Understanding the Causes of Social Anxiety Disorder

Understanding and Treating Social Anxiety Disorder

Understanding the Causes of Social Anxiety Disorder

It can also come with some uncomfortable physical symptoms: racing heart, muscle tension, blushing and sweating, or feelings of nausea or dizziness.

Those with moderate social anxiety — the most common kind — tend to avoid social situations, where they may feel awkward and nervous.

That can result in fewer friendships, fewer and less satisfying romantic relationships, and an inhibited career.

“People with social anxiety disorder also have a much higher incidence of depression, because their lives are so inhibited and isolated,” says Cohen.

People suffering from a milder form of social anxiety disorder may interact with others, but in a kind of “please don't pay attention to me” way.

“They may be quiet, polite and as pleasing as possible,” says Aziz Gazipura, a Portland, Oregon-based clinical psychologist, founder of the Center for Social Confidence and author of The Solution to Social Anxiety: Break Free From the Shyness That Holds You Back. “They basically try to become invisible in plain sight.”


There is evidence that anxiety disorders tend to run in families. If a first-degree relative — say, a parent or sibling — has an anxiety disorder, you are four to six times more ly to also have it, and at least part of that may be genetically based.

But it's also a learned behavior: There is a lot of evidence that social trauma, which tends to include things that are emotionally painful, such as a very traumatic rejection or being criticized, humiliated or bullied — sometimes in public but at least in front of another person — can be the cause of a social anxiety disorder, says Cohen.

The condition is maintained throughout life by avoiding social situations and not asserting oneself.

«If we assume that the worst-case scenario is a foregone conclusion and therefore avoid scenarios,” Hendricksen adds, “we never get a chance to learn that the worst-case scenario usually doesn't happen.»

The COVID crisis may have seemed welcome relief for many socially anxious people — no small talk at social gatherings or facing down co-workers at the Monday morning meeting.

“It's a kind of government-sanctioned avoidance,” says Cohen. “Suddenly, it isn't a bad thing, but a required thing.

” Now that restrictions are lightening up, says Cohen, it has increased social anxiety for people who are returning from a period of minimal interaction.


Research has shown that the most effective treatment is cognitive behavioral therapy (CBT), says Cohen, who notes that typically, anywhere from two-thirds to three-quarters of people with social anxiety disorder who undergo CBT recover.

(Look for a cognitive behavioral therapist with experience treating social anxiety disorder. Psychology Today's Find a Therapist, the APA's Psychologist Locator, and the therapist database ZenCare are good resources.

The National Social Anxiety Center has clinics around the country.)

The premise here: People living with social anxiety experience distorted thinking, including false beliefs about social situations and the negative opinions of others. They may interpret even neutral facial expressions in a negative (say, disapproving or unfriendly) way. CBT helps people develop strategies to change that negative thought process.

«[Someone] with social anxiety behavior has a voice in their head that's constantly telling them, ‘You're doing it wrong’ or, ‘It's going to go badly,’ and they treat these critical thoughts as if they're factual,” says Gazipura. “The whole idea is to change the way you talk to yourself by distinguishing between yourself and the inner critic.”

Push yourself your comfort zone by attempting things that make you a little antsy to slowly build confidence. “The idea is to build up a baseline of small wins,” says Gazipura.

For example, try to venture outside of the house every day, even if it is only to go for a walk or pick up groceries.

Stop passersby and ask them for the time or for directions — even if you know how to get where you're going.

Tips for tackling social situations

Socially anxious people tend to avoid interactions. Even when they do muster up the courage to attend a social gathering, they avoid speaking up. Here, a few tactics for making small talk.

Get your head. “Socially anxious people tend to be very much in their own heads,” says Cohen.

It may be focusing on negative, self-critical thoughts or imagining that the people they're interacting with are having critical thoughts of them.

Or they may start desperately scripting their thoughts — trying to figure out, “What do I say next? — instead of actually listening to what the other person is saying.

The irony is, when we're overly concerned about how we're coming off, we're going to come off less well because we're distracted, says Cohen. Be curious and ask questions. The secret to a good conversation is to make the other person feel interesting.

