Updated December 16, 2014.

Shyness and social anxiety disorder share many characteristics. If you have spent your whole life feeling as though you are just a shy person, how do you know if it is something more serious? Or, if you're a worried parent, you may be wondering if your child is afraid of strangers or not making new friends at school. In either case, how do you know whether it is a serious problem?

You have every right to be worried -- social anxiety disorder (SAD) is often dismissed as just extreme shyness.

Statistics show that although symptoms usually start in childhood, the majority of people with the disorder don’t receive treatment (close to 75% of sufferers), and those who do seek treatment wait a long time to do so -- on average 14 years.

The sooner you act, the sooner you can avoid lost opportunities. When symptoms begin in childhood, they may take over your child’s life. Childhood is the time when social skills develop in preparation for the challenges of adolescence and adulthood. Children who suffer with SAD often do not develop appropriate social behaviors. As children grow with the disorder, they may become accustomed to having social fears and design a life based on avoidance.

What are the results of long-term untreated SAD? Social anxiety disorder can have a devastating impact on your education, career success, financial independence, and personal relationships. Often it will lead to an isolated lifestyle and subsequent depression or substance abuse.

Yet There Is Hope

For the majority of people (studies show roughly 70%), SAD can be treated successfully.

It is so unfortunate that people wait so long or never get help when this disorder is so amenable to treatment.

Am I Just Shy?

The reason many people don’t seek help for SAD is that they don’t realize that they have a recognized psychiatric condition. But it's been officially declared in the most recent revision of the DSM-IV, as an official disorder with diagnostic criteria.
In general, the primary symptoms that distinguish shyness from SAD are the intensity of the fear, the level of avoidance, and the impairment of functioning that it causes in a person’s life. People with generalized SAD don’t just feel nervous before giving a speech. They may worry about the speech for weeks or months beforehand, lose sleep due to anxiety, and have intense symptoms of anxiety during the feared situation such as a racing heart, shortness of breath, sweating, or shaking.

The symptoms usually do not subside but get worse as the situation progresses. The person with SAD usually realizes that his fears are unfounded but is still unable to control them.

Screening for SAD

Your doctor or mental health care professional will conduct an in-depth interview to determine whether you meet the criteria for a diagnosis of SAD. However, as an initial step, he or she may have you complete a screening measure to determine the need for a more thorough follow-up evaluation.

One such screening test is the “Mini-SPIN” (Mini-Social Phobia Inventory) that consists of just three questions. The Mini-SPIN (and it’s sister version the full SPIN) were created by Dr. Jonathan Davidson of the Department of Psychiatry, Duke University Medical Center. In a study of more than 7,000 patients diagnosed with SAD, 89% of diagnosed patients were identified using this screening method.

To complete the SPIN, your doctor will have you rate the following three items in terms of how true they are for you on a scale of 0 to 4, where 0 is “not at all” and 4 is “extremely present.”

• Fear of embarrassment causes me to avoid doing things or speaking to people.
• I avoid activities in which I am the center of attention.
• Being embarrassed or looking stupid are among my worst fears.

Generally, total scores of 6 or higher are indicative of possible SAD, however only a trained mental health professional can make a diagnosis. In addition to the SPIN and Mini-SPIN, there are several other instruments that may be used to screen for SAD including:

• Liebowitz Social Phobia Scale
• Fear of Negative Evaluation Scale
• Social Avoidance and Distress Scale

Although screening instruments are very helpful in identifying potential problems with social anxiety, there is no substitute for a complete diagnostic interview conducted by a mental health professional. Your doctor will be able to provide a full assessment, or refer you to another professional more experienced in diagnosing the disorder.

_Sources:

Rosenthal J, Jacobs L, Marcus M, Katzman M. Beyond shy: When to suspect social anxiety disorder. The Journal of Family Practice. 2007; 56: 369-374.

Connor KM, Kobak KA, Churchill LE, Katzelnick D, Davidson JR. Mini-Spin: A brief screening assessment for generalized social anxiety disorder. Depression and Anxiety. 2001; 14:137-140.