Out of the social anxiety assessments listed on our resource page, I found Painfully Shy’s SAD self-assessment to be the most thorough, and the Liebowitz Social Anxiety Scale to be the best attempt at a more scientific approach. Painfully Shy’s assessment covers fears, avoidance behaviors, and physical symptoms. Taking it again gave me both a positive rush and a little bit of anxiety. A rush because I feel like I have perspective on what happens for me; anxiety because it focuses me on the problem, when I usually try to “ignore” it. Taking an assessment pushes me to embrace my social anxiety and to do something about it rather than simply avoid situations and attempt to deny my feelings.

The Liebowitz scale, although not complete in my opinion, is a good because it takes into account intensity of fear and frequency of avoidance behavior. Doing this is helpful because it helps me to get a more personal assessment of my own social anxiety – we’re not all the same. Also, as the test indicates, it’s also supposed to be beneficial in tracking progress, something I haven’t done personally, but have done with clients. So, if I have moderate fear in small groups and avoid them on occasion, I could try some techniques and aim to experience only mild fear and rarely avoid these situations. The problem I have with this scale is the situations are ambiguous. For example, some small groups don’t bother me much at all, while others scare the hell out of me. It’s hard to lump them together.

One thing I’m going to try is noting all the specific situations I avoid and the various feelings/thoughts I have. Then I could use this as both an assessment and motivation over time.

What’s your experiences with assessments, both initial assessment and understanding your social anxiety, and in assessing your progress?

I am currently on a meditation retreat and will respond to comments when I return August 20. Feel free to comment as fellow readers and the authors will join in.

But when I started to talk about SAD, when I started a journal to examine my history and record incidences, something shifted. I realized I was not dealing with isolated anxious moments but a constant presence. I began to feel overwhelmed.

I began to see just how much anxiety I have, how often I am avoiding situations and people. I saw how much of my life has been curtailed, how many of my ideas about myself and other people are seen through a prism of SAD.

Realizing the extent of my anxiety was causing me anxiety. It was a feedback loop.

I realized that even if I could push through one situation or get comfortable with one particular set of people, when faced with something new I was just going to have to go through it again. It made me want to be around people even less. It made me want to avoid things even more and never push through.

And it got stronger still. I was anxious all the time. It was an unrelenting background hum. And not only was it always present, now I saw that it always had been. I’d just been refusing to fully acknowledge it. This thing, this anxiety, this disorder, is a massive part of who I am. It is why I have always had jobs I am overqualified for, why I’ve had so many troubles with relationships, why I have not gotten nearly as far in life as I had once hoped or thought I would. It is an anchor.

That was difficult to accept. I didn’t want so much of my life to be about anxiety.

And the people I told about SAD could see how talking about it was making it worse. I couldn’t try to explain it without it flaring up.

I was overwhelmed.

But these conversations, one in particular with a fellow sufferer, were eventually what brought my overwhelm under control. And it has made me believe it is vitally important to keep talking.

Because no matter how overwhelmed I was feeling, I kept up the conversations.

The act of talking about SAD, even as that act freaks you out, is a major step forward. It feels like the beginning of really learning how to push through SAD, instead of learning to push through each instance. My SAD screams at me to stop telling people about it, and as I continue to talk, and send emails to a fellow sufferer, and tell a handful of people things I have never told anyone, I am continually learning to press on despite that screaming.

The acts of talking about SAD, writing about SAD, and describing the internal landscape of SAD are all acts of pushing through. Each is a small victory over the voice that tells you to shut up.

Thankfully, the DSM-IV¹ acknolwedges the similarity between APD and SAD:

There appears to be a great deal of overlap between Avoidant Personality Disorder and Social Phobia, Generalized Type, so much so that they may be alternative conceptualizations of the same or similar conditions.

When I read over the criteria² for APD, everything hit right on the mark and described my experiences perfectly: avoiding social situations and interpersonal contact for fear of criticism, disapproval, rejection; unless certain of being liked; restraint in intimate relationships out of fear of being shamed or ridiculed; preoccupied with criticism and rejection; inhibited in new interpersonal relationships because of feelings of inadequacy; views self as socially inept; reluctant to take personal risks/engage in new activities³. Read my intro post and you’ll notice the connections.

You might wonder how APD is any different from SAD, if it is at all. I went back to the criteria of SAD and what I noticed is that APD seems to be a more specified description of SAD. Some researchers conclude that APD is a more intense version of SAD, but I disagree, based on my own experience. I think that its entirely possible that the most intense cases of SAD will also be diagnosed with APD, but not all cases APD are intense versions of SAD. I say this because, as I mentioned in my intro post, most folks don’t know I even have SAD and would never suspect it. Also, I don’t feel like an “intense” version⁴. However, APD hits the nail on the head and is even more to the point about my struggles than is SAD.

The next question is whether these disorders should have entirely different paths of treatment. I think not. Both seem to have the same roots and patterns: cognitive behavioral⁵. I have found the techniques from the Social Anxiety Workbook to be tremendously helpful and get right to the heart of my struggles, so I see no need to have an APD Workbook. I suspect the “Social Anxiety” has taken on a more popularized quality and probably sounds a bit more appealing to the average person than “Avoidant Personality”⁶.

I’m still in the midst of exploring APD and have found a great website appropriately titled, Avoidant Personality. They list a couple of online message groups, as well as some relevant books. What is your experience? Is APD helpful in understanding your experience of SA (or if you are a mental health practioner, helpful in working with individuals)? Do you think they are of the same disorder, or distinctly separate?

1. The DSM-IV is the “Diagnostic and Statistical Manual of Mental Disorders”. The current edition is the Fourth Edition-Text Revision, or DSM-IV-TR. This is the “official” manual used by mental health practitioners and is required by many health insurance providers. [back]
2. Every mental health disorder in the DSM includes certain criteria that an individual must meet in order to be diagnosed with that disorder. This is very important because all of us meet some/a few of the criteria for some/a few of the disorders, for example Generalized Anxiety Disorder. [back]
3. Wikipedia has a nice page on APD, including full criterion. [back]
4. For example, not being able to leave the house, severe occupational interference, etc. [back]
5. Cognitive behavioral theory and therapy maintain that our emotional struggles stem from the thought patterns that we hold and are reinforced by our behavior. Treatment involves examining our thought patterns, challenging and changing them, and creating more accurate thoughts, and to engage in new behaviors supporting our new thoughts and desired outcomes [back]
6. An Amazon.com search of “Avoidant Peronality Disorder” reveals a grand total of zero books [back]