Sweating and social anxiety

What is happening in your body

When you feel anxious, your body’s alarm system gets you ready to act. Part of that is sweating, often on your palms, under your arms, on your face or back. It can start before anything has happened, just from thinking about the event.

In social anxiety, the sweating often turns into a fear of its own: “They’ll see the patches on my shirt.” “My handshake will be wet.” “They’ll think I’m dirty or nervous.” Then you watch for the first sign of sweat, which makes you more anxious, which makes you sweat more.

Two different things can be going on, and it helps to know which:

• Anxiety sweating comes mainly in stressful moments and settles when you are calm.
• Hyperhidrosis is heavy sweating that happens even when you do not need to cool down, often in the same places every day, whether or not you are anxious. The NHS describes it as sweating when your body does not need to cool down. It is a medical condition, and it can also make social situations feel harder.

Some people have both.

Do other people notice?

Much less than you think. You feel every drop. Other people are mostly busy with themselves. In the “spotlight effect” experiments, people expected far more others to notice something embarrassing about them than really did. In a related set of experiments, people believed their inner feelings showed much more than they did.

Damp palms or a slightly shiny face are also very common. Most people see them as normal on a warm day or in a crowded room.

What makes it worse

• Covering up. Wearing thick layers or a jacket to hide patches can make you hotter and sweat more.
• Checking. Looking at your armpits in mirrors, touching your face, wiping your palms again and again.
• Avoiding. Not shaking hands, not raising your arms, avoiding warm rooms, dates or presentations.
• Fighting it. Trying to stop sweating keeps your attention on your body.

These safety behaviours feel protective but keep the fear going. Some also make sweating worse. In an experiment, safety behaviours and watching yourself turned out to be unhelpful in several ways. What keeps social anxiety going explains the loop.

What helps

Treating the fear. If your sweating is mainly anxiety, treating the anxiety is the way to go. The best-tested therapy is cognitive therapy for social anxiety. It includes testing what happens when you stop hiding and checking. Exposure on your own works on the same idea. Medicines that treat social anxiety, such as SSRIs and SNRIs, need a doctor.

Practical steps. Light, breathable clothes. Colours and patterns that show sweat less. A stronger antiperspirant rather than a deodorant. These are fine. They become a problem only when you feel unable to go out without them.

Medical treatment for heavy sweating. If you sweat heavily even when calm, talk to a doctor. The NHS lists these options:

• stronger antiperspirants from a pharmacy;
• creams, or tablets that reduce sweating, from a specialist;
• iontophoresis: a weak electric current passed through water to the hands or feet;
• injections of botulinum toxin (Botox) for the armpits, which may not be available on the NHS;
• surgery, such as removing sweat glands.

A doctor can explain which might suit you, and the benefits and side effects of each. What is available depends on your country.

When to see a doctor

The NHS advises seeing a doctor about heavy sweating if, for example:

• things you do yourself are not helping;
• it has lasted at least 6 months, or happens at least once a week;
• it stops you getting on with daily life;
• it happens at night;
• you take medicine for another condition. Sweating can be a side effect of a medicine, or a sign of another condition.

See a doctor too if fear of sweating makes you avoid work, study or seeing people. Do not stop or change a medicine without talking to your doctor.