ADHD and: Social anxiety

Have you ever spent hours getting ready for a social event, only to feel that same knot of anxiety when it’s time to go? Or maybe you avoid social events altogether, worried you’ll say the wrong thing. 

For some women, juggling ADHD and social anxiety can feel like an ongoing fight. In this episode, Dr. Monica Johnson dives into the connection between ADHD and social anxiety. Watch as she breaks down ways ADHD can make social situations overwhelming. And get tips on how to better manage social interactions.

We love to hear from our listeners. Email us at podcast@understood.org.

Related resources

• ADHD and women

• ADHD and anxiety

Timestamps 

(01:11) What is social anxiety disorder?

(04:28) What does research say about ADHD and social anxiety?

(07:22) Strategies for managing social anxiety

Episode transcript

Dr. J: Are you a woman with ADHD who overprepares for a social event, but you still feel that familiar knot of anxiety in your stomach, wondering how you're going to be perceived? Or perhaps you're the woman who avoids social gatherings altogether, afraid that you're going to make some sort of social misstep or not be able to keep up with conversations.

Many women navigate the complex intersection of ADHD and social anxiety, where the vibrant qualities of their ADHD are sometimes crushed by the weight of societal expectations.

This is "ADHD and," where we talk about everyday life and ADHD. I'm your host, Dr. J. I'm a licensed psychologist who works with people with ADHD. Today we're talking about ADHD and social anxiety.

(01:11) What is social anxiety disorder?

Social anxiety disorder involves an intense fear of being judged, embarrassed, or rejected in social situations. Here is a simplified explanation of social anxiety disorder. The first criteria is a fear of social situations, so you have a really intense fear or intense anxiety about engaging in a lot of different types of social situations. This could be things like meeting new people, presenting in front of a group, or even eating in public.

This fear, this anxiety, is constant and it is provoked almost every time that you have to encounter these types of activities. The social situation almost always provokes fear. So, this isn't something that would happen like once, but then it didn't happen for the other 12 times. The next thing is an avoidance of social situations. Because of this fear, you might avoid social situations altogether or you would endure them with great discomfort.

The next thing is that the fear is out of proportion. So what that means is that your level of fear does not fit the situation. For example, most people feel nervousness before presenting in front of a large group, but in this scenario, your level of fear would be paralyzing. The next thing is it lasts for six months or more. So, basically what that means is that the fear or anxiety has been persistent for at least six months or more.

The next thing is that it has to interfere with your daily life. So, it has to get in the way of your daily functioning in work, at home, or in your relationships. And then lastly, it can't be due to other problems. So, basically what that means is that it can't be caused by another medical condition, medication, or a mental health disorder like depression, panic disorder, or yes, ADHD.

Now, you listen to all of that, and I am confident that you are convinced that you have a clinical social anxiety disorder. In fact, if I had read that list, I'd feel the same way. I'm about as extreme on the introversion scale as you can be. And to be clear, I do not have clinical social anxiety. Why? You may ask. Well, a certain level of social anxiety is actually healthy and normal. I'd be more concerned if you didn't experience any social anxiety at all.

If we are about to go into a novel situation or interact with people who we haven't interacted with in a long time, it is normal and healthy and adaptive to have stress in those situations. And here's the thing about healthy stress, it hurts too. Lots of things that are good for us are unenjoyable. As human beings, we're social creatures. So, being able to conform, belong, and seek approval is highly important to us. This is why you stare at your phone waiting for someone to like your most recent social media post.

That's the issue with self-diagnosis. Everyone has depression, anxiety, sensitivity to rejection, etc. And what makes something a clinical concern over an everyday problem is not always something that a doctor like myself on the internet can give to you in convenient soundbites. So, unless the thought of talking to someone literally makes you vomit, you're going to need to speak with a professional. The issues that you're facing socially may very well be a consequence of your ADHD and not an entirely new diagnosis.

(04:28) What does research say about ADHD and social anxiety?

So, what do we see in the research related to ADHD and social anxiety? Sadly, there isn't as much research on this topic as we would like. The things that we do see is that there is some correlation between ADHD and social anxiety. What we can see from the research is that those with the predominantly inattentive type of ADHD do appear to have higher rates of co-morbidity with social anxiety. But again, that's not really telling us much.

It relies on a person like me to use my clinical judgment to make some inferences until we have better data. This can lead to an increase in negative self-talk and feelings of inadequacy, which can increase your anxiety socially as well.

Secondarily, maintaining relationships does require executive functions like organization and planning. You have to schedule a time to hang out with your friends. You have to remember that your bestie texted you two weeks ago now, and you also have to remind yourself that your kid's birthday is next week.

If we have a history of not being able to follow through on relationship obligations, we're going to be stressed and socially anxious. Lastly, at times we've made the best plan. But what we didn't account for is our buddy impulsivity. Or as I like to talk about it, mood-dependent behaviors. You may have remembered to schedule with your friend, but you also have a history of flaking at the last minute due to not feeling like going or being overwhelmed, whatever the reason may be at that time, which is fine if it rarely happens and is a major issue if it happens routinely.

