SOCIAL ANXIETY DISORDER

Overview of Social Anxiety

Social Anxiety means feeling self-conscious and having a fear of negative evaluation when you are around 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 don’t know what to say.”, 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, 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. I was most self-conscious around strangers and groups of peers, but, for some reason, I was always okay with giving presentations (which is unusual). I have had some patients were comfortable around strangers, but then anxious with close friends. Some actors I’ve treated were completely comfortable on-camera, but acutely self-conscious when trying to engage in small talk. Each person’s specific triggers vary depending on their personal history and life experience. 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.

The intensity of social anxiety also has an unpredictable quality. Although most patients know their triggers, they also notice good days and bad days. I was anxious most of the time, but on rare occasions I was quite outgoing. I distinctly remember hoping that a first date happened on a “good day.” Many of my patients tell me that it’s hard to predict when they will be anxious around their triggers, because some days are better than others. Being mindful of how your day is going will help you pick the right treatment technique for that particular day.

Diagnosing 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 specialist (i.e. a therapist or a psychiatrist). Short of that, you can still get a good idea about the diagnosis from the DSM-V criteria and the Liebowitz Social Anxiety Scale.

The DSM-V (short for Diagnostic and Statistical Manual, version 5) contains the criteria that psychiatrists such as myself use to make a diagnosis. 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 each patient meets each criteria. [Click here for a link to the DSM-V criteria for Social Anxiety Disorder] However, even if you do not qualify as having "full-fledged" Social Anxiety Disorder, the treatments described on this website are likely to help you for whatever level of social anxiety you do have.

The Liebowitz Social Anxiety Scale is a research tool used to measure the severity of social anxiety. While various cut-offs (for example, more than 54 points) can be used to diagnose social anxiety disorder, it is most useful as a way to measure the severity of your social anxiety and to track your improvement later on. The Liebowitz Social Anxiety Scale can be taken (and scored) at the following site: psychology-tools.com/test/liebowitz-social-anxiety-scale

There are three specific social anxiety symptoms that you should also be aware of: Anticipatory Anxiety, Debriefing Anxiety, and Passive Social Anxiety. I will refer to these as you read through the techniques this website, so it’s good to become familiar with them.

Anticipatory Anxiety

Anticipatory anxiety means experiencing worrying or physical anxiety symptoms before a social event. Depending on the event and your level of social anxiety, anticipatory anxiety can start hours, days, or even weeks beforehand. I used to worry about five days before dates, and about two days before all other social events. For some people, anticipatory anxiety for such things as wedding speeches and large presentations, in particular, can start even months beforehand. With treatment, you should notice that anticipatory anxiety becomes less intense, shorter in duration, and then less frequent altogether.

Debriefing Anxiety

Debriefing anxiety refers to feeling anxious about a social event after it has occurred. This typically takes the form of criticizing yourself about how you performed. Debriefing anxiety can last from days to weeks after an event, and if you had a particularly bad experience (for example, an embarrassing moment in grammar school), you can continue to have debriefing anxiety even years later.

I used to have a lot of debriefing anxiety. After a social event (for example, having dinner with a friend), the next morning I would review everything that was said (even if the event itself went well). This would generally start out as an innocent review, but eventually I would always find something to be upset about, and from then on I would just focus on that part of the event. There have been several times where I had fun in the moment, but then I ended up edited it into a bad memory by debriefing too much. Thankfully, debriefing anxiety is also very responsive to treatment.

Passive Social Anxiety

Passive social anxiety refers to feeling self-conscious and having a fear of negative evaluation even though you are not directly interacting with anyone. Common examples include: feeling anxious and self-conscious when walking through a mall, eating a meal, sitting at the beach, walking into a store, or watching a sporting event/concert in a large venue. My passive social anxiety used to be so intense that I would even feel self-conscious just walking down the street in a residential neighborhood. I found it impossible to focus on sporting events or concerts because I was so self-conscious. As with all forms of social anxiety, passive social anxiety is very responsive to treatment.