«And if you're the one speaking,” Cohen adds, “get absorbed in what you're saying as opposed to critiquing how you're coming across.»

Elaborate (a little). Socially anxious people don't to have attention focused on them, because they're afraid it increases their chances of making a bad impression — maybe by putting their foot in their mouth or saying something dumb. When socially anxious people do make a comment, they tend to be very brief. That makes it hard for other people to engage in the conversation.

It also creates a vicious cycle, says Cohen: “A social anxious person sees that the conversation is not going well and thinks it's because they're a bad conversationalist — when it's actually because they're saying too little, which makes it hard to connect with them.” His advice is to say everything in three sentences, not three words.

If someone asks where you're from, don't just answer, “Lancaster, Pennsylvania.” Add a couple sentences about where you live. For instance: “Lancaster, Pennsylvania. We moved there three years ago, and it's lovely. But I've lived in a big city for most of my life, so it's taken a while to get used to the slower pace.

” This greatly increases the chances that someone will connect with what you're saying.

Know how to start and end a conversation. This can be the trickiest part. When it comes to beginning a conversation, the fear can be that the person isn't all that interested in talking to you.

When ending a conversation, you may be afraid you'll cut things off awkwardly or somehow hurt the other person's feelings. Don't overthink things, advises Cohen.

Show interest in the person by kicking things off with a question, such as, “How do you know the host?” or, “Who do you know here?” To bring things to a close, politely say, “I really enjoyed talking with you — I hope to see you later. Enjoy the rest of the party.”

Another crafty way to cut things off while looking super-considerate: Simply say, “I'll let you go,” a polite acknowledgment that you'd love nothing more than to hear all about the other person's grandkids but don't want to deprive the other guests of hearing their entertaining stories.

Источник: https://www.aarp.org/health/conditions-treatments/info-2021/social-anxiety-disorder.html

The causes of social anxiety

Understanding the Causes of Social Anxiety Disorder

As with many mental health issues, it is often difficult to pinpoint a specific cause of social anxiety . There are two main factors that lay the foundations for our mental lives:

  1. Our genetic makeup (i.e. nature)
  2. Our history of personal experiences (i.e. nurture)

These two do not operate in isolation. Rather, they are intimately intertwined, and in combination they make us who we are.

Genetic and biological factors

It has been observed that there is a hereditary component to social anxiety. For example, studies have shown that people whose parents and siblings have social phobia are more ly to suffer from it themselves. However, as we all know, correlation and causation are not equivalent.

In particular, it is possible that some cases of social phobia within a family are learned behaviors. However, there are other ways to study the link between genetics and anxiety (such as twin studies), and in general it is accepted among scientist that there is a genetic component to social anxiety.

One estimate is that genetics explains about 30% of the observed variability in the population.

Biological factors include sex and age. Social phobia is slightly more prevalent in women; however, we still do not know for certain if this is biological or cultural. Onset is typically in the early teens, but symptoms can arise later in adulthood. If left untreated symptoms can persist throughout one's life.

The causal link between genetics and social anxiety is not well understood. We do know that no single gene has been discovered that is able to explain the complex nature of the problem.

One theory is that genes influence the levels of neurotransmitters in the brain, and an imbalance may lead to feelings of fear and anxiety in certain situations. Some studies have used brain imaging to investigate the link between neuroanatomy and social phobia.

There is some evidence of a connection with the «amygdaloid-hippocampal» region of the brain, which is involved in emotional reasoning and creating emotional memories.

When considering the relationship between genetics and mental health, it is very important not to adopt a deterministic attitude.

Our genes may predispose us to certain behaviors, but we all have the ability to overcome their influence and alter the way we think and behave.

In fact, this is one of the underlying principles of Cognitive Behavioral Therapy (CBT), and imaging studies have directly observed changes to the brain after CBT treatment.