So, again, you can see how normal ADHD symptoms can lead to social anxiety. For women, there are so many societal expectations that they have to live up to socially. For example, I had a patient who was going through a rough breakup, and she felt like she had to maintain appearances. What did that look like? Well, she never missed a blowout, her nails were always done, and she had impeccable makeup every single day.

Women are often expected to be polite, kind, and accommodating, even at the expense of asserting themselves. So, she had to put on this mask of happiness every single day and struggled with setting the appropriate boundaries so that she could take care of herself.

Women are often expected to provide emotional labor in their relationships, offering support to their partners, friends, and family members. However, when they need emotional support, it can be difficult letting go of taking care of others and allowing space and opportunity for them to be taken care of.

(07:22) Strategies for managing social anxiety

Over time, with my guidance, she was able to set appropriate boundaries and create the space she needed to heal without disengaging from her social responsibilities. Here are three effective strategies for dealing with social anxiety, and I'm also going to give you a bonus Dr. J skill that I use all the time.

The first thing that I want to mention is gradual exposure. Gradual exposure involves facing social situations step by step. You start with less intimidating scenarios first and then build up to more challenging ones over time. This helps desensitize you to anxiety over time. Here's an example using Emma.

Emma feels anxious about talking to strangers, so what she does is she starts by saying hello to her cashier at the grocery store. Once that becomes easier over time, then she upgrades to asking the cashier how they're doing. Over time, she's able to get to the point where she can engage with co-workers at social events.

The next thing that I want to mention is challenging negative thoughts. Social anxiety often involves negative or catastrophic thinking, like everyone is going to think I'm stupid. Challenging these thoughts with evidence can lower their power. Let's use the example of Jennifer.

Jennifer worries that she's going to embarrass herself during a team presentation to challenge these thoughts, she asks herself, What evidence do I have that this will happen? Have I given a presentation before and how did it go? And what is the worst that can realistically happen?

The third thing that I'm going to mention is practicing relaxation techniques. Relaxation techniques such as deep breathing mindfulness or progressive muscle relaxation can help to manage the physical symptoms of anxiety. For this one, we're going to use Marisol as an example.

Before attending a holiday event, Marisol notices that her heart race is really high and her hands are shaking. She uses the 4-7-8 breathing technique, which is where you inhale for four seconds, hold for seven, and exhale for eight seconds in order to calm her nervous system. During the event, she periodically checks in with her body to ensure that she's staying grounded.

Here is the Dr. J bonus that I use all the time, and that is to put a clock on it. If you have a social situation that you feel obligated to go to and you also know that you have a limited capacity, then what you want to do is put a clock on it. For example, I might have a friend who invites me to their birthday party and I want to show up and support them and show my care for them. On the flip side, though, going to a party where the only person I know is the host is a literal introvert's nightmare.

However, if I tell myself that I can show up to the party for an hour and then leave if I want to, all of a sudden my anxiety fades and the situation becomes much more manageable. I actually end up staying longer because in reality, imagined anxiety is usually worse than the lived experience. These strategies can be combined for even greater effectiveness.

For example, you might not believe it, but filming this podcast is actually hard for me. I thought talking to people who I could actually make eye contact with was really hard. I was so wrong. Me having to stare into this camera, talking to all of you and not being able to engage with you in real time is so much worse. So, I use all of these skills as well.

I've used graded exposure over the decades in order for my introversion not to get in the way of my goals. I engage in a lot of activities, like talking to people on the Internet, that aren't natural to me because I've developed skills and a tolerance over time. When I have thoughts like, "Am I going to be misunderstood?" Wouldn't it be ironic if I was misunderstood on the "MissUnderstood" channel? I challenge my thoughts in the same manner that I describe here.

I use deep breathing and I remind myself of how long filming normally takes and that I can do this. This is all to say that you're not alone. When you see all of those people that you assume do everything with ease, they don't. Your struggles don't define who you are. What you choose to do in the face of them does. And we all have bad days that are a total wash.

Remember that you are capable of growth, resilience, and creating a fulfilling life that feels true to who you are. There may be some social awkwardness along the way, but those are the best stories and it makes the victories even more satisfying.

That's it for this episode of "ADHD and." If you decide to use any of these strategies, let me know. I'm genuinely curious. You can email me at podcast@understood.org or if you're using YouTube comment below.

If you enjoyed this session, I'd highly recommend our episode on ADHD and rejection sensitivity. In it, I share how ADHD can amplify feelings of rejection and share tips on how to manage those emotions. Don't forget to subscribe to our channel and I'll see you on the next episode of "ADHD and."

This show is brought to you by Understood.org, a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. Learn more at Understood.org.

"ADHD and" is produced by Tara Drinks and edited by Alyssa Shea. Our video producer is Calvin Knie. Ash Beecher is our supervising producer. Briana Berry is our production director. Neil Drumming is our editorial director. Our audio engineer and music composer is Justin D. Wright. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Dr. J.