This paper examines social phobia (Social Anxiety Disorder) as it manifests in children and adolescents. It defines the condition, distinguishing it from ordinary shyness, and reviews prevalence statistics from the National Institutes of Mental Health. The paper then explores the neurobiological, temperamental, and psychosocial factors that contribute to the disorder's development, followed by a detailed account of its physical and psychological symptoms. It considers the disorder's impacts on educational achievement, social development, and mental health—including links to substance abuse and depression—before outlining treatment frameworks that involve parental engagement and environmental factors.
It is natural for people to feel shy, self-conscious, or nervous in front of others on certain occasions. Anyone can feel self-conscious or experience sweaty palms and a racing heart when addressing a large audience or presenting themselves in public. Most people can manage such feelings and overcome them without lasting difficulty. For others, however, the anxiety that accompanies these feelings is so extreme that it cannot be handled easily (Lyness, 2013).
The anxiety can be so intense that students may fear answering questions in class, avoid making eye contact with teachers and classmates, and refrain from participating in group discussions (Lyness, 2013). When self-consciousness and anxiety reach a degree that makes a person incapable of socializing with others, the condition can no longer be called shyness. Instead, it is a psychological condition known as social phobia (Lyness, 2013).
Social phobia, also known as Social Anxiety Disorder (SAD), is a common anxiety disorder characterized by intense fear, humiliation, embarrassment, and the expectation of negative evaluation by others in various social situations. People suffering from this disorder have a strong tendency to avoid social situations (Kashdan and Herbert, 2001).
A person suffering from social anxiety disorder experiences an unreasonable and excessive fear of social encounters. This fear and stress typically arise from the dread of being negatively judged and evaluated by others, or from poor social skills and an inability to handle social situations effectively (Sierra Tucson, 2013).
People with social anxiety disorder develop a habit of avoiding social encounters and may also suffer from anticipatory anxiety—a state in which they begin dreading a social situation before it even occurs, becoming anxious for days or weeks in advance. Despite being aware that their fear is unreasonable, they are unable to overcome it (Sierra Tucson, 2013).
In the past, social phobia was defined narrowly as an inability to perform in front of others. Research later showed that the disorder encompasses all the fear and anxiety that impairs an individual's everyday routine in social situations. For example, a person may feel excessively uncomfortable having a conversation with strangers and may avoid dinners with others out of fear of being watched while eating (American Psychiatric Association, 2013).
Studies indicate that millions of people suffer from social anxiety disorder. Approximately seven to eight percent of the total population of the United States suffers from this disorder, and the lifetime prevalence rate for developing it is estimated at thirteen to fourteen percent. The disorder is also associated with other mental illnesses, such as panic disorder, obsessive-compulsive disorder, and depression (Sierra Tucson, 2013).
Recent studies have indicated that social anxiety disorder is very common among adolescents. The lifetime prevalence rate among young people in the United States and Germany ranges between five and fifteen percent. According to statistics provided by the National Institutes of Mental Health, the lifetime prevalence rate among thirteen- to eighteen-year-olds is 5.5% (National Institutes of Mental Health, 2013).
Broken down by age group, the lifetime prevalence rate among thirteen- to fourteen-year-olds is 3.9%, among fifteen- to sixteen-year-olds it is 6.1%, and among sixteen- to seventeen-year-olds it is 6.9%. The National Institutes of Mental Health also reported that, based on gender, the prevalence rate among female adolescents is 6.6% and among males is 4.5%. The rate of severe social anxiety disorder is reported to be 1.3% among thirteen- to eighteen-year-olds (National Institutes of Mental Health, 2013).
Social phobia generally begins developing during adolescence or at an even younger age. Children suffering from this disorder demonstrate intensely shy behavior in social situations because they fear that anything they do will lead to embarrassment (the Child Anxiety Network, 2013).
Children and adolescents with this disorder also believe that others are more capable and competitive than they are. Social phobia differs meaningfully from shyness: shy people do not completely avoid situations that make them uncomfortable, whereas those with social phobia tend to avoid social encounters entirely. This avoidance disrupts normal life and deteriorates school performance and social relationships (the Child Anxiety Network, 2013).
