Social anxiety disorder (SAD) is a type of anxiety disorder that’s estimated to affect around 7% of US adults and is characterized by intense fear and self-consciousness in regards to social situations. People with SAD may avoid social interactions altogether, or endure them with marked distress. Their daily lives can be significantly impacted as a result, since this condition may make work, school, and maintaining social relationships difficult. Only a qualified healthcare provider can properly diagnose social anxiety disorder; however, understanding the diagnostic criteria that’s commonly used may help an individual understand whether it might be time to seek support for symptoms they may be experiencing.
Diagnostic Criteria For Social Anxiety Disorder
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide to mental illnesses that’s published by the American Psychiatric Association. The first edition of the guide was published in the 1950s, and its content has been updated several times since then as new research and understandings of mental health have emerged. The most recent edition is the DSM-5, released in 2013. It lists specific criteria for all currently recognized clinical mental health disorders that mental health professionals can use to diagnose and treat their clients.
Some of the key criteria for diagnosing SAD as outlined in the DSM-5 include:
- Excessive fear of being judged and/or embarrassed in social situations
- Physical symptoms such as blushing, shaking, sweating, and a racing heart when facing social situations
- Avoiding eye contact, speaking softly, or limiting gestures in social situations
- Fear that can be considered out of proportion to the situation at hand
- Excessive self-consciousness and self-criticism
- Low self-esteem or self-image
- Difficulty forming and maintaining relationships as a result of anxiety
- Avoidance even of social situations that may be essential to one’s life goals, such as important work, school, or family events
- Worrying about social situations for days or weeks beforehand
The manual also notes that, in order to potentially qualify as social anxiety disorder, these symptoms must persist—typically for six months or more. They must not be explainable by another physical or mental health condition, they must interfere with daily functioning, and they must not be limited only to situations where the person has to speak or perform in front of an audience.
Again, only a qualified healthcare professional can provide an accurate diagnosis of any mental health condition, but comparing their symptoms to the criteria above may help an individual decide to seek treatment. With the proper support, social anxiety disorder is generally considered to be treatable.
Risk Factors For Developing Social Anxiety Disorder
Who is at risk for developing social anxiety disorder? As with many mental health conditions, the causes of social anxiety disorder are not yet fully understood but are thought to be complex. Several factors may play a role, including:
- Genetics: According to research on the topic, heritability for social anxiety disorder is considered to be “significant”, meaning that if you have a biological relative with the disorder, you could be more likely to develop it as well.
- Brain chemistry: Abnormalities in an individual’s levels of certain neurotransmitters, or chemical messengers in the brain, may also contribute to the development of SAD.
- Life experiences: Having experienced traumatic or otherwise difficult life experiences, such as bullying or abuse, could increase an individual’s risk of developing social anxiety disorder.
- Temperament: People who are naturally introverted or shy may be more prone to developing SAD.
- Personality. Individuals with perfectionist or self-critical tendencies might be more at risk of developing SAD, as it may make them inclined to judge themselves harshly for every detail of their social interactions.
- Environmental factors: Chronic stress, which may be caused by financial difficulties or relationship problems for example, may also contribute to the development of SAD or any number of other mental health conditions.
Treatment For Social Anxiety Disorder
Again, social anxiety disorder is considered to be a treatable condition. The recommended treatment method may vary based on an individual’s specific circumstances, including the severity of their symptoms and any other co-occurring mental or physical health conditions. That said, some form of psychotherapy is typically a key tenet of treatment, sometimes in combination with medication.
Exposure therapy is one type of therapy that’s commonly recommended for those with SAD. It usually involves teaching the client relaxation techniques and then gradually exposing them to the object of their fear until it no longer triggers symptoms. For example, depending on the specific source of a client’s social anxiety, a therapist might encourage them to work their way up to attending social functions by commenting on a social media post to start a conversation with a stranger, posting a video of them speaking, complimenting someone they don’t know, or calling a restaurant to order food.
