How to Diagnose Social Anxiety Disorder

Diagnosis based on whether your meet specific criteria

Getting a diagnosis of SAD can be difficult.
The DSM-5 outlines the criteria for a diagnosis of SAD. Ned Frisk / Getty Images

Social anxiety disorder (SAD), also known as social phobia, is defined as the intense, persistent fear of either doing certain things in public (such as speaking or performing) or being around people in general. Given the wide berth of the definition, it may seem difficult to determine who exactly has the disorder and needs treatment.

Is there a distinct line between someone who has SAD and a person who may just be painfully shy?

How Diagnoses Are Made

A diagnosis of social anxiety disorder cannot be made with any lab test or physical exam. As with all mental disorders, a diagnosis is based on whether a person meets certain standardized criteria set by the American Psychiatric Association (APA).

To this end, mental health professional will refer to handbook called the Diagnostic and Statistical Manual of Mental Disorders published by the APA. Currently in its fifth edition, it is popularly referred to as either DSM-5 or DSM-V.

Diagnosing SAD

The process of diagnosis would begin a review of the patient's mental health history and an interview to evaluate the person's perceptions and experiences.

With regards to SAD, the aim of the evaluation would be to determine whether the fear is so severe as to interfere with the person's daily functioning, school work, employment, or relationships.

Among some of the key characteristics outlined in the DSM-5:

  • The person will have a significant and persistent fear of social (or performance) situations and will be intensely afraid of embarrassment or humiliation
  • There will almost always be physical symptoms of anxiety or a panic attack.
  • The person will recognize the fear is unreasonable but be unable to stop it.
  • The person will avoid feared situations or endure them with intense anxiety.
  • The symptoms will have persisted for at least six months.

To make a definitive diagnosis, the evaluating professional would need to rule out all other possible causes of these symptoms, including medications, substance abuse, neurological disorders (like Parkinson's disease or dementia), and other mental conditions (such as bipolar disorder or schizophrenia). It is also essential to differentiate SAD from other anxiety disorders such as panic disorder.

In some cases, SAD can co-exist with other mental conditions including depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

While the process may seem subjective, the diagnosis of SAD is actually more precise than some might imagine. There are certainly gray areas that require interpretation (and, as such, creates the potential for misinterpretation), but, for the most part, the DSM-5 provides a relatively strong framework by which to make a diagnosis.

Seeking Help

If you are concerned that you are experiencing the debilitating effects of social anxiety disorder, speak with your family practitioner and ask for a referral to a qualified mental health professional in your area.

Before meeting, make notes about any events or experiences that may have caused you extreme social distress, whether among acquaintances, at work, or out in the general public. Try to date those chronologically as best you can. The more information you are able to provide, the more likely a diagnosis can be more or excluded.

Sources:

American Psychiatric Association DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, Virginia; published May 18, 2013.

Heimberg, R.; Hofmann, S.; Liebowitz, M. et al. "Social Anxiety Disorder in DSM-5." Depression and Anxiety. 2014; 31(6):472-479.

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