Social Anxiety: Feeling Anxious When You Want to Have Fun?
Rachel Sykes | I Work with Stressed Out Professional Women | Licensed in Massachusetts
Rachel C. Sykes, LMHC, LLC Rachel@rachelcsykes.com
During the week between Christmas and New Year’s, I met up for lunch with a couple of my high school friends. In fact, we were close in high school, college, and our 20s, so have probably seen each other at some fine moments of poor choices. We don’t seem to find as much time together as we would like but I can truly say there are few people who know me as well as they do, and vice versa.
One of the things we spoke about was how differently he have all felt going out since covid quarantine times. I shared that I have been more insecure in many of my personal relationships—something that I haven’t felt since I was a little kid. More specifically, I have recently wondered if I may have said the wrong thing, or that one of my jokes may have missed the target and just been awkward. One of my other friends was talking about a similar experience-she felt as if she were anxious in advance of a social situation, been stressed during the event, and then felt badly about things afterwards. The third friend was perhaps less stressed or self-critical after the fact but had been avoiding hanging out with certain friend groups who she used to see all the time. While we are chatting about this, it occurred to me that we were all showing some signs in common with social anxiety disorder (also called social phobia).
What is social anxiety?
According to the accepted diagnostic criteria from the DSM-V, social anxiety/phobia can be described as fear or anxiety related to being in social situations where one is concerned about being criticized or scrutinized by others. The thought of these social situations is anxiety-producing, sometimes to the extent that the sufferer avoids the situation altogether, and the actual social experience is marked by fear or anxiety. The fear or anxiety has to be disproportionate to the circumstance, and has to occur for long period of time (6 months+) and has to result in clinical distress impacting functioning at work, home, school, etc.
Meet Percy
Percy (he/him) is a 28-year-old man who owns his own social media marketing business. He has a long-term partner and lives in a small city close to many of his friends and family. While Percy is successful in his business, he believes it is important for him to make new business contacts and wants to spend more time speaking at industry events. Unfortunately, Percy has had some difficult experiences since he started to focus more on marketing himself rather than clients. For example, the night before a presentation at a local technology conference, Percy was up all night with racing thoughts, high levels of anxiety, and even stomach pains. Nonetheless, Percy attended the event but was overwhelmed by fear before, during and after his presentation. In particular, he was afraid that his peers wouldn’t take him seriously and would start talking over him, and maybe that they would make fun of him. Intellectually, he believed that these thoughts were a little irrational, but he felt that he couldn’t help it. At present, he is rethinking his upcoming presentation at another event coming up next month, even though backing out might damage his professional image and hold him back with respect to his career goals.
public speaking
Photo by Marcos Luiz Photograph on Unsplash
Diagnosis
Based on the information presented, I would say that Percy is just shy of a formal diagnosis of social anxiety but only because the duration of his symptoms have not met the threshold needed for formal diagnosis (6 months or more). Technically, I would probably diagnose him with an Unspecified Trauma- and Stressor-Related Disorder strictly because of the duration aspect but would update the diagnosis if the symptoms continued.
Rules outs
There are a lot of other diagnoses that are similar (agoraphobia, panic, generalized anxiety, phobias, autism, etc.), so it might be helpful for a person with similar symptoms to seek an evaluation from a trained professional. It is also possible for a person to just be shy, and that is not a mental health issue, although a person may choose to work on their shyness to the extent that it helps them lead a happier life. Nothing wrong with being shy!
Treatment considerations
Social anxiety can be treated by psychotherapy and also by medication, although I will remind you that I am not a prescriber. One therapeutic method for treating social anxiety is called exposure therapy, which involves gradual exposure to the anxiety-provoking stimuli that starts off small and build over time. Again, this work should be done with a trained professional, as it can be damaging to be forced into a feared experience too quickly. This type of therapy will probably take some time to produce meaningful change, so don’t expect an overnight improvement. I think therapy of any kind can be difficult but hopefully, it will ultimately yield beneficial results.
Importance of Social Relationships
friends
Photo by Priscilla Du Preez 🇨🇦 on Unsplash
During COVID, the thing that I craved the most was being in the physical company of friends. We had video calls and outdoor walks and even “side by side” visits where we parked in our cars in the same lot but it wasn’t really enough. I was luckier than many - no one in my family or close friend group passed away, although that was not the case for many. And while I do feel lucky, I also feel like I am still shaking off that bleak period of time where there was so much unknown. Over the last year, I have really tried to reach out to people who have meant a lot to me, even if we haven’t connected recently. It also reminds me of how important it is to put energy into maintaining your friendships and family relationships.
Speaking of social relationships…
I am an Adlerian therapist – you probably never heard of that, right? It means that my personal beliefs about how people and the world works are closely aligned with the work of famous psychologist Alfred Adler. He was originally a lesser known peer of Sigmund Freud, so he is what you may call psychodynamic in perspective. To me, psychodynamic approaches believe in the presence of the subconscious mind at work, such that individuals may not necessarily be aware of all the reasons for their thoughts, feelings and actions. I like Adler’s work in particular because he took the famous system articulated by Freud and updated it to better reflect his observations of the importance of social relationships. I see Adler as more optimistic than Freud, as Adler is anti-deterministic (believes that people can change) and his work is more forward-looking although it still respects the importance of one’s past—childhood, in particular. Adler, by the way, was also recognized for acknowledging the impact of cultural forces and power imbalances on mental health. His views at that time may not reflect contemporary thinking but I believe he was progressive for his time. [As an aside, I have long disliked many things about Freud’s work, especially his narrow and limiting depiction of women, which I believe further perpetuated women’s subordinate role in society. I have, however, developed a begrudging respect for the many accomplishments he had and the impact those concepts have had, even after these many years.]
Upon reflection
Okay, back to my lunch with my old high school buddies. Maybe our own personal experiences were technically not clinically relevant, as the nature of the anxiety was not severe enough, or that it was not persistent, or that it did not result in significant impairment in functioning. However, it reminded me of a blog I wrote a few months ago that talked about what I called post-covid anxiety. That article talked about how the remnants of that scary period of time left a mark on us, leaving many unsure, worried, and spending too much time in one’s own head thinking unhelpful thoughts. I hadn’t at the time thought specifically about social anxiety but it’s interesting to me now to notice that the unease remains—we may not have a surreal experience when shopping at the mall but maybe we are still less at ease with friends.
Contact me
Questions? Check out my website, request an appointment, or call/email to ask for a free 15-minute consultation.
email: Rachel@rachelcsykes.com
phone: 617.804.6471
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Psychiatry Online. (n.d.) https://doi.org/10.1176/appi.books.9780890425787