemiology of social anxiety disorder: data from the World Mental Health Survey Initiative. BMC Medicine, 15, 143. https://doi.org/10.1186/s12916-017-0889-2