How to Tell Symptoms of Social Anxiety? And What to Do About It

Social Anxiety Disorder (formerly known as Social Phobia) can be a significant hurdle to your happiness, health, and ability to achieve your potential in relationships and at work Here's a common scenario: You’re the kind of person that likes others. You want friends, you want to hang out with your co-workers for hors d’oeuvres after work, and you definitely don’t want someone to hang out with on Friday nights. You just can’t make your reality fit with your wishes. Here’s one scenario that often happens: after wish you could be bold at work, make friends, and ask for that raise, the minute you’re invited to golf with your boss, do a presentation for the team, or come to a friend’s anniversary party…you bail out. You don’t feel smart enough, worthy enough, prepared enough…it is never enough…so you say “no’ to the very thing you wish you could do. So, on one hand, you’re happy because you got to avoid the anxiety-provoking personal encounter, but you’re simultaneously miserable because – yet one more time – you didn’t go after what you want most. This can hurt your self-esteem even further, which only makes you less apt to try again the next time. The vicious cycle can go on for years on end. Clearly, this disorder has the potential to rob you of your health or prevent you from meeting your goals at work and having positive, healthy relationships. But here’s the good news about Social Anxiety Disorder – you don’t have to let it rob your future!

Is It Social Anxiety Disorder?

First, let’s figure out what we’re dealing with.

The Fancy Definition 

According to the National Institute of Mental Health, Social Anxiety Disorder (formerly known as Social Phobia) is an “intense, persistent fear of being noticed and judged by others” to the degree that it can prevent you from reaching your potential at work and other areas of your life.   It’s not “just” being shy. The anxiety must last over six months and cause “considerable impairment” in your life, according to the Diagnostic and Statistical Manual (5^th ed.).((American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM–5))) In addition, the anxiety must be constant, intense, and disabling to qualify.  You’re not the only one! According to Social Phobia org, social anxiety is the third- largest mental health issue in the world, and affects 7% of US citizens.((Theravive: Social Anxiety Disorder (Social Phobia) DSM-5 300.23 (F40.10))) It often (not always) begins around middle school which is inherently a period of intense self-consciousness. 

The Theories

Research is still divided on the cause of Social Anxiety Disorder, but some theories indicate there is a genetic/inheritable component while others argue that it can be a learned behavior. Others believe the problem is multi-determined and can be a combination of genetics, social learning, and other factors combined. 

10 Scenarios That are Potential Triggers 

The Social Anxiety Association lists several scenarios that can be triggers for your anxiety including these common ones:((Social Anxiety Association: Social Anxiety Fact Sheet: What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis))

• Being teased or criticized
• Being the center of attention
• Being watched or observed
• Having to say something in a formal, public situation
• Meeting people in authority ("important people/authority figures")
• Feeling insecure and out of place in social situations ("I don’t know what to say.")
• Feeling embarrassed (e.g., blushing, shaking)
• Meeting other peoples’ eyes
• Swallowing, writing, talking, making phone calls if in public
• Being introduced to other people

3 Major Symptom Categories

When we encounter our triggers, sufferers tend to become symptomatic. According to Psycom, there are 3 main categories of symptoms for this disorder:

1. Physical symptoms: racing heart, dizziness, stomach trouble, blushing, sweating, trembling, and dry mouth
2. Emotional Symptoms: panic attacks, poor body image, nervousness, high levels of anxiety and fears.
3. Behavioral Symptoms: Avoiding places/situations where you think you will be the center of attention; not pursuing activities for fear of embarrassment; becoming isolated, quitting school or a job, substance abuse.

NIMH adds that poor eye contact, mind going blank, speaking softly, self-consciousness, and feeling awkward are also commonplace. Remember: these symptoms can be “normal” – we are looking only for a situation where it is prolonged and a true hinderance to functioning!

What To Do About It

The important factor is to do something about your Social Phobia as it can become more self-perpetuating over time. Here’s are a few ideas of how to get started.

1. Ask a Doctor

Don't self diagnose, ask a doctor. Reach out! If you are concerned that social anxiety is preventing you from reaching your full potential, then seek consultation from a mental health professional or medical provider. Don’t suffer in silence! Fewer than 5% of people with social anxiety seek treatment after their symptoms begin and, in fact, 1/3 of sufferers report having symptoms for ten years or more before reaching out for help.  This is a needless impediment to your wellbeing, because studies indicate that this condition is highly treatable. In fact, one study claims an 85% improvement and sometimes full recovery after treatment! ((Psycom: Social Anxiety Disorder Overview)) A family doctor, internal medicine physician, psychologist, or psychiatrist are among the types of providers experienced in diagnosing and treating Social Anxiety Disorder. Be sure to check reviews and recommendations in your community.

Insider Tip!

Experienced mental health providers always ensure that other factors aren’t the cause of your problem before assigning a psychiatric diagnosis. Many medical issues, medications, and even substance abuse can mimic psychiatric issues so it is essential to rule these out first.  Special note: Make sure your provider considers all angles without making any assumptions because some people truly do have both genuine psychiatric symptoms and a coincidental medical problems which can mimic it.  Diagnostics can get complex, so this is why only a credentialed provider should diagnose your concerns! 