Environmental factors

The previous section mentioned that genetics can account for roughly 30% of the causes underpinning social anxiety. this estimate, it is clear that one's history and environment play a significant, and often dominant, role. This makes sense, as certain aspects of the condition are social by their very nature, and must be experienced first-hand.

There is some debate about the role of «negative life events». In the past psychologists believed that social phobia was the result of a «trigger event».

While it is certainly true that there are significant events in one's life that have a large impact on their psyche, it would be an oversimplification to say that all symptoms of social phobia can be traced back to a single event.

With that in mind, the following trends have been reported in peer-reviewed literature:

  • Certain parenting styles can influence a child's development. For example, parents who are overprotective, irritable, depressed, controlling, or fail to encourage their children to engage with others are more ly to have socially anxious children.
  • Bullying during school years is correlated with social anxiety.
  • A relationship has been observed between people who have suffered traumatic events during childhood and adults with social phobia.
  • There are cultural aspects to the disorder. For example, there appears to be differences in prevalence, symptoms and feared situations when comparing Western countries and Asian countries.

Needless to say, there are many people who have social phobia who do not fit any predefined categories. Furthermore, it is possible that some «negative life events» only occurred due to a genetic predisposition towards fear and anxiety, and the negative event served to reinforce an existing condition, rather than causing it.


In summary, the origins of social phobia are varied and complex. Certain genetic trains may predispose us to the condition, and experiences during our formative adolescent years can introduce or strengthen a fear of negative evaluation.

Fortunately, the problem is largely treatable. It is important not to dwell too heavily on the underlying causes of social anxiety.

Rather, the focus should be on targeting the unhelpful thinking patterns that are actively maintaining it (see how to treat social anxiety).

Источник: https://www.ai-therapy.com/social-anxiety/causes

Penn Psychiatry

Understanding the Causes of Social Anxiety Disorder

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  • Symptoms
  • Onset and Course
  • Causes
  • More Information

Many people feel nervous in certain social settings. Meeting new people, going on a date, giving a performance — nearly everyone has experienced the anxiety that these situations can provoke.

Social anxiety disorder, or social phobia, however, describes a marked, intense, and persistent fear of social situations that can be differentiated from the more typical fear that comes with discomforting situations.

The anxiety associated with SAD not only leaks into an individual’s social life but interferes with his or her everyday activities and professional life. While other mental health disorders cause social anxiety symptoms (e.g. sweating, palpitations, or panic attacks), social anxiety disorder refers only to individuals who specifically avoid or fear social situations.

Common Symptoms

The first mention of social anxiety disorder dates back to 400 B.C. It is popularly accepted that Hippocrates made mention of the disorder while describing a man who «loves darkness as life and…thinks every man observes him.» The socially phobic person’s tendency to overestimate the extent to which others «observe him» is characteristic of the disorder.

Individuals suffering from social anxiety disorder typically experience the following symptoms:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (e.g. having a conversation, meeting new people, giving a speech, eating in front of others)
  • The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (will be humiliating or embarrassing, or lead to rejection)
  • Social situations almost always provoke fear or anxiety, and are avoided or endured with fear or anxiety
  • The fear or anxiety is proportion to the actual threat posed by the situation and context

Those diagnosed with social anxiety disorder are continually hindered by the feeling that “all eyes are upon them.” While many people have memories of being discomforted by a social situation, an individual with social anxiety disorder is debilitated by the feeling.

The anxiety may interfere with an individual’s professional life, academic life as well as his or her everyday activities, often hindering an individual’s ability to form intimate relationships.

Importantly, a person also develops a fear of the phobia itself, reinforcing the initial avoidance reaction.

Social anxiety disorder is harder to diagnose in children. Because children do not have the means to describe the quality of their anxiety as effectively as adults, the disorder may go unrecognized despite a child developing habits frequently encountered with social anxiety.

Some common personality and behavioral traits seen in children with social anxiety disorder are crying, tantrums, clinging to familiar people, extreme shyness, refusing to speak in front of their class, and fear or timidity in new settings and with new people.

In order for a child to be diagnosed with social anxiety disorder, the child must experience anxiety with their peers as well as with adults but also show the capacity to form social relationships with familiar people.

