Social phobia, also known as social anxiety disorder, is a condition where the person feels an intense shyness or fear. Persons affected with this disorder are constantly anxious and worried about what others might think of them or how they might be judged by others These constant thoughts of how other people view them may result in affecting one’s daily work and activities.

Initial Diagnosis

For all mental disorders, the basic assessments include analyzing the person’s medical history to look for any physical cause for the anxiety. Sometimes, social anxiety may occur along with a few other health disorders. Apart from the medical history, a full-body examination is done to identify any other physical causes that could have paved the way for anxiety. Also, the healthcare provider should provide an environment in which the patient feels comfortable describing the symptoms and their duration.

Sometimes, a list of situations is provided as questionnaire to ensure that the type and severity of the symptoms is captured correctly. These criteria are listed in the Diagnostic and Statistical Manual of mental disorders (DSM-5), recognized by the American Psychiatric Association as the standardized criteria for the diagnosis of mental conditions.

General Diagnosis of SA

The mental healthcare provider, at the time of diagnosis, must search for the major symptoms to conclude whether the person is suffering from social anxiety or any other mental health condition. The following queries may be posed over a period of time:

• Have you ever worried about a situation in which you think you will be judged?
• Have you ever had a constant thought that is humiliating to yourself?
• Have you ever worried about being offended by someone?
• Have you ever felt insecure or fearful about talking to a stranger?
• Have you ever felt that someone may notice when you look anxious?
• Have you ever felt physical symptoms like sweating, shaky voice, or even blushing in public?
• Have you ever stopped doing things like stopping yourself from talking to people out of fear?
• Have you ever avoided situations where you have been the center of attraction?
• Have you ever felt anxious about any event or activity where you were scheduled to perform?
• Have you ever analyzed the performance you made and identified the mistakes you committed?
• Have you ever expected the worst results in a social situation?

In the case of young children, a child who suffers from anxiety may present with frequent crying, clinging, or refusing to speak with strangers.

Some people may have SA that is related to performance. They feel intense shyness or fear while performing or speaking in public or in any type of gathering.

Eliciting the Physical Symptoms

The next step in the diagnosis is based on the physical behavior of the patient. The following are some of the symptoms about which the patient may be asked:

• Have you ever felt your heart beating faster than usual when you were not exercising?
• Have you often felt a stomach upset or stomach pains?
• Have you ever had a hard time in catching your breath?
• Have you ever had frequent dizziness?
• Do you often feel confused or dissociated from the world?
• Have you ever had frequent diarrhea?
• Have you ever had constant muscle tension?

Behavioral Symptoms Suggestive of Social Anxiety

Every condition or disorder has a mild or extreme behavioral sign to represent it. The behaviors that indicate social anxiety include:

• Being afraid to use public toilets
• Being afraid to make eye contact with a person or start a conversation
• Being afraid to return purchased items to a store
• Being afraid to eat in front of other people, even with friends
• Being afraid to go to school or work
• Being afraid to take part in public gatherings, functions, and even parties
• Being afraid of walking into a roomful of seated people

Complications

Patients who suffer from extreme social anxiety are likely to be school or college dropouts. They often fail to sustain durable relationships or marriage. People with social anxiety often go through divorces.

They also have issues in keeping their jobs or, conversely, may be unduly devoted to their work. All these factors may be present in a person with self-confirmation of anxiety symptoms, which shows the huge impact of social anxiety disorder.

Social anxiety disorder may change over time. Overly anxious thoughts may emerge or become controlling at a certain point when one is facing a huge amount of stress. People may avoid anxiety-occurring situations to avoid feeling bad. If proper treatment is not provided, the person remains anxious for a longer period.

Self-diagnoses for social anxiety disorder are known to be inaccurate. For a clear diagnosis an assessment is required from a qualified healthcare provider who is well trained in evidence-based treatment or psychiatric diagnosis. Social anxiety might arise along with other disorders like substance abuse, depression, other anxiety disorders like, panic attacks, phobias, and generalized anxiety disorders. Appropriate tests should be ordered to rule out these conditions as well.

References

• http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/tests-diagnosis/con-20032524
• http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/symptoms/con-20032524
• https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
• http://www.calmclinic.com/anxiety/diagnosis
• https://nihseniorhealth.gov/anxietydisorders/riskfactorsandcauses/01.html]
• http://online.grace.edu/news/human-services/how-to-treat-social-anxiety-disorder/
• https://mhreference.org/anxiety-disorders/
• https://www.anxiety.org/social-anxiety-disorder-panic-attacks-specifier

Further Reading

• All Social Anxiety Disorder Content
• Social Anxiety Disorder (SAD) – Social Phobia
• When to Get Help for Social Anxiety
• Social Anxiety Disorder History
• Treatment Options for Social Anxiety

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.