Occasional uneasiness or nervousness in social situations is a common human experience. People struggling with Social Anxiety Disorder, also known as social phobia, can experience intense anxiety resulting in negative thoughts related to excessive fear of judgement and physical anxiety symptoms such as sweating or trembling. This article provides information on the impacts of social anxiety, strategies for coping, and considerations for pursuing diagnosis.
What is Social Anxiety Disorder?
Social Anxiety differs from shyness or feelings of uneasiness about a situation. Social Anxiety Disorder is a mental health condition characterized by an overwhelming fear of social situations, leading to persistent avoidance. The fear and anxiety of the situation is generally disproportionate to the actual threat. Experiences of ongoing anxiety and continuous avoidance significantly impact a person's daily life, relationships, and overall well-being.
Impact on Daily Life
Imagine viewing the world through a lens which emphasizes negative self-judgement. People with Social Anxiety Disorder experience constant worry about how others may evaluate them. Social anxiety can deeply impact various aspects of life, such as:
- Avoidance and Isolation: Avoiding (or attempting to avoid) social settings due to the fear of embarrassing or humiliating interactions leads to isolation and loneliness. In children, attempts at avoidance can manifest as crying, freezing, or behavioural responses.
- Impact on Relationships: Difficulty opening up to others, as well as avoidance can lead to relationship challenges and misunderstandings.
- Daily Activities: Having difficulty with routine interactions such as making phone calls, attending an appointment, or visiting a shop.
- Work or School: According to the DSM-5, those with Social Anxiety Disorder have a higher school dropout rate and more difficulty with work productivity. Avoidance can also lead to missing work or school.
- Low Self-Esteem & Emotional Toll: Placing a lot of value on the perceived evaluation of others versus one’s own balanced self-examination. People with Social Anxiety Disorder have lower levels of self-compassion, which means they have difficulty showing kindness towards themselves.
Strategies & Coping Mechanisms
There are practical steps that one can take to help manage symptoms of Social Anxiety Disorder and improve daily life.
- Practice Self-Compassion: Access resources for self-compassion, to increase the ability to be understanding with oneself and curb negative self-talk.
- Mindfulness: Anxiety quickens our breathing, activates the fight/flight/freeze response, and increases negative thoughts. Mindfulness activities can slow our brain and body, leading to a more rational perspective.
- Professional Support: Working with a mental health professional increases awareness and offers personalized strategies. Therapy can be a very helpful step in addressing Social Anxiety Disorder. Engaging in therapy aids in cognitive restructuring, which assists in shifting how we view certain situations.
- Eliminate Avoidance: Although avoiding a situation provides temporary relief, it can increase the anxiety over time. Learning how to face the situation whenever possible allows people to learn how to work through their thoughts and emotions and overcome the anxiety.
Understanding the Diagnosis Process
There are some benefits to obtaining a diagnosis, but it is also important to determine if a diagnosis aligns with your mental health needs. The diagnostic process requires people to share emotions, thoughts, reactions and sometimes challenging life experiences. Making an informed decision about pursuing a diagnosis is essential.
Benefits of a Social Anxiety Diagnosis?
For those grappling with social anxiety, a diagnosis can sometimes be a helpful step in managing Social Anxiety Disorder. Benefits of pursuing a diagnosis include;
- Clearer Understanding of Symptoms: A diagnosis can provide validation by providing a name to the symptoms and confirming that the anxiety extends beyond nerves or uncertainty.
- Accessing targeted supports: Cognitive Behavioural Therapy or Acceptance and Commitment Therapy are effective treatments for Social Anxiety Disorder. For some people, having a diagnosis provides a more in-depth understanding of symptoms and can act as a guide to creating an individualized therapy plan.
- Consideration of medications: The decision to utilize medication is a personal choice and should be discussed with your Physician or Psychiatrist. Having a diagnosis can assist you in facilitating the discussion with your health care provider about the right medication for managing anxiety symptoms.
What to Expect in the Diagnostic Process
Forming a Social Anxiety Disorder diagnosis involves gaining a comprehensive understanding of your emotions and reactions to social situations. The diagnostic process does require readiness to discuss personal history, life circumstances, and provide some information on traumatic life events. Honesty is essential to forming the proper diagnosis, emphasizing the importance of comfort and trust in the rapport with the professional you are working with. Other key components include:
- Assessment: An initial meeting with a qualified mental health professional (typically a psychologist or psychiatrist) to discuss symptoms, history and experiences.
- Clinical Interview: As follow up to the assessment, the clinical interview is an in-depth discussion delving more into thoughts, emotions, behaviours, and the impact of social anxiety in your life.
- Psychometric Testing: Some providers will also use standardized questionnaires as an additional tool of the assessment process, referred to as ‘psychometrics’. The questionnaires are used to gather specific information about symptoms that cannot always be clearly expressed during the assessment or interview.
- Social Anxiety Disorder and the DSM-5: All diagnoses are made based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The assessing professional compares your information and symptoms against a checklist of criteria outlined in the DSM-5. The criteria in DSM-5 for Social Anxiety Disorder is related to thoughts, emotions, and reactions surrounding social settings.
- Collaboration: The diagnostic process should be a collaborative approach. While the assessing professional leads with questions and provides information, you are an active member in your healthcare journey. It is okay to express your thoughts, ask questions, and advocate if you disagree with something that is being proposed.
Preparing for Therapy Services or Diagnosis
- Request a consultation: If possible, research and consult with a few different mental health professionals, specifically those experienced in working with social anxiety. Determining who you feel most confident in and who you feel most comfortable with is part of making an informed decision about services.
- Take your Time & Ask Questions: Feeling nervous while discussing vulnerable topics is quite normal, so take your time when answering the questions. If at any point if you are uncertain about the purpose of a question or how the information will be used, you have every right to seek clarification, and should expect to receive a reasonable response.
Conclusion
Social Anxiety Disorder can impose significant emotional and functional challenges. However, with the right support and strategies, managing social anxiety and improving comfortability in social settings is possible, which can enhance social interactions, relationships, and understanding of self. If you believe that you have social anxiety, don't hesitate to seek professional help – you're not alone, and support is available to help you on your journey.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Anxiety Canada. (n.d.). Self-help strategies for social anxiety. Anxiety Canada | Self-help Resources, Programs & Services. https://www.anxietycanada.com/sites/default/files/adult_hmsocial.pdf
Anxiety Canada. (2022, November 6). Social anxiety in adults. https://www.anxietycanada.com/disorders/social-anxiety-in-adults/
Centre for Addiction and Mental Health. (n.d.). Social anxiety disorder. CAMH. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/social-anxiety-disorder
National Collaborating Centre for Mental Health. (2013). Social anxiety disorder: The nice guideline on recognition, assessment and treatment of social anxiety disorder. British Psychological Society. https://www.ncbi.nlm.nih.gov/books/NBK327674/
Werner, K. H., Jazaieri, H., Goldin, P. R., Ziv, M., Heimberg, R. G., & Gross, J. J. (2012). Self-compassion and social anxiety disorder. Anxiety, Stress & Coping, 25(5), 543-558.