Cognitive behavioral therapy (CBT) is another common type, which relies on helping an individual learn to recognize and then reframe distorted patterns of thinking. For example, a therapist might help a client question the validity or likelihood of the thought that everyone will laugh at them if they stumble over their words when introducing themselves and replace this thought with a more realistic, optimistic alternative.
Getting Support For Social Anxiety Symptoms
Since social anxiety disorder can have such a significant impact on a person’s daily functioning and well-being, seeking treatment can be important. That said, some people may find it difficult or impossible to meet with a therapist for a traditional in-person appointment due to their symptoms. In cases like these, online therapy can represent a viable alternative. With a virtual therapy platform like BetterHelp, you can get matched with a licensed therapist who you can speak with via phone, video call, or even in-app messaging to address the challenges you may be facing. One study suggests “a strong efficacy” of online cognitive therapy treatment for social anxiety disorder, so this format can represent a more comfortable but equally effective option for addressing symptoms of SAD in those who prefer it.
Like other clinical mental health conditions, social anxiety disorder should only be diagnosed and treated by a licensed mental health professional. However, understanding the clinical criteria for a diagnosis can help an individual experiencing symptoms decide when it may be time to seek professional support.
How does the DSM-5 define social anxiety?
The DSM-5 defines social anxiety disorder as an intense feeling of anxiety or fear about social situations where a person may be scrutinized by others. The DSM lists the following diagnostic criteria:
- Intense anxiety regarding one or more social situations in which the individual is subject to public scrutiny.
- Fear that the person will act in a way or show anxiety symptoms that will be negatively evaluated by those around them.
- Social situations almost always provoke fear and anxiety.
- Social situations are avoided when possible.
- The anxiety or fear is disproportionate to the actual threat posed by the social situation.
- The anxiety or fear is persistent and has been experienced for at least six months.
- The anxiety or fear causes clinically significant distress in social, occupational, or educational settings.
In addition, to be diagnosed with social anxiety disorder, a person’s anxiety must not be attributable to another medical condition, substance use, or another mental disorder like autism spectrum disorder, panic disorder, or body dysmorphic disorder.
What are 5 symptoms of social anxiety disorder?
The symptoms of social anxiety disorder vary and may differ from person to person. However, every person diagnosed with the disorder feels fear, anxiety, or avoidance at the thought of social situations where they may be scrutinized, regardless of other symptoms that may be present.
Some common symptoms of social anxiety disorder include:
- Self-conscious behavior and an insecure self-presentation.
- Self-defeating and disparaging thoughts about their social abilities which are often not based in reality, commonly called cognitive distortions.
- Discomfort when meeting new people.
- Embarrassment or humiliation following social interaction, even if the interaction was within typical sociocultural norms.
- Physiological signs of anxiety, such as tremors, difficulty breathing, high heart rate, and sweating.
Is social anxiety a DSM-5 diagnosis?
Social anxiety is a diagnosable condition, according to the DSM. It is formally called social anxiety disorder (SAD) and was previously referred to as a social phobia. Today, the DSM distinguishes between specific phobias and the anxiety caused by social interaction. Generally, a diagnosis of social anxiety disorder is given when a person experiences extreme distress in social situations where they may face scrutiny.
A qualified mental health professional must make the diagnosis to rule out other conditions like autism, panic disorders, and avoidant personality disorder. In addition, social anxiety disorder frequently appears alongside other disorders, such as bipolar disorder or ADHD. The skills and experience of a psychiatrist, psychologist, or therapist are required to differentiate seasonal affective disorder from similar or co-occurring conditions.
What are the key symptoms of social anxiety?
The main symptom of social anxiety is a feeling of intense dread, anxiety, or fear when engaging in social situations where a person may be judged. The person may also feel similarly when considering the prospect of socialization. Often, the distress produced by social interaction is enough that the person avoids social engagements and may struggle to meet new people or interact in large groups.
Depending on how long they have avoided socialization, the person may also have impaired social skills. They may also feel humiliation or embarrassment after a social encounter, regardless of whether it violated social norms. Even if the person behaved reasonably and did not create a negative impression on the person they interacted with, they may feel their social abilities were well below par.
How do you assess for social anxiety?
