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Social Anxiety


Social Anxiety
SW 3710
By: Heather Warczinsky

Social Anxiety

Social anxiety disorder is a very common psychiatric problem that presents itself in
children, adolescents and into adulthood and is becoming more common each year. Generally a
person with the disorder is scared of being embarrassed, or being judged or having people think
badly about them in social situations. According to Diagnostic and statistical manual of mental
disorders – 4
ed. Revised (DSM – IV R), social anxiety as “a marked and persistent fear of one
or more social or performance situations in which the person is exposed to unfamiliar people or
to possible scrutiny by others.” Social anxiety can affect a person’s development both
emotionally and intellectually. It is a very serious problem for many people, and as of late
gained serious attention in clinical practices and research due to the increasing number of people
being diagnosed with the disorder. To examine the idea of social anxiety disorder the causes of
the condition and behaviors of the disorder must be evaluated. To evaluate the disorder we must
start with what we already know about the disorder.
This diagnosis of the disorder dates back to around 400 BC during the time of
Hippocrates. Hippocrates wrote about certain people who appeared to be shy, bashful, timid and
dark. He was afraid to spend time with anyone with these characteristics due to his uncertainty of
his safety around these people. In the 1930s scientist began to view these characteristics of social
anxiety disorder as a phobia but it was not until the 1980s that it was really accepted as a
disorder. The current definition of the disorder involves the same characteristics as created by
Hippocrates but evolved further to include the effects of others on the person with the disorder.
Typically, a person with social anxiety will be very concerned with the negative evaluation from
other people. They believe that other people will judge them in a negative way or think critically
of them. It is common knowledge that an individual cannot be liked by everyone, but in the
mind of a person with social anxiety everyone should approve of them or the world will end.
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This type of thinking is very extreme and even unrealistic, but it results in excessive
feelings of unworthiness in a person with social anxiety. Individuals with social anxiety also
tend to focus their attention towards the reactions and thoughts of other people. They will often
wonder what people are thinking of them and how they appear to other individuals. Other
common symptoms within social anxiety would consist of any public interaction or speaking
experiences such as asking questions in a group, being introduced in a group or simply being
observed. Individuals with social anxiety are also not likely to be assertive in any situations.
This is a very difficult way to live and can be very disruptive to a person’s life. The early onset,
that will be discussed later, has serious consequences for a child’s future social development
along with their academic development. If social anxiety is left untreated, then other difficulties
are likely to arise such as, alcoholism, drug abuse, self-injurious behavior or the developing of
other psychological problems that may even include suicide. An individual’s development is a
sensitive characteristic, which should be approached in a healthy method because of the many
disorders that may develop.
Social anxiety is one of the most common main diagnoses for adolescents who pursue
treatment, and is supported by an epidemiological study that focused on the occurrence rates of
social anxiety in adolescents. This study reported that 16% of a sample of 1035 male and female
adolescent’s presented a DSM IV lifetime rate of social anxiety (Velting & Albano, 2001).
These adolescents were randomly selected and were between the ages of 12 and 17 years of age.
However, there are limited studies that have established the prevalence rate of social anxiety in
preadolescents. The onset of this disorder can be present at any age, and are equally likely to
occur between men and women. According to Velting and Albano (2001) the average age of
onset falls between 11 years 3 months to 12 years 3 months. Velting and Albano (2001) also
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argue that approximately 40% of individuals with social anxiety have their onset before the age
of ten and approximately 95% will experience an onset of social anxiety before the age of
twenty. It is very unlikely that there will be any onset of social anxiety after the age of twenty-
five years old. At the late childhood or early adolescent stage is where we begin to develop fears
and anxiety provoking feelings, and social anxiety evolves from normal feelings of anxiety,
which are magnified by social expectations of the preadolescent years (Velting & Albano, 2001).
It’s around this time where people are introduced to anxiety provoking tasks. Examples of these
task are answering questions in class, presenting oral reports, working or playing in groups,
taking tests or performing academically, musically or athletically. When these new task are
combined with cognitive development of self-awareness, there is an increased chance for social
anxiety. Even though these task add to the anxiety there are also other factors which help cause
the disorder.
There are many suggested causes of social anxiety disorder, but not one specific cause.
Studies reveal that temperamental, pathophysiological, genetic, environmental and psychological
causes factor into the onset of social anxiety. All of these categories have their own aspects
within them that may be the cause of social anxiety. There are many temperamental aspects that
can be seen across the developmental lifespan that contribute to the transformation into social
anxiety. Temperamental aspects specifically include development behavioral inhibition in
youngsters. Velting and Albano (2001) describe behavioral inhibition as the reluctance to
interact with and withdrawal from unfamiliar settings, people or objects. Behavioral inhibition
in youngsters can be both physiological and behavioral. Behavioral characteristics within
behavioral inhibition include, interrupting ongoing behaviors, stopping vocalization, looking for
any kind of comfort from other familiar people, and retreating from and avoiding anything that
Social Anxiety

