1. Health
You can opt-out at any time. Please refer to our privacy policy for contact information.

Discuss in my forum

Why Do People With Social Anxiety Disorder Shake?

Shaking as a Symptom of Social Anxiety Disorder


Updated June 14, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Shaking or trembling of the hands or other parts of the body is a common physical symptom of social anxiety disorder (SAD). When shaking results from anxiety, it is a byproduct of the fight-or-flight response. Shaking can also be the result of a medical condition such as Parkinson's disease or the side effect of some medications.

Physiology of Shaking

Shaking that is due to anxiety is a result of the fight-or-flight response. This physiological response to threats in the environment increases alertness and prepares the body for exertion. The response becomes a problem when it happens in situations where there is no physical threat.

If you are in a social or performance situation that you find anxiety-provoking, your body will release the hormone epinephrine (also known as adrenaline). Epinephrine directs blood to the skeletal muscles. Other effects include increased heart rate, blood pressure, and blood sugar. A second hormone, norepinephrine, is also released and involved in many of these bodily changes. Shaking due to anxiety is a byproduct of these and related processes in the body.

Shaking and Social Anxiety Disorder

If you suffer with SAD, you may have problems with shaking in front of others. You might have trouble raising a glass to your lips or holding notes during a speech without shaking. Your legs might shake or your lips might quiver.

Often these symptoms are also maintained by a cycle of negative thinking. Seeing yourself shake makes you feel more nervous and in turn you tense muscles to try and reduce shaking, or try to hide your shaking by keeping hands out of sight. Fighting against your anxiety and avoidance strategies tend to make shaking worse.

Treatment for Shaking

Treatment methods for shaking that is a symptom of anxiety include medication and psychological 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 addresses underlying psychological issues. Talk therapies such as cognitive-behavioral therapy (CBT) can be helpful for changing thought patterns that contribute to social anxiety symptoms.

When shaking is the result of a medical condition or medication, a medical doctor will determine the best course of treatment.



Cordingley GE. Nervousness and shaking: Are they the same thing? Accessed October 27th, 2010.

University of Utah. How cells communicate during the fight or flight response. Accessed October 27th, 2010.

©2014 About.com. All rights reserved.

We comply with the HONcode standard
for trustworthy health
information: verify here.