A few months ago I wrote a profile for Mind, one of the five charities that I am trying to raise funds for. In that profile I mentioned that I had previously been diagnosed with Social anxiety. With today being Time to Talk Day I thought it would be a good idea to write a bit about this. More specifically I wanted to write about the impact that this has had on me.
My diagnosis of Social Phobia, now more commonly called Social Anxiety Disorder, came nearly 20 years ago. I still find it very difficult to clearly answer when people ask what that means. Most of what I know about Social Anxiety generally I have learned by searching the internet rather than from anything I’ve been told by medical professionals. I went to seek help as I had been depressed and self-harming. After an interview the clinical psychologist said that ‘if he were’ to give a diagnosis it would be Social Phobia rather than Depression. The rather vague wording of this verdict has only increased this confusion and I generally say that I have been diagnosed with Social Anxiety to keep things simple.
Of course it can be difficult to ascertain the nature of an issue from one interview. There are no simple and clear-cut tests for diagnosing most mental health conditions. When researching these things it is very easy to look at a list of symptoms and decide that they fit your situation. There are also numerous online tests that purport to be able to help diagnose mental health conditions, although the more honest ones will inform you that you may have a condition and that you should seek professional help where the test identifies something. But a test looking for one condition will not identify other conditions and there are numerous conditions that have overlapping symptoms.
One example of this is the AQ (Autism Spectrum Quotient) Test. The first time I took this test I scored 28. Having taken it again as I was writing this post I scored a 27. Both of these scores put me in the range that ‘gives a borderline indication of an autism spectrum disorder. It is also possible to have aspergers or mild autism within this range.‘ I’m pretty confident that I am not autistic. The high scores (relative to the general population – the score goes up to 50 so it could be a lot higher) that I get on this test relate to my social issues. I expect that other people with Social Anxiety Disorder would score similarly if they took this test. The AQ test is doing what it is designed to do and is picking up on characteristics that can be indicators of autism. But these same characteristics are not exclusive to autism and the test is not designed to look for alternatives.
An alternative diagnosis that seems much more plausible to me is Avoidant Personality Disorder. I’m not going to go into the details of what this diagnosis would mean. It is something that I came across whilst researching Social Anxiety. I recently took a couple of online tests for Avoidant Personality Disorder out of interest to see the results. Both tests came back stating that I had Avoidant Personality Disorder (one of these tests prefaced this by saying I am sorry). I’m not going to share links to these tests as I do not trust them and do not approve the absence of ‘may’ from their verdict. It is not possible to diagnose something like this by answering some questions online. At best these tests are potential indicators and at worst they can be actively misleading.
It is also worth considering that there is a huge ongoing debate as to what should be classed as a mental health condition and where lines should be drawn in terms of diagnosis. There is an argument that we are treating too many things as mental health conditions (with a potential driver being the pharmaceutical industry’s desire to sell more of their products by getting them licensed for more things). Given that there is a debate as to whether Avoidant Personality Disorder is in fact just Social Anxiety Disorder (possibly a more severe form) it should be no surprise that someone with Social Anxiety will see a lot of themselves in the description of Avoidant Personality Disorder.
So why have I waffled on about all of the above? Well by doing this research my main conclusion is that it does not really matter what the diagnosis is. What matters is how I am affected by my mental health and making sure that I have adequate coping mechanisms in place. More importantly the same thing applies to everyone regardless of whether they have a ‘condition’ or whether they are ‘normal’. When we look at physical health it is easier to see when things go wrong. We can easily spot differences in the scale of an injury from a cut to a broken limb to something potentially fatal. We are also very used to thinking and measuring physical fitness and the effects that this can have on our health. It seems to me that we need to get used to thinking of mental health in similar terms. A mental health issue can be a temporary issue or an ongoing issue and can be relatively benign or potentially fatal.
So ignoring any labelling, what are my issues? Answering this is not straightforward but I want to attempt to give this a straight an answer as possible. I’m going to avoid analysing the past to look at causes or to highlight issues that are not necessarily current issues. Naturally the answer I give will be coloured by my own perceptions and as such other people who know me may disagree. Some of my ‘issues’ may be all in my head in more ways than one!
Let’s start with self-esteem. As with many people with anxiety related issues, mine is not particularly high most of the time. Because I have issues with socialising my default opinion is that other people don’t like me or find my uninteresting. This is particularly true when meeting new people. For existing close friends and loved ones I have come to accept that they do like and appreciate me. For other friends, colleagues and acquaintances I suspect that I get their opinions of me wrong quite often. Particularly as the way I think that they perceive me can change quite drastically. When work colleagues praise the work I do I accept this as normal as I think I am really good at my job. If the same people were to compliment me or praise my personality I would be very surprised. In short I have self-esteem issue relating to the way other people perceive me but in other ways I can be confident or even arrogant about my own abilities.