may be unfamiliar. Physiological characteristics are related to biological and neurophysiological
aspects. These characteristics include a stable heart rate that may be uncharacteristically high,
the acceleration of heart rate that results in mild stress, dilation of the pupils, or increased
salivary cortisol. Behavioral inhibition can be seen as early as infanthood in the developmental
life of a person. Infant’s behavioral inhibition is demonstrated through irritability. As a toddler,
behavioral inhibition is seen as fearfulness and shyness, and a school-aged child demonstrates
cautiousness, reticence and introversion (Velting & Albano, 2001).
In order to address the problem there have been several studies and many treatments that
have been tested. In the past many of the studies focused on the physical characteristics and ways
to make a person more sociable. Modern studies examine the characteristics and also the cause of
the disorder. Numerous studies that have linked these early behavioral inhibition characteristics
to the development of social anxiety, and these characteristics should be considered risk factors.
Behavioral inhibition has been linked to many anxiety disorders in young adolescents, but recent
research as shown that it is most commonly linked to social anxiety (Mick & Telch, 1998).
Hayward, Killen, Kraemer and Taylor (1998) completed a study that demonstrated the risk of
behavioral inhibition in childhood to later onset of social anxiety into adolescents and adulthood.
Their study consisted of 2242 high school students, and each of the students completed a self –
report measure that assessed their levels of behavioral inhibition while they were elementary
students. The high school students who participated in the study also completed a structured
diagnostic interview that would establish a current diagnostic status. Hayward, Killen, Kraemer
and Taylor (1998) concluded that adolescents that reported characteristics of behavioral
inhibition were four to five times more likely to experience social anxiety than those who did not
experience behavioral inhibition as children. However, this study does show some weaknesses
Social Anxiety

in that the adolescents who are currently dealing with social anxiety may have memories of their
childhood that are less than reliable. Overall, the research seems to indicate that behavioral
inhibited temperament as an infant or early childhood is an early indicator of social anxiety as an
adolescent or adult. Anyone who has been affected by social anxiety disorder
Pathophysiological factors related to the development of social anxiety have much less
supporting research. However, many studies have been completed to link various compounds
such as, lactate, caffeine, pentagastrin or adrenaline with the development of panic disorders,
which has led to the belief that similar compounds may have the same effect on the development
of social anxiety (Velting & Albano, 2001). The limited studies that have been completed have
focused on adults rather than children or adolescents. McCann, Slate, Geraci, Roscow-Terrill
and Uhde (1997) found that adults with social anxiety or social phobia do not appear to have any
irregular responses lactate or adrenaline, but may have slight abnormal responses to pentagastrin
or caffeine. However, most would agree that anxiety that these adults experience is more likely
to be related to a basal arousal rather than any specific neurobiological abnormality (Velting &
Albano, 2001). It would appear that much more research must be completed before any concrete
conclusions can be determined.
Researchers are only recently beginning to make new leads into the brain activity and its
relationship to the development of social anxiety. Some studies suggest specific areas in the
brain may contribute the development and onset of social anxiety. The amygdale is one small
region in the forebrain that is involved with the output of conditioned fear responses, such as
freezing up behaviors, blood pressure changes, stress hormones release, or the startle reflex
(Velting & Albano, 2001). Animal based studies are strongly responsible for the thoughts that
link a hypersensitive amygdale to individuals with social anxiety. However, there has been a
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study that paired human individuals with social anxiety with a functional magnetic resonance
imaging, which measures the activity in the amygdale (Velting & Albano, 2001). This study
exposed the individuals to slides of neutral faces that were paired with a negative odor, and then
later were exposed to the faces with the absence of the odor. The study concluded that adults
with social anxiety have an increased activity level in the amygdale. These studies support some
evidence for increased activity in the amygdale within adults with social anxiety, but there is
limited research to support the same finding in children. While some possible causes have been
found there are some treatments that have been approved by many researchers.
There have been many attempts to treat the disorder. During Hippocrates time the people
who had the disorder were thrown in social situations and were forced to interact with people
against their will. In the 1930s having the person go through a stressful situation and tell the
researchers how they felt about it treated those with social anxiety disorder. It was a more
therapeutic approach but still remained an issue for many of the research participants. In modern
day doctors use Serotonin inhibitors, beta-blockers or other various inhibiting medications to
help the person control their phobia and feel in control during the situation. To go along with the
medication there the person is also put through behavioral therapy as well as psychoeducation.
There are also treatments for the family so they can also learn to cope with the social anxiety
disorder. Families will often times go to therapy on their own or join the person with the disorder
in a group session to provide needed support. Many people are not comfortable saying they
partake in therapy for this disorder due to they do not want others to think less of them or that
they have social issues. This stems back to the disorder itself due to the need of social
acceptance. A lot of people still do not view this as a disorder that can be hard for those who
have been diagnosed. Sometimes people will disregard the signs and mistreat the person with the
Social Anxiety

