Social anxiety and the Mini-SPIN: what three questions can and cannot tell you

You are invited to a colleague's birthday drinks. For days before, you picture the moment when you have nothing to say and everyone notices. In the end you send a message that something came up. Most people know a milder version of this. For some, the same fear decides which jobs they apply for and how often they see friends.

Three questions from a longer scale

In 2000 Kathryn Connor, Jonathan Davidson and colleagues published the Social Phobia Inventory (SPIN), a 17-item questionnaire about fear and avoidance of social situations. A year later the same group picked out three of its items as a quick screener and called it the Mini-SPIN.

Our social anxiety screening test (Mini-SPIN) uses those three items:

• "Fear of embarrassment causes me to avoid doing things or speaking to people."
• "I avoid activities in which I am the centre of attention."
• "Being embarrassed or looking stupid are among my worst fears."

You answer each one with an option from "Not at all" to "Extremely", scored 0 to 4, so the total runs from 0 to 12. The original asks how much each problem bothered you during the past week. Our version shows the statements without that time frame.

What a score of 6 or more means

Connor and colleagues found that a total of 6 or more separated people with generalised social anxiety disorder from people without it in most cases. We use the same cutoff. A score at or above it means social anxiety is possible and worth a closer look. It does not mean you have a disorder. A screener only flags a possible problem. Only a doctor or psychologist who asks about your history, how long this has lasted and how much it gets in your way can make a diagnosis.

A score below 6 does not rule anything out either. Three questions cover fear of embarrassment and avoidance, and nothing else. If social situations cost you a lot and the score came out low, take your own experience seriously.

Shyness or social anxiety

Shyness is a temperament. Many shy people feel awkward in the first minutes with strangers and then settle in. Social anxiety disorder, as diagnostic manuals describe it, is a fear of being judged that is intense and lasts for months. People avoid the situations they fear or get through them with strong distress, and work, study or relationships suffer.

It is common. In 2005 Ronald Kessler and colleagues estimated, from a large US survey, that about one adult in eight meets the criteria for social anxiety disorder at some point in life.

In 1995 David Clark and Adrian Wells described how the fear keeps itself going. In a feared situation, attention turns inward, to how you seem to others. People also use safety behaviours, such as rehearsing sentences, avoiding eye contact or holding a glass with both hands so no one sees them shake. These make the moment feel survivable. They also stop the person from learning that the judgement they fear often never comes.

When to talk to someone

Consider talking to a doctor or psychologist if your score is 6 or more. The same applies if fear of embarrassment has made you turn down work, study or relationships you wanted, or if you rely on alcohol to get through social events. There are established treatments. In 2013 the UK's National Institute for Health and Care Excellence (NICE) recommended individual cognitive behavioural therapy as the first option to offer adults with social anxiety disorder.

Social anxiety often comes together with other worries. The GAD-7 anxiety scale screens for generalised anxiety, and the post on generalised anxiety and the GAD-7 explains what that scale measures. If your difficulty is less about fear and more about not knowing what to say, the social skills test looks at that side.