People with social anxiety disorder experience intense anxiety and fear of social situations. Check off any of the following situations that might make you feel fear or anxiety. If you check off four or more, you may be experiencing symptoms of social anxiety.
- shopping alone at the mall
- asking a salesperson for help
- greeting someone who is an authority figure
- singing at a karaoke bar
- going on a job interview
- saying hello to a stranger
- answering the phone without seeing who is calling
- interrupting someone during a conversation
- talking when there’s a lull in a conversation
- speaking to a group of four or more people
WHAT IS SOCIAL ANXIETY DISORDER?
People with social anxiety dread social situations involving interactions with other people. These individuals are afraid of being evaluated or judged by others, and their symptoms impact nearly every aspect of their life. Patients with social anxiety usually come off as quiet, shy, inhibited, nervous, and aloof, and although they want to make friends and be included in groups, their anxiety and fear hold them back. The disorder is chronic, and many patients are reluctant to undergo any type of treatment.
A variety of situations will trigger symptoms, such as being introduced to new people, being teased, or being the center of attention. Public speaking is usually a major trigger for symptoms, as is dealing with authority figures or making direct eye contact with other people. Even swallowing, shaking hands, or making a phone call can bring on symptoms. Conversations with others, encountering unfamiliar people, and eating or drinking in public places are common triggers.
The symptoms of social anxiety disorder usually develop in childhood or adolescence: 75 percent of cases have their onset between the ages of eight and fifteen years old. Sometimes it begins after a stressful or humiliating experience, such as being bullied or having a panic attack in public, or the symptoms may develop slowly without a clear precipitating event.
DIAGNOSING SOCIAL ANXIETY
Many individuals with social anxiety disorder live with it for years or even decades without seeking help so they are unaware of their diagnosis and the possibility of receiving effective treatments that are available. Mild social anxiety is common in nearly everyone—at some point in life almost all of us experience fear of public speaking or anxiety in certain social situations, but the degree of the symptoms and their duration don’t impair our lives to the extent that they do in patients with the disorder.
Patients with social anxiety disorder need to be differentiated from those experiencing other related mental health conditions. Normal shyness is a common personality trait and doesn’t disrupt the individual’s life. In fact, in some societies, shyness is perceived as an asset. Only about 10 percent of people who are shy actually have social anxiety disorder.
People with agoraphobia or fear of crowds and public places sometimes experience fright and anxiety in social situations because they are worried that they may not be able to escape if they develop a panic attack. By contrast, those with social anxiety fear the scrutiny of other people.
Socially anxious patients may experience panic attacks because they are scared that others will evaluate them in a negative way, whereas those with panic disorder fear their actual panic attacks. Patients with generalized anxiety disorder often have social worries, but their focus of concern is more about relationships in general rather than scrutiny from others.
Many patients with social anxiety disorder suffer from other psychiatric disorders as well, including substance abuse, major depression, and bipolar disorder. Usually the social anxiety precedes the development of the other disorder. In Larry’s case, he became depressed because of the isolation he experienced from his social anxiety. Other patients will self-medicate with drugs and develop alcohol or substance abuse disorders.
DIAGNOSTIC FEATURES OF SOCIAL ANXIETY DISORDER
Specific diagnostic criteria have been described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders and include the following features:
- The individual experiences prominent fear or anxiety triggered by social situations that induce a perception of being scrutinized by others.
- There is fear that the display of anxiety symptoms will lead to humiliation, rejection, or embarrassment or somehow offend others.
- The same social situations almost always provoke the symptoms.
- The individual avoids the anxiety-provoking situations or endures them with intense fear or anxiety.
- The fear and anxiety are out of proportion to the actual threat.
- The symptoms have persisted for at least six months.
- The symptoms and avoiding them disrupts social, occupational, or other areas of function.