Additional Symptoms

There are a number of traits frequently seen in individuals with social anxiety disorder that the clinical description of the disease does not take into account. Such traits include a difficulty being assertive, feelings of inferiority, and a hypersensitivity to criticism and other negative judgments that can lead to excessive anger.

This hypersensitivity also results in fear of others making both direct and indirect judgments. Thus, individuals with social anxiety disorder may have extreme test anxiety or refuse to participate in class. This compromises academic performance and later professional performance and may lead to both dropping school and long-term unemployment.

Unsurprisingly, the social limitations of the disorder also make it more difficult for those with social anxiety disorder to develop intimate relations. They are less ly to marry, less ly to have fulfilling friendships, and more ly to live with members of their biological family.

Suicidal thoughts are also associated with severe cases, particularly when other disorders are present. The strong feelings of fear and despair lead to substance abuse and the development of other anxiety and mood disorders.

In addition, many other mental health disorders have features associated with social anxiety disorder.

Particularly, social anxiety disorder is highly correlated with the presence of avoidant personality disorder. There has, however, been a long-standing debate within the mental health community questioning whether avoidant personality disorder and social anxiety disorder are in fact distinct disorders.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) currently defines them as two separate disorders; however, many dispute this fact on the basis of both the overlapping clinical criteria and experimental evidence. Empirical results suggest that avoidant personality disorder is a more severe form of social anxiety disorder.

Avoidant personality disorder is characterized as an inability to relate to others while social anxiety disorder is defined as an inability to perform in social situations.

Nonetheless, the generalized form of social anxiety disorder does indeed seem to encompass an element of avoidant personality disorder, strengthening the argument that the difference between the disorders is a matter of severity.

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Onset & Course

Social anxiety disorder can affect people of any age. However, the disorder typically emerges during adolescence in teens with a history of social inhibition or shyness.

The onset is usually accompanied by a stressful or humiliating experience and the severity varies by individual. Risks have been defined to be temperamental, environmental, genetic, and physiological.

The disorder is divided into the following two categories:

  • Generalized: symptoms present in most social situations
  • Nongeneralized (specific): symptoms present in specific social situations

Individuals who develop generalized social anxiety disorder fear most social settings; this includes both social interactions as well as performance situations. Often the range of social fears is so large that individuals do not report the list in full.

Individuals who identify a less extensive list of fears meet the criteria for nongeneralized social anxiety disorder.

These individuals may fear one specific situation or several settings but they do not fear most situations and such cases typically do not involve symptoms as severe as generalized social anxiety disorder.

The severity of the disorder, both generalized and nongeneralized, may be influenced by a variety of stressors in an individual’s life. At times, the symptoms diminish for stretches of time during adulthood or they worsen with the events, such as a change in job or the loss of a spouse. Nonetheless, the symptoms typically persist in some form and intensity for the duration of one’s life.

Epidemiological Information

The lifetime prevalence of social anxiety disorder varies with respect to gender and ethnic background. Research estimates that 12% of the U.S. population meets the criteria for social anxiety disorder with rates in other countries varying widely. Women are more ly to develop the disorder than men.

The disorder is prevalent in other populations; however, the anxiety may present itself differently. One form of the disorder, Taijin Kyofusho, is strongly culture-specific. Taijin Kyofusho is primarily found in Japan and Korea, and many of the features of the disorder reflect cultural differences that exist between American and Japanese culture.

Un the more westernized form of social anxiety disorder, individuals with Taijin Kyofusho do not fear embarrassing themselves but rather have an irrational fear that others will be embarrassed by their own smell, facial expression (e.g. blushing), or movements. They have a persistent fear that their physical presence will be offensive or displeasing.

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What Causes this Disorder

There is evidence that genetic factors may play a role in the development of social anxiety disorder, particularly in for the generalized form.

There is a higher incidence of social anxiety disorder in individuals with first-degree relatives affected by other panic and anxiety disorders. However, there is no one gene that explains this biological trend.