Moving on to my social issues, both perceived and real. It is my perception that I lack social skills. To me it feels like I don’t understand how to interact with other people. I don’t really understand how to do small talk. What do I talk about and why would other people want to listen? I feel that I don’t know how to interact with multiple people at the same time. When is it appropriate to talk? I had something interesting to say about a topic but the conversation has gone past so is it appropriate to go back and say what I wanted to say anyway? The issues get larger with the number of people involved. At large gatherings I will usually hide away in a corner and only talk to those who talk to me. I am aware that I should probably make an effort to go up and say hello to other people who I know. But which people? What should I talk about? What do I do if I say hello but then there’s an awkward silence? And through all this I’m feeling anxious because I don’t think I belong or fit in and nobody would miss me if I wasn’t there.
Perception is not always reality. The better I know people the more relaxed I am round them. I feel I understand how things are done. I may not become outgoing but I do talk. Similarly, if I do manage to relax then I can talk to people I don’t know. When people talk to me then I can talk back – but then its always easier when someone else leads the way. During obstacle races I have been known to talk to fellow runners, which is possibly one of the reasons I have always enjoyed them. So is my perceived lack of social skills just an illusion? I don’t think it is but I do think that my anxiety about socialising makes me think that my social skills are worse than they are. Which clearly doesn’t help.
The social anxiety goes further than that though. I get anxious about having to make phone calls, even to people I know, and tend to put them off. Sadly part of my job involves occasionally calling customers. Fortunately I have scripts, prepared questions and I know what subject we’ll be talking about, which does take a bit of the pressure off. I do often have to build myself up to making the calls and the wait to see if the customer answers is agonising. The calls themselves aren’t too bad once I get on them (although listening to them back with my hesitations, ums and ahs is horrendous) but that doesn’t stop me getting anxious before each one.
I can also get anxious about having to ask other people about routine things. At times I will get up to go and ask someone about something only to decide that I can’t do it right now. So I sit back down and do something else and tell myself that I’ll go and ask them later (sometimes I even do). If someone doesn’t say hello or goodbye to me first then I can get anxious about whether I should be saying hello or goodbye to them, even when I know it is generally expected.
It’s not just talking either. Having to write a letter or email can also cause me anxiety and is something I frequently postpone even when I know it would be better to act promptly. I have been on Twitter for six and a half years but have Tweeted less than 4000 times. A good half of these tweets have been made when I pushed myself to attempt to Tweet 1000 times in 10 days. I attempted it twice having failed the first time round. A number of other tweets were automatic tweets from Runtastic when I used to use that app on my phone to track my runs. What you’ll find very little of in my Tweeting is actual interactions with other people. Social media without the social part.
Career planning is a bit problematical for me. I can’t see myself ever fitting in as a manager or team leader as I would not be able to handle dealing with the people under me. What kind of job doesn’t involve social interaction? A lot of workplaces look to reward those who take on extra responsibilities and get involved in lots of things outside their job description. For those of us who are not good at putting ourselves forward where does this leave us? Sadly being really good at your job doesn’t get as much recognition as it should. It’s not surprising that I tend to stick in the job I’m in rather than looking round to see if there’s anything better for me out there.
Every so often I will go through periods of depression. There is not always a trigger for these, although given that everyday life makes me anxious it is perhaps more accurate to say that there is not always an obvious trigger. I’m happy to say that these days I have improved my coping strategies for this and have not self-harmed in several years, though I’ll admit it remains a temptation at times. Running is one of my ways of dealing with stress on a more day-to-day basis rather than letting things build up. I love the feeling of zoning out, thinking about the run and nothing else. I love the endorphin buzz you can get after exercising. There is also the satisfaction you can get from completing a race or setting a new PB. On a non day-to-day basis when I get stressed or worked up I like to do something trivial but constructive. For instance I will go and do some long neglected housework so that I can distract myself and feel that I’ve done something positive. These may not work for everyone but they do help me.
I am a quiet person and I do feel the need for a bit of me time now and again. But I am not somebody who is a loner by choice. I like to spend time with friends and wish I was better at building relationships with others. It’s not normal that after five and a half years in my current job I don’t have one single telephone number for a current work colleague. I do have a numbers for a couple of people who have left now but I don’t use them. Similarly I don’t socialise with anyone that I have met in my current job outside of work or work organised events (e.g. team lunches or nights out). This is partly the whole social anxiety and insecurity that I have covered above but I think there is another element here too.
It is in my nature to feel most comfortable when there are clear rules or guidelines to follow. When I am working I am being paid to work so that is what I do. I sometimes feel uncomfortable joining in with conversations at work because I should be working. Mobile phones are not allowed at desks so I never look at mine until I’m on break. I’ve never called in sick when I haven’t been sick. When driving I follow the speed limit. When walking I stick to the pedestrian side of the pavement and don’t like to go on the cycle path even when there is nobody else about. You may have noticed earlier references in this post to not knowing the rules of social interactions. There is something reassuring about following guidelines. Perhaps I do take this too far and I need to learn when to break out of my comfort zone and to change my routine.
I’m not sure if there’s anything else to add here. This post has been long, meandering and confused. This post has been very me. I don’t know if this has helped anyone understand anything but it would be nice if it did. But at least I’ve made the effort to talk about it for once. Is it time for you to talk too?
Run Big Year 