Recovery from Social Anxiety and Related Conditions

Dr. Robert F. Mullen
Director/ReChanneling

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The distinction between social anxiety and social anxiety disorder is in severity. We are not all affected by the same symptoms or relentlessness. The characteristics and traits are equivalent. These conditions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior. While comorbidities dramatically benefit, the recovery methods identified are for social anxiety and social anxiety disorder, and reference to one includes the other.

The Limitations in Diagnosing Social Anxiety

Mental health misdiagnosis is a cautionary phenomenon. Even mainstream medical authorities have begun to “criticize the poor reliability, validity, utility and humanity of conventional psychiatric diagnosis (Kinderman, 2014). It is essential to understand the causes, symptoms, and impact of our social anxiety to avoid the likelihood of misdiagnosis and recognize that we know more about the effects of our condition than our clinicians.

Experts may have extensive knowledge of medications and treatment programs, but that expertise is useless if the client is misdiagnosed and mismanaged.  

For example, the Anxiety Institute in Phoenix reports an estimated 8.2% of clients had generalized anxiety, but just 0.5% were correctly diagnosed (Richards, 2014).

Experts cite the mental health community’s difficulty distinguishing different disorders or identifying specific etiological risk factors due to the DSM’s failing reliability statistics. Imagine being treated for the wrong condition. A failure in psychological diagnosis is like being hospitalized for strep throat and losing a leg. 

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Symptom Variables

The DSM changes drastically from one edition to the next, even though psychiatrists support its credibility. One study on antisocial personality disorder (Lynam and Vachon, 2012) cites the concern that criteria are “added, removed, and rewritten, without evidence that the new approach is better than the prior one” (Stein et al., 2016). Another study points out that DSM-IV listed nine possible symptoms or traits for narcissistic personality disorder; DSM-V contains only two (Lynam & Vachon, 2012).   

The massive number of revisions, substitutions, and changes from one Diagnostic and Statistical Manual of Mental Disorders to the next is never universally accepted. Psychiatrists, psychologists, and researchers specializing in or surviving by funding are justifiably protective of their territory. Even under the best circumstances, it is challenging to get a proper diagnosis.

Bipolar personality disorder, a psychosis, shares characteristics and symptoms with avoidant, social anxiety, obsessive-compulsive, and post-traumatic stress disorders. Psychologists cite the “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” of social anxiety (Nagata et al., 2015). Before my extensive studies, I was misdiagnosed with depression (including bipolar) and ADHD. Social anxiety was never considered, although I met nine of the ten criteria for the disorder.

The distinction between social anxiety and social anxiety disorder is in severity. The characteristics are the same. We are not all affected by the same symptoms.

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Comorbidity

A significant challenge in determining the impact of our condition are its comorbidities. Social anxiety disorder often coexists with other mental health conditions, which can complicate diagnosis and treatment.

The Anxiety and Depression Association of America (ADAA, 2019) and other experts report that many disorders are related to social anxiety, including major depression, panic disorder, alcohol abuse, PTSD (Koyuncu, 20190, avoidant personality disorder, generalized anxiety disorder, substance abuse, eating disorders (Vrbova et al., 2017), Schizophrenia (Cuncic, 2018), ADHD, and agoraphobia (Koyuncu, 2019).

Anxiety and depression are commonly comorbid. “Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety”(Salcedo, 2018).

Anxiety and depression are commonly comorbid. “Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety” (Salcedo, 2018).

Dependent personality disorder has characteristics and symptoms mirroring social anxiety, avoidant personality, and histrionic personality disorders (DPD, 2017). One misdiagnosis is bad enough, not to mention two, which can only result in worse treatment outcomes. Misdiagnosis can lead to inappropriate or ineffective treatments, which can worsen the symptoms or lead to additional complications. This is why accurate diagnosis is crucial for effective treatment and better outcomes.