General findings indicate that personal experiences, social environment, and biology all play a role in the development of the disorder.

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More Information

National Institute of Mental Health (NIMH) An organization with the National Institute of health dedicated to mental health research:


Источник: https://www.med.upenn.edu/ctsa/social_anxiety_symptoms.html

What Is Social Anxiety Disorder? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Understanding the Causes of Social Anxiety Disorder

Treatment for social anxiety disorder is intended to help you function in your daily life. (2) The two most common types of treatment for social anxiety disorder are psychotherapy (psychological counseling or talk therapy), medications, or both, according to the Mayo Clinic. (4)

Psychotherapy helps most people with social anxiety disorder, because it teaches you how to change negative thoughts about yourself. You also learn skills that help you gain confidence in social situations.

Cognitive behavioral therapy (CBT) is the most effective type of psychotherapy for anxiety, and it works just as well whether it’s conducted individually or in groups.

In exposure-based cognitive behavioral therapy, you work up to facing the situations you fear most, little by little. This can help you develop the confidence you need to cope with anxiety-provoking social situations. You may also engage in social skills training or role-playing to practice your social skills.

CBT may even create positive changes in the brain.

 A study published in August 2017 in Molecular Psychiatry found that when those with social anxiety disorder participated in 10 weeks of CBT group therapy, it reduced the size of parts of the brain that process and regulate emotions. (6) Scientists call this process «normalizing,» and the changes were more pronounced when the therapy was most successful.

Medication Options

Certain medications typically used to treat depression may be very helpful for social anxiety disorder, by preventing symptoms or making them less severe. (2) These medications include:

  • Medications such as selective serotonin reuptake inhibitors (SSRIs) may be used when social anxiety is present with other anxiety or depressive disorders. In these cases, your healthcare provider may prescribe Paxil (paroxetine) or Zoloft (sertraline), per the Mayo Clinic. (4)
  • The serotonin and norepinephrine reuptake inhibitor (SNRI) Effexor XR (venlafaxine) is another medication option for social anxiety disorder. Other antidepressants may also be recommended.
  • Beta-blockers block the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs, so they may be prescribed to control symptoms for a particular anxiety-inducing situation, giving a speech.

Alternative and Complementary Therapies

Various herbal supplements have been studied as treatments for anxiety, with mixed results, according to the Mayo Clinic. (4)

Supplements such as kava and valerian increase the risk of serious liver damage.

Others, such as passionflower or theanine, may have a calming effect, but they're often combined with other products, so their effectiveness on their own remains unclear.

Talk to your doctor before taking any herbal remedies or supplements to make sure they're safe for you and won't interact with any medications you take.

Healthy lifestyle changes may help reduce the frequency of social anxiety attacks, including exercising regularly, getting enough sleep, and having regularly scheduled meals. (2) Reducing or avoiding the use of caffeine, some over-the-counter cold medicines, and other stimulants may also be beneficial. Joining a support group may also reduce the stress of having social anxiety.

The following tips may also help you avoid triggering your social anxiety symptoms:

  • Learn stress reduction skills
  • Eat a healthy, well-balanced diet
  • Socialize with people you feel comfortable being around

Learn More About Treatment for Social Anxiety Disorder: Medication, Alternative and Complementary Therapies, and More 

Prevention of Social Anxiety Disorder

There's no way to prevent social anxiety disorder, but these techniques can help you reduce anxiety symptoms, per the Mayo Clinic: (4)

Get help as soon as possible. Anxiety can be more difficult to treat if you delay seeking treatment.

Start journaling. Keeping a record of your thoughts and experiences can help you and your healthcare provider figure out what's causing your symptoms and what makes you feel better.

Figure out your priorities. Carefully manage your time and energy, and spend time doing things you enjoy.

Avoid unhealthy substance use. Using alcohol and drugs, as well as caffeine or nicotine, can cause anxiety or make it worse. But quitting can also cause anxiety. If you’re addicted to any substances, look for a doctor, treatment program, or support group that can help.

Источник: https://www.everydayhealth.com/social-anxiety-disorder/guide/

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