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When It’s Not Just Shyness: ADHD and Social Anxiety

By Maria Romaszkan

Does your heart always beat faster when you think about starting a conversation with a stranger — and not in a good way? Or maybe you practice saying your order as you wait in line to get coffee, palms sweating and stomach twisting? Perhaps you have social anxiety — one of the most common mental health conditions that can happen along with ADHD.

Defining Social Anxiety

Social anxiety disorder, or SAD, also known as social phobia, is one of the most prevalent subtypes of anxiety. According to The Anxiety and Depression Association of America, around 15 million people in the United States have it, making it the second most common type of anxiety diagnosed.

It’s crucial not to mistake social phobia for shyness. Shyness can be a natural personality trait; social anxiety or social phobia is a condition that often makes everyday functioning — not to mention leading a fulfilling life — difficult.

Social anxiety is characterized by intense, persistent fear of being judged negatively or rejected. This fear arises when a person encounters specific triggers.

Each person’s triggers can be different. Some people may have trouble using a public bathroom or ordering food but be OK with making phone calls or even giving a presentation.

Still, there are some common symptoms, such as:

  • Fear of everyday social situations, such as striking up a conversation, ordering food or shopping
  • Avoidance of social activities, such as parties, meetings and extracurricular activities
  • Worrying about an event days or even weeks before
  • Low self-esteem
  • Physical symptoms, like gastrointestinal issues, dizziness, excessive sweating and heart palpitations
  • Avoiding eye contact

In extreme cases, social anxiety can isolate you to the point of missing school or work and opportunities to truly experience life. This significant loneliness may lead to a higher risk of depression or substance abuse.

ADHD and Social Anxiety

Social anxiety disorder is one of the most common comorbidities of ADHD, or conditions that happen along with ADHD. One 2019 study in the journal Drugs in Context cited research that found that up to 60-70% percent of people with social anxiety disorder had been diagnosed with ADHD in childhood.

However, there is no clear answer as to why the connection exists between these two conditions.

ADHD symptoms such as distractibility, impulsivity or hyperactivity may contribute to social anxiety as they may make connecting with others more difficult. Also, people with ADHD are at a higher risk of bullying and discrimination, which can be a factor in social anxiety.

“Individuals with ADHD might struggle with paying attention to social cues, which can contribute to difficulties in forming and maintaining relationships,” says David Tzall, a licensed psychologist based in Brooklyn, N.Y. “This can result in social isolation and lead to social anxiety due to negative experiences and low self-esteem.”

Tzall says the hyperactivity and impulsivity associated with ADHD might lead to impulsive behaviors during social interactions. These behaviors could be socially inappropriate or disruptive, potentially leading to negative social feedback and triggering social anxiety, he says.

“People with both (ADHD and social phobia) might experience excessive worry and overthinking,” he says. “While ADHD might contribute to racing thoughts, social anxiety could exacerbate these thoughts by focusing on potential negative outcomes in social situations. ADHD-related difficulties in attention and organization could lead to challenges in school or work settings, which might contribute to performance anxiety. This anxiety could extend to social situations where the individual fears being judged based on their performance.”

Managing Social Anxiety with ADHD

How can you manage social anxiety when you have ADHD? A good start is learning as much as possible about ADHD and social anxiety to understand how they impact you, says Tzall. This helps you identify your specific triggers and challenges.

Here are some other expert recommendations in managing social anxiety when you have ADHD:

• Nurture self-compassion

ADHD and social anxiety can lower your self-esteem and inviting negative self-talk, harsh judgment and constantly comparing yourself to others. All of that fuels the anxiety.

Becoming more self-compassionate is key to silencing your inner critic and calming your fears. Be patient with yourself and accept your mistakes. You’re perfectly human, and that’s OK. You’re allowed to make mistakes or not be liked by some people. It doesn’t mean you’re unlovable or unworthy of respect, acceptance and care.

You can try to treat yourself like you would a loved one. Would you yell at them, or call them stupid or hopeless? You deserve the same love and understanding you give others.

• Take It Slow

It may be tempting to give in to that ADHD impulse to do everything all at once and throw yourself into the deep end right from the start. Try to resist this urge. Jumping too far out of your comfort zone can discourage you from trying again and significantly worsen your mental health.

Instead, set small, specific and achievable goals. Those might include posting on an online forum, complimenting a coworker or engaging in small talk with a barista.

Be prepared for a lot of discomfort and difficult emotions. You will fight against old mechanisms and negative perceptions of yourself. While they are an unavoidable element of change and growth, it’s essential to take it as slow as you need and ask for help — whether from a loved one or a mental health professional.

Learning coping techniques or asking a supportive family member or friend to cheer you on can help you stay accountable.

• Learn to Self-regulate

As we’ve mentioned, coping strategies can help you calm your anxiety and bring inner balance. In other words, you can self-regulate by calming down your nervous system. You can do that through techniques like breathwork or engaging your senses. Try several of them a few times to see which ones work best for you.

You can also try regular walks, yoga, meditation or journaling, which is simply writing out your thoughts and feelings to help you better understand them.

• Medication

If ADHD significantly influences your social phobia, stimulant medication can help you manage the symptoms and thus lessen the anxiety.

“I often tell people with ADHD and anxiety that their anxiety may improve with adequate treatment of ADHD,” says Bruce Pace, a licensed psychologist in western New York state. “Once attention and memory are improved, people with ADHD begin to have confidence that they can complete tasks and not disappoint people. They begin to relax and feel less anxious. This may happen quickly after treatment with medications.”

However, stimulant medication can heighten anxiety as a side effect. In this case, you might try non-stimulant medications that can help.

Your doctor will be your most important guide. If your doctor decides to focus on your social anxiety, there are several treatment options available. They include anti-anxiety medication like benzodiazepines and antidepressants, such as selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SNRIs.

• Therapy

Certain medications, including benzodiazepines, can be highly addictive and thus should not be used long-term. But plenty of non-medication treatments are available to help you manage social anxiety and ADHD.

Tzall suggests consulting with a mental health professional who has experience with both ADHD and social anxiety if possible. “They can provide an accurate diagnosis, personalized strategies and potentially recommend a combination of therapies and medications,” he says.

Certain types of therapy, such as cognitive-behavioral therapy, or CBT, seem effective in both ADHD and social anxiety.

Another alternative is exposure therapy, designed to lessen your social anxiety by helping you face your stressors. “It entails exposure to the anxiety-producing environments where a person can practice breathing relaxation and thought-changing techniques,” says Pace.

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