How Social Anxiety Disorder Is Diagnosed

Social anxiety disorder, also known as social phobia, is a type of anxiety disorder characterized by intense emotional distress around social interactions in which you may be scrutinized by others. People with this disorder feel anxious or scared in specific or all social situations, such as meeting new people and job interviews, and avoid these situations.

Only approximately 20% of those with symptoms seek treatment. Symptoms of social anxiety overlap with those of other anxiety disorders, making diagnosis of this mental illness difficult. Mental health professionals diagnose social anxiety disorder by using specific criteria from the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5).

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Professional Screenings

To make a diagnosis, a mental health professional will ask some questions about anxiety symptoms and life circumstances. Based on this assessment, the person may be diagnosed with an anxiety disorder based on symptoms alone.

Symptoms

A mental health professional will ask about symptoms, including how frequently and when they occur.

People with social anxiety disorder may exhibit many cognitive and emotional symptoms during social situations, including:

  • Overwhelming sense of fear
  • Panic
  • Feeling unreal
  • Fear of loss of control

Anxiety can also result in physiological changes, including:

  • Palpitations
  • Shortness of breath
  • Increased sweating
  • Pins-and-needles
  • Nausea
  • Blushing
  • Tremor
  • Urgency to urinate

Since anxiety disorders affect both children and adults, it is important that people of all ages be assessed for symptoms.

A parent or guardian may notice symptoms of anxiety in their child at a young age, or a teacher or mentor may bring these symptoms to their attention. Since anxiety can emerge early in life, it is important for parents or guardians to have their child assessed by a pediatrician.

DSM-5 Criteria

Your doctor will use the DSM-5 criteria to determine whether you have social anxiety disorder. The DSM-5 criteria for social anxiety disorder include the following:

  • Marked fear of social situations where the person may be scrutinized by others; examples include conversations with unfamiliar people, eating in front of others, or giving a presentation
  • Fears of acting in a way that will show anxiety symptoms and will lead to embarrassment or rejection
  • Social situations consistently induce symptoms of anxiety and are therefore avoided
  • Feelings of anxiety that are much greater than what would be expected, and fear and worry cause significant life disruption
  • Symptoms last for at least six months and are not related to a medical condition or another mental health disorder and are not attributed to substance use

In the DSM-5, the term "social phobia" was updated to "social anxiety" since “phobia” does not clearly articulate the degree of impairment caused by this condition. The updated version also redefines a criterion of the disorder to include fear of negative evaluation and the social consequences of this behavior. In addition, the former “generalized” specifier has been updated to “performance only” since some people with social anxiety disorder are only fearful of specific performance situations such as speaking in front of an audience, for example, rather than of general social situations.

Screening Tools

Certain screening tools are also used to better understand social anxiety symptoms, and can help evaluate the severity of the condition.

Surveys administered by a mental health professional to screen for social anxiety disorder include:

  • Liebowitz Social Anxiety Scale (LSAS): This 24-question survey asks people to assess their anxiety symptoms. It includes questions on fearfulness and avoidance of situations that cause feelings of anxiety or worry. It is the most common scale used to assess people with symptoms of social anxiety.
  • Brief Social Phobia Scale (BSPS): This instruments uses 11 items to measure the severity of fear and avoidant behaviors. It can also be used to assess the effects of treatment over time.

Labs and Tests

A primary care physician would consider many different factors that could explain or contribute to symptoms of anxiety. They may ask questions about the person’s life that could be causing these symptoms, such as a stressful job, unhappy romantic relationship, difficult relationships with loved ones, or more serious factors, such as living in an unsafe environment.

In addition, they may ask questions about any recent changes to diet, activity levels, or physical trauma that could impact the body and brain.

To ensure that anxiety symptoms are not related to medical conditions, physicians may perform several tests, including:

  • Physical exam: Vital signs such as blood pressure, heart rate, and weight, as well as a comprehensive look at the body that could detect any abnormalities in physical health
  • Blood tests: A complete blood count (CBC) to check the levels of blood cells and hormone and vitamin levels as well as metabolic panels

Based on the results of the physical examination and blood tests, the physician may order additional tests to further explore potential clinical causes of anxiety symptoms. If all assessments come back normal and there are no identified clinical causes that could explain the anxiety symptoms, the physician would likely refer the person to a mental health professional.

Anxiety in Women

While anxiety disorders affect both men and women, the prevalence of these conditions is significantly higher in women, approximately twice the prevalence in men. Therefore, it is recommended that women and girls 13 years or older be routinely screened for anxiety.

Self/At-Home Testing

People who are worried that they have social anxiety disorder can also take a survey at home. The Social Phobia Inventory (SPIN) evaluates fear, avoidance, and physiology using 17 items. It is a sensitive and brief tool that is easily scored. There is also a shorter version called the Mini-SPIN, which contains three items.

Additional self-reported scales include the Social Phobia and Anxiety Inventory, Social Phobia Scale, and Social Avoidance and Distress Scale.

If you or your loved one is having trouble managing symptoms of social anxiety, reach out for help. You can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for support.

A Word From Verywell

Everyone experiences stress sometimes; it’s a natural part of life. However, persistent fear and worry during social situations may indicate that you have social anxiety disorder. Contact your primary care physician or a mental health professional if you notice symptoms. They can run tests and evaluate your symptoms. Based on the findings from your exam and screenings, they can make a diagnosis and help you manage your condition. It's important to tackle social anxiety disorder early to minimize the impact it can have on your daily life.

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