What Should You Expect?

Most providers will conduct an intake evaluation where they will take a thorough history, check your symptoms against the DSM-5 criteria, provide you with an anxiety checklist or other type of self-report test instrument, and review your medical records to name a few possibilities. Be prepared to speak honestly about your history as the more data, the more accurate your diagnosis and recommendations will be. There are also resources, by Mayo Clinic and others, which provide some of the questions you might be asked. Preparation can certainly help with your anxiety about the interview. ((Mayo Clinic: Social Anxiety Disorder)) 

2. Treatment Options

Here are some ways to try to regain your health!

Psychiatric Treatments

The most common types of treatment for social anxiety are psychotherapy, medication, or some combination thereof.  If you elect to take medication, your doctor can help you decide which one is right for you. Be sure to ask about how long it will take to notice improvement, any potential side effects, and how to weigh the risks versus benefits of the medication. As for psychotherapy, Cognitive Behavioral Therapy is a common option and NIMH found particularly good outcomes using cognitive therapy combined with a behavioral therapy group.((SAA: Social Anxiety Fact Sheet)) While the prospect of a group treatment might seem terrifying, it is deemed important so you can work on your symptoms in real-life scenarios with other group members. What is the goal of psychiatric treatment?  A good goal to aspire to in the treatment of Social Anxiety Disorder is to decrease symptoms, learn to reframe negative thoughts about yourself, developing confidence in social situations, which in the end should help you develop the type of friendships, relationships, jobs, and other opportunities that you previously could not negotiate on your own.

Alternatives

Some organizations are proponents of alternative medicine as an adjunctive treatment. Treatments such as massage, meditation, mindfulness, hypnotherapy, and acupuncture are common place.  NAMI also suggests various self-management strategies (identifying one specific time to worry during the day, becoming an expert on your triggers, etc.); stress and relaxation techniques (e.g., breathing exercising, focused attention), and yoga (physical postures, breathing, and meditation). Exercise, like in many other areas, is also recommended but check with your doctor before starting an exercise plan.((NAMI: Anxiety Disorders Treatment))

3. Community Support

Many churches, clubs, and local organizations provide support and healing opportunities for Social Anxiety Disorder.  The National Alliance of Mental Health provides educational and support resources to those with mental illness including social anxiety at 1-800-950-NAMI or info@nami.org

4. Help Yourself!

NAMI and other organizations provide many ideas for self-help as a first step or as an adjunct to formal treatment. Here are some  ideas for being proactive in your care:

1. Become educated about medication and treatment options. 
2. Know your personal triggers and stressors and plan ahead. 
3. Actively participate in your treatment. 
4. Don’t QUIT if it isn’t helping. Keep at it until something does.
5. Live a healthy lifestyle – engage in exercise and de-stressors and watch your diet.
6. Avoid drugs and alcohol as they affect emotional balance, sleep, and can interactive with medication. *This includes too much caffeine!
7. Join online discussion groups.

Practice Makes Improvement (If Not Perfect)

Mayo recommends that sufferers participate in social situations by being with those you feel comfortable around.  Then, slowly increase the “risk” by branching out a bit more. Rather than throw yourself into a wild frat party, you might first want to take a small interesting class where the teacher does most of the talking. You might find that these are “safe” settings to meet people since it is highly structured and there is inherently a reason to speak with your peers. It also levels the playing ground as all of you are “new” in this social setting. ((Mayo Clinic: Social Anxiety Disorder)) Mayo further suggests that you actually practice socializing, just as you might practice piano. Here are some examples they suggested:

• Eat with a close relative, friend or acquaintance in a public setting.
• Purposefully make eye contact and return greetings from others, or be the first to say "hello".
• Give someone a compliment.
• Ask a retail clerk to help you find an item.
• Get directions from a stranger.
• Show an interest in others — ask about their homes, children, grandchildren, hobbies or travels, for instance.
• Call a friend to make plans.

While these might seem like basic tasks to our more extroverted friends, this can be seemingly unsurmountable to our friends with Social Anxiety Disorder!

Be Kind (To Yourself)

Learning these new social skills is taxing. Remember to be kind to yourself along the way. Mayo suggests that you spend some time with people you already know and feel comfortable with such as long-term friends and family.  Another idea is to engage in pleasurable activities and hobbies when you’re anxious.  Remind yourself that anxiety doesn’t last forever and that you have survived it before and will survive it again. 

Never, Ever Give Up

As you begin your treatment strategies, don’t give up. Don’t ever, ever give up.  Social Anxiety Disorder, as we stated earlier, is a treatable disorder, so every single small step gets you further to your end goal. Remember: As you practice, you will invariably fail and have set-backs. It is normal so just expect it! Progress isn’t linear-- it occurs with step-by-step small gains over time. 

The Future You

Remember that the best time to start is now. Be a strong, stubborn, tenacious self-advocate. Get help if needed to take the step toward wholeness and healing now! No matter whether your goal is having close friends, being more effective at work, or even finding a new relationship partner, being able to successfully connect with others can indeed transform a lonely, frustrating life into a more fulfilling one. Take the step.