Social Anxiety Disorder
Social Anxiety means feeling self-conscious and having a fear of negative evaluation by other people. It is usually most intensely triggered by strangers, groups of peers, authority figures, and people that you admire and/or are attracted to. The anxiety usually takes the form of self-deprecating thoughts such as “They can tell I’m anxious.”, "I am acting weird", “I'm too quiet”, or “They don’t like me.” For some people, social anxiety also or even mainly takes the form of physical symptoms such as sweating, blushing, heart racing, chest tightness, and/or nausea.
The anxiety, the thoughts, and physical symptoms are all very responsive to treatment.
The triggers of social anxiety vary greatly from person to person. The most common pattern is to be comfortable with family and very close friends, but then anxious in all other situations, especially around groups of peers, authority figures, and dating situations. However, the triggers of social anxiety can vary substantially from patient to patient. I have had some patients who were comfortable around strangers, but then anxious with close friends. Some actors are completely comfortable on-camera, but self-conscious when trying to engage in small talk. Some people find acquaintances to be the most anxiety-provoking. Although the pattern of social anxiety varies from person to person, each person I have treated usually has a good sense of what their triggers tend to be. Knowing your triggers is an excellent step towards treating your social anxiety. It will help you as you practice the treatment techniques found on this website.
The intensity of social anxiety also has an unpredictable quality. Although most patients know their triggers, they also notice "good days" and "bad days", making it hard to predict how anxious they will be. Being mindful of how your day is going will help you pick the right treatment technique for that particular day.
Some people also have "Passive Social Anxiety" which means feeling self-conscious and having a fear of negative evaluation when you are in a crowd, even though you are not directly interacting with anybody. Common examples include: feeling self-conscious walking through a mall, eating a meal, sitting at the beach, walking into a store, or watching sports/a concert in a stadium. When the anxiety is very intense, it can make it impossible to focus on the task at hand. As with all forms of social anxiety, passive social anxiety is very responsive to treatment.
How do I find out if I have Social Anxiety Disorder?
The best way to find out whether or not you have Social Anxiety Disorder is by meeting one-on-one with a mental health professional (i.e. a therapist or a psychiatrist). Short of that, you can still get a good idea about the diagnosis from the DSM-V and various online scales.
The DSM-V (short for Diagnostic and Statistical Manual, version 5) contains the criteria that psychiatrists such as myself use to make a diagnosis of Social Anxiety Disorder. The criteria attempt to be objective and clear-cut, but, in practice, we have to use a lot of judgment to decide whether or not a patient meets each of the criteria. The DSM-V criteria are copyright protected, but if you google “DSM-V Social Anxiety Disorder” you will find similar criteria on-line and also on-line scales (such as the Liebowitz Social Anxiety Scale) to assist you.
What are the treatments for Social Anxiety Disorder?
Generally speaking, psychotherapy and medications are the most effective treatments for managing anxiety disorders, including Social Anxiety. Combining both approaches is usually the most effective, though either method can work alone.
Cognitive Behavioral Therapy is the most effective and the most well-researched form of psychotherapy for the treatment of Social Anxiety Disorder. It is a collection of techniques including relaxation training, cognitive therapy, gradual exposures, and assertiveness training which are taught over the course of 5-8 sessions with a skilled professional.
Medications are also highly effective for Social Anxiety Disorder (more so when they are combined with Cognitive Behavioral Therapy). The best way to learn about medication options and whether or not they are right for you is through a one-on-one evaluation with a qualified medical professional such as a psychiatrist.