Social Anxiety and Depression: When to Seek Help

Social Anxiety Disorder, Depressive Tendencies

Hello, doctor.
I have a question that has been troubling me for a long time.
I tend to be overly concerned about how others perceive me, and I really dislike being the center of attention.
When I walk down the street, I often look down to avoid making eye contact with others.
When I go out to eat, I might choose to skip it if there are too many people.
If I want to buy snacks or instant noodles, I find myself thinking, "Will others think that what I'm eating is unhealthy?" This often leads me to abandon my original decisions.
I know I care too much about what others think of me, but I can't seem to control it.

When I introduce myself, I feel nervous, my heart races, my mind goes blank, and I even shake.
The same happens when I have to give a presentation.
Once, I was late to class in my first year of high school, and when the teacher said good morning, I became the focus of everyone's attention.
I dislike making mistakes in front of others because it makes me feel like, "Do others think I have flaws too?" Additionally, some activities in clubs have made me doubt my abilities, which led to a period of depressive tendencies.
During that time, I realized I was pretending to be strong, confident, outgoing, and optimistic, all to appear perfect and be liked by others.
However, being overly concerned about others' opinions has caused me to start doubting myself, even questioning my own self-worth, and I have had thoughts of self-harm or suicide.
Although I no longer cry every day, when I encounter negative feedback from others or fail to meet my own expectations, I still find myself trapped in negative emotions that are difficult to detach from and control.
Doctor, do you think I need to see a psychiatrist? Thank you.

Gao Er Xue Sheng, 10~19 year old female. Ask Date: 2021/03/16

Dr. Lin Mianzhang reply Psychiatry

Hi there! It seems that you may be experiencing social anxiety disorder, and you might also have symptoms of depression; however, a definitive diagnosis can only be made through an evaluation by a psychiatrist.
Beyond the diagnosis, what is truly important is understanding the underlying reasons for your social anxiety.
I believe this relates to your personality, your family background, and your past experiences.
This aspect requires time to explore, and psychotherapy can assist you in this process.
Therefore, I recommend that you seek psychiatric care as soon as possible, utilizing medication, psychotherapy, and family therapy to help you through this challenging time.
With proper treatment, you can expect significant improvement in your condition! Wishing you peace and health!

Reply Date: 2021/03/16

More Info

It sounds like you are experiencing significant distress due to social anxiety and feelings of inadequacy, which can indeed be overwhelming. Your concerns about how others perceive you, your fear of being the center of attention, and the physical symptoms you experience during social interactions are all indicative of social anxiety disorder (SAD). This condition can lead to avoidance behaviors, such as choosing not to go out or engage in social situations, which can further exacerbate feelings of isolation and depression.

Social anxiety is characterized by an intense fear of being judged or embarrassed in social situations. This fear can manifest in various ways, including physical symptoms like rapid heartbeat, sweating, trembling, and even panic attacks. It's not uncommon for individuals with social anxiety to feel a sense of dread about situations that involve interaction with others, leading to avoidance of those situations altogether. This can create a cycle where the avoidance reinforces the anxiety, making it even harder to engage socially.

Your experience of feeling the need to present a facade of confidence and perfection is also common among those with social anxiety. Many individuals feel pressured to meet certain expectations, whether they are self-imposed or perceived from others. This pressure can lead to feelings of inadequacy and self-doubt, especially when faced with criticism or failure to meet those expectations. It’s important to recognize that these feelings are not a reflection of your true worth or abilities.

Given your description of experiencing depressive symptoms, such as self-doubt, feelings of worthlessness, and even thoughts of self-harm, it is crucial to seek professional help. While you may feel hesitant about visiting a mental health professional, doing so can provide you with the support and tools you need to manage your anxiety and depression effectively. A mental health professional can help you explore the underlying causes of your anxiety, develop coping strategies, and work towards building your self-esteem.

Cognitive-behavioral therapy (CBT) is one of the most effective treatments for social anxiety. CBT focuses on identifying and challenging negative thought patterns and beliefs that contribute to anxiety. It also involves exposure therapy, where you gradually face social situations that trigger your anxiety in a controlled and supportive environment. This process can help desensitize you to those situations and reduce your fear over time.

In addition to therapy, medication may also be an option to consider. Antidepressants and anti-anxiety medications can help alleviate symptoms and make it easier for you to engage in therapy. A psychiatrist can evaluate your situation and determine if medication is appropriate for you.

It’s also important to practice self-care and develop a support system. Surrounding yourself with understanding friends or family members can provide a sense of comfort and reduce feelings of isolation. Engaging in activities that you enjoy and that promote relaxation, such as exercise, mindfulness, or hobbies, can also help improve your mood and overall well-being.

Lastly, remember that seeking help is a sign of strength, not weakness. Many people experience similar struggles, and reaching out for support can be the first step towards feeling better. You deserve to live a fulfilling life free from the constraints of anxiety and depression. If you are unsure where to start, consider reaching out to a school counselor or a local mental health service to discuss your feelings and explore your options for support.

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