disorder to try to shake them out of it. This can be a very dangerous action due to it can cause
someone with the disorder to shut down mentally. The social stigma prevents society from fully
accepting this disorder. People have been conditioned to believe there is no problem with a quiet,
reserved, approval-seeking person except that they want attention so society keeps pushing the
person away and does not realize the consequences it can have on the person.
In Japan, South Africa and Romania there are some similarities and differences to the
United States in the way the disorder is treated. All three countries, like the United States,
originally thought the disorder was just a phase and something one could easily grow out of by
taking part in social interactions. The disorder was treated as a behavioral issue and was seen as a
way of acting out to gain attention. As time progressed Japan, South Africa and Romania also
accepted social anxiety disorder as a true disorder. In a study that compared people from Japan,
South Africa and Romania, they found that the same percentage of people were effected in each
of the countries and displayed similar characteristics. It was found that no matter the country at
least one parent was anxious and usually overbearing on their children. If a child is raised by
parents who display and model symptoms of social anxiety, then they will be more likely to also
experience these same symptoms of anxiety. Messages given to the children by their parents,
friends or the media can easily play into the disorder. As time continues research is increasing in
these countries and there are more treatment options available for people with social anxiety
disorder. One area with a lot of focus right now is the effect of genetics on the disorder.
Genetic factors play an important role in the development of social anxiety within an
individual. Many people have researched the idea of whether the disorder could be heredity.
Usually the research is focused on twins but in recent years the studies have expanded out to
various types of people. Warren, Schmitz and Emde (1999) used a sample of 326 monozygotic
Social Anxiety

and dizygotic 7-year-old twins. They primarily focused on kid’s self-reported anxiety. Warren,
Schmitz and Emde (1999) found that genetic influences accounted for approximately one third of
the children’s social anxiety. Environmental factors accounted for the largest portion of social
anxiety within these children. While twin studies are important it is also important to look at
family studies. Mancini, Van Ameringen, Szatmari, Fugere and Boyle (1996) did a family study
of individuals with social anxiety and their children. The results showed the parents had a large
impact on their children. 30% were diagnosed as overanxious disorder, 23% as social anxiety
disorder, 13% as generalized anxiety disorder, and 13% as simple phobia according to the DSM
III-R criteria. This studies proves there is a correlation between the children and those relatives
around them who already experience social anxiety (Mancini, Van Ameringen, Szatmari, Fugere
& Boyle, 1996).
When the media evaluates social anxiety disorder it is generally seen as a phase. Most
people do not understand that the person is truly suffering from a disorder and chose to instead
see their behavior as being sheltered and attention seeking. In the early 1990s and 2000s the
media did not assist in helping society understand the severity of the disorder. Instead they chose
to ignore the characteristics and treat it as a non-issue. In recent days there have been more
articles and public service announcements to help people realize that having frequent and
constant anxiety is not common and could possibly be social anxiety disorder. To help people
better understand the characteristics/ symptoms of a person who has the disorder they usually
provide a list and explanation of each of the more dominant characteristics for the disorder such
as excessive worry and unreasonable fears. With the media being more knowledge to the people
it has assisted in diagnosing more people with the disorder. It has also helped to raise funds to
further study the disorder to help find treatments and uncover other potential triggers for the
Social Anxiety

disorder. Most of the services are aimed more at people ages twelve through thirty but has been
expanding in recent years due to an increased number of people over thirty stating they fit the
characteristics. As society’s view continues to expand so will the understanding and acceptance.
Personally I feel the problem is caused by overbearing parents as well as the weight on
our shoulders to be accepted by society. From the time we are born we are taught to follow the
rules of society, to believe what society believes and that straying from the social norm is
unacceptable. As more studies are completed we will be able to better treat people with the
disorder as well as to better accept it as a whole. We as a whole a responsible to help but it is up
to the person with social anxiety disorder to reach out for help and to be open to treatment. As
more people are willing to ask for help we as a society must keep researching the disorder to be
able to grasp a full understanding of the ins and outs specific to this disorder. Some possible
steps to improve the situation would be to remove the stigma from the disorder. We need to
make sure that those with the disorder know they can come forward to get help and that we are
here to help them.
The treatment of this issue relates to social work values and ethics because it focuses on
bettering the life of an individual who may not have always had their disorder understood or
accepted. As those in the social work profession we should be there to assist anyone who needs
help especially if they are reaching out for guidance. With social anxiety disorder we must be
open to new treatment styles and therapies. We must grow with the disorder so that we will be
able to best treat the person with the disorder.
There are many causes that can point to a person having social anxiety and the research
done supports these causes. What we must understand is that the research is still very new and
there are a lot more areas that have not been examined for social anxiety. Due to this, it is very
Social Anxiety

important that we take all known causes into consideration when dealing how social anxiety is
developed. Like other disorders, there will usually be more than one of these causes that play a
major role in development of social anxiety. Hopefully research will continue so we will be able
to better understand social anxiety disorder.

Social Anxiety


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