Diagnostic Reevaluation

Thomas Insel, director of the National Institute of Mental Health, has been “re-orienting [the organization’s] research away from DSM categories, declaring “that traditional psychiatric diagnoses have outlived their usefulness” (Insel, 2013).

A program of recovery cannot be determined if the problem is misdiagnosed. A recent article in Scientific American (Kinderman, 2014) suggests replacing traditional diagnoses with easily understandable descriptions of the issues. 

Social anxiety disorder is a challenging problem since its susceptibility begins in childhood, onsets roughly at age thirteen, and may not manifest until later in life. Ostensibly the most underrated and misunderstood emotional affliction, SAD is nicknamed the ‘neglected anxiety disorder.

Few understand its counterintuitive nature and even fewer know how to address it effectively. One must experience social anxiety to recognize its predictable negative trajectory that leads to self-destructive and adverse self-appraisal

Affected individuals may also not recognize their symptoms because of clinical and public misunderstanding (is shyness a symptom?), level of severity (social anxiety versus social anxiety disorder, and the diagnostic confusion between social phobia and social anxiety.

Inventories and Scales

There are clinically supported self-evaluation scales readily available on the Internet. These tools can help us estimate if we are on the spectrum of social anxiety. The SPS: Social Phobia Scale, for instance, is a 20-item self-report measure that gauges our fear of being scrutinized or observed during routine activities such as eating, drinking, and writing. It indicates the probability of experiencing social anxiety disorder in terms of none (0), mild (1), moderate (2), severe (3), or extreme (4).

The Social Interaction Anxiety Scale, commonly referred to as SIAS, is a 20-question, self-report measure specifically designed to assess the likelihood of experiencing social anxiety disorder. It can help to identify and understand our susceptibility or diagnosis.

The Social Avoidance and Distress questionnaire, a comprehensive tool comprising 28 statements about your feelings in social gatherings, is specifically designed to measure the anxiety we experience in social situations and the extent to which we avoid these situations.

However, there are caveats to the self-administration of these inventories. They are not as indicative of the severity of our social anxiety as they are of our current disposition. Notwithstanding, if your scores all point to social anxiety disorder, then you are likely diagnosable.

However, there is no easy test that can let someone know if there is a mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness.

How do we definitively determine the probability or extent of social anxiety? This is where professional guidance becomes crucial. Despite the potential for error in self-assessment, you can always rely on the symptoms and characteristics of social anxiety disorder provided by reputable sources like the Cleveland Clinic (2022), Mayo Clinic (2021), or this website (Mullen, 2024). If possible, consulting with an expert specializing in social anxiety can reassure you and provide the support you need. Many experts recommend someone who has experienced the condition and has the expertise to address it.

Etiology and diagnosis drive the disease model. Which disorder do people find most repulsive, and which poses the most threat? What behaviors contribute to the disorder? How progressive is it? How effective are treatments? Recognizing how these attributions affect treatment options is essential.

A simple list of people’s problems (properly defined) would have greater scientific validity and be more than sufficient as a basis for individual care planning and service design. We should focus on the character strengths that generate motivation and persistence toward recovery-remission, ensuring accurate diagnosis and treatment planning. 

Self-diagnosis is a slippery slope, but a client armed with the knowledge of the traits and characteristics of their disorder and its impact will have a far better possibility of an appropriate diagnosis and treatment options. The DSM can be utilized for a more thorough analysis but should not be our only source.

The signs and symptoms of mental health issues vary widely in severity and frequency from person to person. That’s why it’s not always easy to determine if what you’re feeling is situational or whether it’s something persistent that may require professional help.

It’s important to know that mental health issues do not need to be “serious” for you to reach out for support.

If you or someone you know is experiencing a mental health, suicide or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at 988lifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.

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References

ADAA (Anxiety and Depression Association of America). (2019). [Online.] Facts and Statistics. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq.

Chapdelaine A., Carrier J-D., Fournier L., Duhoux A. Roberge P. (2018). Treatment adequacy for social anxiety disorder in primary care patients. PLoS ONE 13(11) (2018). doi.org/ 10.1371/journal.pone.0206357.

