Social anxiety disorder is defined by a persistent fear or overwhelming phobia of social situations, or situations with other people. The condition goes beyond shyness or feeling introverted, and it can be harmful to a person’s ability to enjoy life. Everyday activities like going to the grocery store, talking on the phone, or work meetings can lead to intense anxiety.
Although this condition can be disruptive to daily functioning, it is one of the most common anxiety disorders. An estimated 19.2 million people in the United States suffer from social anxiety disorder. It typically begins around adolescence, and it is more common in women than men.
What Is Social Anxiety Disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines social anxiety disorder more broadly than previous manuals. Originally, the condition was defined as a phobia of performing in front of others, but the new manual adds that social phobias involve intense fear of being in any social situation, out of proportion with the actual situation. For example, feeling anxious before going on stage or feeling a little nervous before meeting a lot of new people is normal; however, suffering a panic attack before attending a party with unfamiliar people is out of proportion to the actual event and could be an indication of social anxiety disorder.
Fortunately, there are successful treatments combining medication and therapy that can help reduce panic attacks and ease other symptoms of social anxiety disorder. It is important to visit a therapist or doctor to identify when symptoms cause distress. A medical professional can diagnose social anxiety disorder and rule out other underlying causes of the mental health condition.
Diagnosing A Social Anxiety Disorder
The steps to getting a diagnosis of social anxiety disorder are outlined below.
Step 1: Learn the signs and symptoms of social anxiety disorder.
Before a medical professional can diagnose social anxiety disorder, they must identify symptoms of the condition and classify these symptoms as social anxiety disorder rather than a different anxiety disorder, other mental health issue, or a separate medical condition. For example, sometimes an overactive thyroid can produce symptoms similar to those of an anxiety disorder.
Symptoms associated with social anxiety disorder include:
- Having difficulty speaking to others in social situations due to intense fear or anxiety
- Experiencing self-consciousness due to a deep fear of being rejected
- Intense fear of offending others
- Worrying about social events for days or weeks before they occur
- Intentionally avoiding social situations to avoid the fear
- Having a difficult time making or keeping friends
- Blushing excessively, sweating, or trembling around other people
- Feeling nauseous or sick when around other people
In order for symptoms to be accurately diagnosed as social anxiety disorder, and not symptoms of a different condition, the person must experience several of these symptoms for at least six months with no easing or changes.
Sometimes, the person may begin self-medicating with alcohol or other central nervous system (CNS) depressants or sedatives. If the person is unable to be in a social situation without being intoxicated, it could be a sign of a serious social anxiety disorder that has gone untreated for too long.
Step 2: Visit a mental health professional.
When a person visits a mental health professional to get help for their anxiety symptoms, the physician or therapist will get a list of symptoms the person experiences. The physician will also take account of the person’s behavior. People with social anxiety disorder have some character traits in common, such as:
- Difficulty being assertive
- Feelings of inferiority
- Hypersensitivity to negative judgments or criticisms from others
- Excessive anger or sadness when judged harshly
- Appearing depressed or anxious being around the medical professional
- Speaking softly or hesitantly
- Preoccupation with social experiences, dwelling on these excessively after the event
People who struggle with the most extreme forms of social anxiety disorder are more likely to drop out of school, less likely to have intimate relationships, less likely to marry, and more likely to experience divorce. They are more likely to have difficulty maintaining employment, or they may have high turnover in their work life. If a physician or therapist finds these character traits to be present, along with self-reports of other social anxiety symptoms, it is a good indication that the person suffers social anxiety disorder. However, there are other tests to fully define the condition and eliminate other possibilities.
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Step 3: Take specific tests.
There are a few basic tests used to diagnose social anxiety disorder, including gathering information about symptoms and their persistence. Some physical symptoms that can be monitored when a person is undergoing diagnosis for social anxiety disorder include:
- Elevated blood pressure
- Rapid heartbeat
- Sweating or facial flushing
- Elevated cortisol levels
If these are present while a doctor is examining a patient, especially during interview questions regarding social situations, they could be an indication that the person is struggling with social anxiety disorder. However, other diagnostic tests, like blood work and a general physical, are important to rule out heart conditions or other physical causes. A doctor may perform a physical exam and take blood work to make sure that there are no underlying physical causes of the mental condition.
If the person struggling with anxiety goes to a general physician, they may receive a referral to a therapist or psychiatrist who specializes in working with people who struggle with anxiety disorders to receive a more thorough diagnosis. The doctor or therapist will conduct an interview with the individual to get an idea of symptoms and the person’s reaction to specific situations. They may also have the individual fill out a questionnaire regarding symptoms and social situations. The questionnaire most commonly used is the 3-Item Mini-Social Phobia Inventory (Mini-SPIN). A general practitioner may also ask:
- Does the patient intentionally avoid social situations or activities?
- Is the patient embarrassed or fearful in social situations, out of proportion to the event?
If their patient answers “yes” to either of these, they will likely be referred to a specialist for further diagnosis and treatment.
Step 4: Get professional help for social anxiety disorder and addiction.
If a person experiences social anxiety disorder, and they do not receive help to combat this condition, they are more likely to develop a substance use disorder as a method of self-medicating the symptoms. Many social situations among adults involve alcohol, and a person with social anxiety disorder may imbibe alcohol specifically to ease symptoms. Other recreational drugs, such as cigarettes, marijuana, or narcotics, may also become problematic for people with social anxiety disorder. Additionally, a person who may have been misdiagnosed with a different panic or anxiety disorder could also struggle with addiction to prescription medications, such as benzodiazepines.
When a person suffers both a substance use disorder and a mental health condition like social anxiety disorder, they struggle with co-occurring conditions. As more research is being conducted into co-occurring disorders, rehabilitation facilities are becoming better equipped to treat clients struggling with two conditions together. It is important to treat both the mental illness and the addiction simultaneously, so the person can get back to a healthy, sober life. A treatment plan that includes detox, therapy, and some prescription medications, like anti-anxiety medications, is often the best approach to helping people recover from addiction and manage social anxiety disorder.