How To Know If You Have Social Anxiety Disorder: DSM 5 Criteria

Updated August 23, 2022 by BetterHelp Editorial Team

Do you have social anxiety?

Are You Concerned You May Have Extreme 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 and social phobia, such as intense fear, anxiety, and avoidance with people, frequently overlap with those of other intense anxiety disorders and other mental disorders. Social anxiety often accompanies an additional diagnosis or a differential diagnosis. If you have Panic Disorder, the symptoms such as feared social rejection may be exacerbated by social anxiety disorder and other mental disorders. 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 additional mental disorders such as PTSD, Major Depressive Disorder, Avoidant Personality Disorder, Autism Spectrum Disorder, Body Dysmorphic Disorder, Substance Use Disorder, and Generalized Anxiety Disorders can all cause the sufferer to have anxiety symptoms in social situations. Not to mention that a number of medical issues, including diabetes, Parkinson’s and tumors, can cause social anxiety symptoms such as intense fear, anxiety, and avoidance with no actual threat posed.

But in order to receive the right treatment, correctly identifying a social anxiety disorder and social phobia with clinically significant distress is key to mollifying the fear or anxiety.

Fortunately, we have far more tools at our disposal than ever before to correctly diagnose and treat social anxiety disorder and social phobia with symptoms like feared social rejection. While social anxiety and 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 and social phobia as a separate illness from other similar disorders.

Even today, though, our understanding of social anxiety and social phobia 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.

Two groups that help define social anxiety are the American Psychiatric Association and the Mental Health Services Administration. The American Psychiatric Association states, “fear of social situations in which embarrassment may occur (e.g., making conversation, meeting strangers, dating) or there is a risk of being negatively evaluated by others (e.g., seen as stupid, weak, or anxious). Social anxiety involves apprehensiveness about one’s social status, role, and behavior.” The  Mental health Services Administration states, “Social anxiety disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends.”

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. Feared social rejection is common. These situations of fear or anxiety almost always trigger symptoms of fear or anxiety that are irrational and out of proportion to the event. Avoidance is persistent typically in many people over social situations. Anxious anticipation over undesirable events is also common.

Because of this fear or anxiety, the person may avoid such situations, or else endure them with great distress. Also, the fear or anxiety cannot be attributed or negatively evaluated to another illness or disorder (like autism spectrum disorder, panic disorder, body dysmorphic disorder, substance use disorder, separation anxiety 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 with marked and persistent fear.

To be classified according to the DSM, social anxiety must interfere significantly with the individual’s daily life in social interactions in their career, academics, and/or relationships that provoke fear.

A recent addition to the DSM criteria for the medical condition of social anxiety is that it is persistent for six months or more in social interactions. This is a change from previous revisions, in which a time constraint of marked fear or anxiety was only included in the diagnosis of children for risk factors.

While this might not seem to represent a big change in regard to other anxiety disorders and the sociocultural context, it is still important for the diagnostic criteria of the medical condition. It excludes some of the normal, day-to-day social anxieties that we all feel that invariably provokes anxiety. If you are enduring family conflict with negative consequences, new work demands with different occupational functioning, social settings with a performance situation, or any kind of physical disfigurement, some feelings of social anxiety and individual fears with direct physiological effects are normal during this period in these social situation’s examples. 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 rather than other medical conditions.

While the current DSM 5 definition does clarify many things about social anxiety disorder, it is still often misdiagnosed and confused with psychiatric disorders like 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 with social situations.

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 due to social situations.

While any child can show signs of shyness on occasion like with performance situations or possible scrutiny, a social anxiety disorder can deeply impact a child’s relationships and school performance due to the psychological and physiological effects. Social anxiety interferes significantly with a person’s normal routine and social situations, which can cause significant distress for children.

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. They may have other symptoms like a panic attack or specific phobias and marked distress around unfamiliar people in peer settings.

According to the DSM 5, social anxiety disorder is defined when children show symptoms in peer setting 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 such as fear, anxiety, and avoidance 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

Are You Concerned You May Have Extreme Social Anxiety?

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.

Treatment

If you believe that you or someone you love suffers from extreme social anxiety, help is available to you.

A medical professional can use the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association to give you an objective diagnosis. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders to give medical professionals objective diagnostic criteria to give accurate diagnoses. They can look at the duration of symptoms like fear, anxiety, or avoidance to determine whether or not you meet the criteria for a medical condition.

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. You can also pursue psychotherapy through group therapy which is one of many effective treatments.

Anti anxiety 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.

Other Commonly Asked Questions

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