Cleveland Clinic. (2022). Social Anxiety Disorder (Social Phobia.) [Online.] https://my.clevelandclinic.org/health/diseases/22709-social-anxiety

Cuncic, A. (2018). How Social Anxiety Affects Dating and Intimate Relationships. [Online.] verywellmind. https://www.verywellmind.com/adaa-survey-results-romantic-relationships-3024769;

DPD. (2007). Dependent personality disorder. [Online.] Harvard Health Online.

Insel, T. (2013). Post by Former NIMH Director Thomas Insel: Transforming Diagnosis. [Online.] Washington, DC: National Institute of Mental Health. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

Kinderman, P. (2014). Why We Need to Abandon the Disease-Model of Mental Health Care. [Online.] Scientific American. https://blogs.scientificamerican.com/mind-guest-blog/why-we-need-to-abandon-the-disease-model-of-mental-health-care/.

Koyuncu, A., İnce, E. , Ertekin, E., & Tükel R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context 2019, 8. doi:10.7573/dic.212573;

Lynam, D. R. & Vachon, D. D. (2012). Antisocial Personality Disorder in DSM-5: Missteps and Missed Opportunities. Personality Disorders: Theory, Research, and Treatment, 3(4) 483– 495 (2012). doi:10.1037/per0000006

Mayo Clinic. (2021). Social anxiety disorder (social phobia.) [Online.] https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561

Mullen, R. (2024). Symptoms and Traits of Social Anxiety. [Online.] https://rechanneling.org/2025/03/18/symptoms-and-traits-of-social-anxiety/

Nagata, T., Suzuki, F., Teo, A.R. (2015). Generalized Social Anxiety Disorder: A still‐neglected anxiety disorder 3 decades since Liebowitz’s review. Psychiatry and Clinical Neurosciences, 69(12): 724-740 (2015).  doi.org/10.1111/pcn.12327. 

Richards, T.A. (2014). Overcoming Social Anxiety Disorder: Step by Step. [Online.] Phoenix, AZ: The Social Anxiety Institute Press.

Salcedo, B. (2018). The Comorbidity of Anxiety and Depression. [Online.] National Alliance on Mental Illness.  https://www.nami.org/Blogs/NAMI-Blog/January-2018/The-Comorbidity-of-Anxiety-and-Depression 

Stein, D. J., Fineberg, N. A., Bienvenu, O. J., Denys, D., Lochner, C., Nestadt, G., Leckman, J. F., Rauch, S. L., & Phillips, K. A. (2010). Should OCD be classified as an anxiety disorder in DSM-V? Depression and Anxiety, 6:495-506 (2010). doi:10.1002/da.20699.

Vrbova, K., Prasko, J., Ociskova, M., & Holubova, M. (2017). Comorbidity of schizophrenia and social phobia – impact on quality of life, hope, and personality traits: a cross-sectional study. Neuropsychiatric Disease and Treatment, 13: 2073-2083. doi: 10.2147/NDT.S141749

Zimmerman, M. (2012). Is there adequate empirical justification for radically revising the personality disorders section for DSM-5? Personality Disorders: Theory, Research, and Treatment. Personality Disorders. Oct;3(4): pp 444-57. doi:10.1037/a0022108

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INDIVIDUAL RECOVERY. The symptoms of social anxiety make it challenging for some to participate in a collective workshop. Dr. Mullen works one-on-one with a select group of individuals uneasy in a group setting. ReChanneling offers scholarships to accommodate the costs. What is missed in group activities is provided in our monthly, no-cost Graduate Recovery Group. In this supportive community, graduates interact with others who have completed the program.  Contact ‘rmullenphd@gmail.com’.

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Committing to recovery is one of the hardest things you will ever do.
It takes enormous courage and the realization that you are of value,
 consequential, and deserving of happiness.