How To Know If You Have Social Anxiety Disorder: DSM 5 Criteria
By: Amy Gardner
Updated May 11, 2020
Medically Reviewed By: Aaron Horn
Do you have social anxiety?
We all have moments when we feel shy or awkward in public. It's normal to feel nervous about a job interview or a public speaking engagement. And the thought of going out on a date with someone new can make almost anyone's heart pound.
But when does that social anxiety cross the line from normal to neurotic? How do you know whether you just need a little pep talk, or some serious help?
To make things even more complicated, the symptoms of social anxiety frequently overlap with those of other disorders. If you have Panic Disorder, the symptoms may be exacerbated by social anxiety. If you dread going out in public, it's hard to sort out whether it's due to social anxiety or a phobic fear of crowds (agoraphobia). And PTSD, Major Depressive Disorder and Generalized Anxiety Disorder can all cause the sufferer to feel anxious in social situations. Not to mention that a number of medical issues, including diabetes, Parkinson's and tumors, can cause social anxiety symptoms.
But in order to receive the right treatment, correctly identifying a social anxiety disorder is key.
Fortunately, we have far more tools at our disposal than ever before to correctly diagnose and treat social anxiety disorder. While social anxiety (or social phobia) has only been recognized as a legitimate illness since the 1980s, we have made major strides in understanding and controlling it.
Now, with resources like the Liebowitz social anxiety scale and the DSM, it is much easier to diagnose social anxiety disorder as a separate illness from other similar disorders.
Even today, though, our understanding of social anxiety continues to evolve as we learn more and more about it. This evolution is reflected in recent changes to social anxiety criteria in the DSM 5. Social anxiety is not an easy thing to pin down, but we're closer than we've ever been before.
Social Anxiety Symptoms
The DSM 5 defines social anxiety disorder as "a persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others." The individual fears that he or she will be embarrassed, humiliated, or otherwise negatively valued. These situations almost always trigger symptoms of fear or anxiety that are irrational and out of proportion to the event.
Because of this anxiety, the person may avoid such situations, or else endure them with great distress. Also, the anxiety cannot be attributed to another illness or disorder (like panic disorder, body dysmorphic disorder, obesity or Parkinson's).
Social anxiety disorder may be specific to a certain situation (such as speaking in public). More often, it is generalized, meaning that it occurs in a variety of situations in all areas of life.
To be classified according to the DSM, social anxiety must interfere significantly with the individual's daily life in career, academics, and/or relationships.
A recent addition to the DSM criteria for social anxiety is that it is persistent for six months or more. This is a change from previous revisions, in which a time constraint was only included in the diagnosis of children.
While this might not seem to represent a big change, it is still important. It excludes some of the normal, day-to-day social anxieties that we all feel. If you are enduring family conflict, new work demands, or any kind of physical disfigurement, some feelings of social anxiety are normal during this period. However, if it escalates to interfere with your daily life for more than six months, the problem is properly diagnosed and treated as social anxiety disorder.
While the current DSM 5 definition does clarify many things about social anxiety disorder, it is still often misdiagnosed and confused with Panic Disorder and/or Generalized Anxiety Disorder. Sometimes these illnesses can exist together, but they are separate disorders which are defined differently.
So if you never make plans with friends because of your social anxiety, or if you frequently call in sick to work because of your fear of interacting with others, there's a good chance you are suffering from social anxiety disorder.
Social Anxiety In Children
Symptoms of social anxiety disorder typically begin to present during adolescence. But sometimes it can show up in younger children. In these cases, it can start out as a natural tendency to shyness which may be escalated by an incident of bullying or some other trauma.
While any child can show signs of shyness on occasion, a social anxiety disorder can deeply impact a child's relationships and school performance.
But in children, anxiety can look very different from how it is manifested in adults.
Where adults may become quiet and withdraw from social situations, an anxious child may appear openly defiant. Excessive crying, tantrums, and clinginess are all signs that your child may be experiencing social anxiety. He or she may also show a fear of criticism that is out of all proportion to the situation, constantly asking for reassurance about what might happen if he or she says or does something wrong in public. Physical symptoms (including a racing heart and the inability to speak) may also be present.
According to the DSM 5, social anxiety disorder is defined when children show symptoms in peer-to-peer interactions, rather than specifically interactions with adults.
Social anxiety in children may be based on performance, triggered by situations in which your child must speak in public or perform other tasks while being observed or evaluated by others. Another type of social anxiety is interactional, causing a fear of going to school or using public restrooms.
As with adults, the best tools to help children with social anxiety is simply naming their symptoms and teaching strategies to manage them. Relaxation, positive affirmations, and cognitive behavior therapy can all be useful tools to help your child with social anxiety.
The Role Of Social Media
When it comes to social anxiety, digital media sites like Facebook, SnapChat and Instagram are definitely a mixed blessing.
On the surface, these platforms appear to be a lifesaver to the socially phobic, and in many ways, they are. These sites make it easy to form connections without leaving the house, picking up the phone, or talking to someone face-to-face…all of which can trigger severe anxiety for those social phobics. When you can chat with a fellow human without ever hearing their voice or seeing their face, it can feel a lot safer.
In addition, it can be a huge relief for a socially phobic person to have the time to carefully construct their words before speaking and build the image that they want to present. In face-to-face interactions, this is usually impossible, leading to anxious post-interaction rumination about what they should have said or should not have said.
If you suffer from any social anxiety at all, you are familiar with the tortuous thought process of "Why did I say that?" and "That was so stupid!" The ability to press the edit or delete button, or to backspace while typing a post, eliminates most of these painful after-the-fact reflections.
But this freedom is a double-edged sword. The avoidance of real-time communication makes it all the more difficult to face when the individual eventually must enter the real world and interact with others face-to-face. Eye contact and the accurate reading of social cues, those constant thorns in the side of the socially anxious, become even more of a problem when you're not used to them.
Besides, it is well known that there is a strong correlation between social media and anxiety, and that social media use can cause an overall increase in anxiety and depression symptoms. Social media users often post idealized versions of their real lives, leading to inevitable "social media anxiety," as other people's lives appear so much better than our own. And being in front of a screen all day can interfere with sleep and overall health.
If you believe that you or someone you love suffers from extreme social anxiety, help is available to you.
Your first line of defense is psychotherapy. The most effective therapy for social phobia is cognitive behavioral therapy (CBT). CBT for social anxiety consists of 12-16 weekly sessions in which you are gradually exposed to triggering situations, while learning relaxation techniques and other coping skills.
Medications may also be helpful in treating extreme social anxiety. Generally, SSRIs (Selective Serotonin Reuptake Inhibitors) have been found to be most effective. The most commonly prescribed of these are Paxil and Zoloft.
In some situations, other medications (like beta blockers or benzodiazepines) may be helpful.
At BetterHelp, our therapists are trained in the effective use of CBT in treating anxiety. Don't hesitate to reach out to them for help.
As you embark on your journey of healing social anxiety disorder, don't give up. There will be good days and bad days as you continue your treatment plan. But remember that healing takes time, and you deserve to feel better.