Assessment and diagnosis of social anxiety disorder must be done by a qualified mental health professional. There are co-occurring and similar conditions that can produce symptoms similar to those seen in social anxiety disorder, and a mental health professional’s knowledge and experience are required to differentiate between the various disorders.
Assessment typically begins with a clinical interview in which the mental health practitioner takes a detailed history of their client. They will inquire about social anxiety symptoms, how long they have been present, and establish the degree to which the individual fears social situations. They will also gather information about the client’s medical, psychological, social, and occupational history to rule out comorbid conditions and determine the disorder's impact on their client’s life.
The practitioner will likely select one or more assessment instruments to gather more information about their client’s unique presentation, such as the Liebowitz Social Anxiety Scale. They may also initiate cognitive testing to investigate brain function or personality testing to search for underlying personality traits that may contribute to the client’s symptoms.
When all information has been gathered, the practitioner will leverage their expertise to determine whether the client meets the criteria for social anxiety disorder or another condition. If they do, the practitioner may initiate therapy and develop a treatment plan with the client’s consent.
What are the types of social anxiety?
Many people experience the symptoms of social anxiety differently. For some people, the difference is primarily one of severity. Some people may be comfortable around others they know well, and others may be able to interact with unknown people in certain social settings. Some can consciously suppress the feelings of social anxiety with relative ease, while others struggle to tamp down the fear and dread.
While the current version of the DSM recognizes no official subtypes of social anxiety, experts frequently discuss two informal subtypes: generalized social anxiety disorder and non-generalized social anxiety disorder. Those with the more generalized presentation fear most, if not all, social situations, while in the non-generalized presentation, symptoms tend to appear only for specific situations, such as public speaking. Both types invariably provoke anxiety, but of the two subtypes, the generalized type is more likely to have a substantial negative impact on a person’s life.
What is the difference between anxiety and social anxiety?
Anxiety is an emotion characterized by feelings of apprehension, fear, or dread upon anticipation of a perceived threat. Anxiety is often associated with physiological symptoms associated with the fight-or-flight response. Muscles become tense, the heart rate rises, and breathing becomes faster as the body prepares to deal with what it perceives as an imminent threat to physical or psychological well-being.
Social anxiety refers to the appearance of anxious symptoms in response to social situations where a person perceives that they may be judged. The emotion is the same; feelings of fear appear, and the physiological signs (raised heart rate, sweating, etc.) begin in response to socialization or the prospect of socialization. In essence, anxiety is a broad emotion that can be felt in many contexts, while social anxiety is that same emotion when felt in response to social activity.
What is the difference between shyness and social anxiety?
Shyness refers to a mild-to-moderate discomfort when interacting with unfamiliar people. It is common in childhood, and while many people grow out of shyness, many adults consider themselves shy. Sometimes young children may display extreme shyness alongside dependence on a caregiver, such as with separation anxiety disorder. The key difference between shyness and social anxiety is their impact on a person’s life.
Shyness is a personality trait, similar to introversion, that generally does not cause problems in day-to-day life. Many of the signs of shyness are similar to those found in social anxiety disorder, but they are typically much less severe, and the person is usually able to overcome their feelings of discomfort and engage in normal social activity. In contrast, a diagnosis of social anxiety disorder requires that the discomfort associated with social situations have a substantial impact on the person’s overall well-being and ability to function in daily life.
What causes social anxiety?
The cause of social anxiety is still debated among researchers. It is likely best understood as a combination of several different factors. Evidence suggests that genetics plays a role, similar to other anxiety disorders, but evidence further indicates that environmental factors play just as significant of a role, if not more so. Two major environmental factors have been linked to the development of social anxiety disorder, both related to childhood experiences.
The first environmental factor is related to stressful social events in early life. Stories of being bullied, abused by family members, and publicly embarrassed are common in the histories of those diagnosed with social anxiety. The second environmental factor concerns how a person was parented during childhood. Evidence indicates that a parent who couples modeling fearful and avoidant behavior with an overprotective parenting style significantly increases the likelihood of their child developing social anxiety.
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