The feared situations commonly encountered by children with social anxiety disorder include crowds and parties; initiating or participating in conversations; speaking to a large audience; expressing opinions; meeting new people; shaking hands; using public restrooms; shopping; talking to authority figures; being watched in everyday activities such as eating or answering a phone call; and any situation that places them in the spotlight (Anxiety Recovery Centre Victoria, 2013).
The common fears arising from these situations include: the apprehension that others will notice and identify the physical symptoms of their anxiety, such as nervousness, sweating, blushing, and stammering; the concern that their actions will make them appear stupid, silly, or ridiculous; the fear that others will perceive them as quiet, boring, arrogant, or unattractive; and the belief that others will judge them as socially inadequate or incapable of handling social situations (Anxiety Recovery Centre Victoria, 2013).
The major causes of social phobia have been identified as a combination of physical and environmental factors, discussed below under three main categories.
Research from 2002 provides some evidence that social phobia can be inherited. A study conducted at Yale identified a locus on chromosome 3 linked with agoraphobia, and two additional genetic loci on chromosomes 1 and 11q were found to be linked with panic disorder (Advameg, Inc., 2013). Since social phobia shares characteristics with panic disorder, there is a probability that an individual's genetic makeup increases his or her susceptibility to social anxiety disorder.
Positron Emission Tomography (PET) scans of people with social phobia have shown increased blood flow to the amygdala—a brain region associated with fear responses—when these patients are asked to speak in public. Researchers have concluded that people with social phobia show a distinctive neurochemical response to social situations that activates the limbic system rather than the cerebral cortex, which is the region activated in people who do not have the disorder (Advameg, Inc., 2013).
Research has identified that an individual's inborn temperament, or natural predisposition, is an important risk factor for the development of mood and anxiety disorders, including social phobia. Children who demonstrate behavioral inhibition at an early age are more likely to develop social phobia, particularly if that inhibition persists over time (Advameg, Inc., 2013).
Behavioral inhibition refers to a collection of behaviors a child demonstrates when confronted with unusual situations or unfamiliar people. These behaviors include crying, excessive movement, and irritability; withdrawal from unfamiliar people and a need for comfort from familiar ones; and a high degree of self-consciousness when being observed by strangers (Advameg, Inc., 2013).
Researchers have also found that children of parents who are depressed, anxious, or chronically stressed are more likely to demonstrate behavioral inhibition. Studies of children with social phobia have found that most of them displayed behavioral inhibition during early childhood (Advameg, Inc., 2013).
Much of the research indicates that the development of social phobia is heavily influenced by the nature of parent-child interaction in the family of origin. Children with depressed parents—regardless of the cause of that depression—are more susceptible to social anxiety disorder. There is a significant probability that such children will acquire attributes from their parents that make them more vulnerable to social phobia. Studies have found that children with social phobia tend to hold a negative cognitive assessment of unfamiliar situations, underestimating both the manageability of those situations and their own ability to cope with them (Advameg, Inc., 2013).
Children with social phobia tend to overestimate the difficulties, dangers, and uncertainties of life while simultaneously underestimating their own capabilities and talents. Another psychosocial factor linked to social anxiety disorder is the disruption of the social fabric in developed countries following World War II. Researchers and social therapists have noted that children are increasingly exposed to aggressive behavior and harsh language—both in real life and through media—and encounter unpleasant social realities at an earlier age than previous generations (Advameg, Inc., 2013).
Elevated rates of social phobia and school refusal among adolescent girls have been linked to higher levels of teasing and harassment from boys in junior high and high school. According to a study by the American Association of University Women, approximately 70% of girls encounter verbal sexual harassment in high school, and 50% experience unwanted sexual touching. While these societal factors may not directly cause social phobia, they represent significant indirect influences on its development (Advameg, Inc., 2013).
Social anxiety disorder was first described in 400 B.C. by Hippocrates, who noted a man who "loves darkness as life and thinks every man observes him." The tendency of patients to overestimate the degree to which others observe them is the key characteristic of this disease (University of Pennsylvania, 2013).
People suffering from social anxiety disorder generally experience the following symptoms:
"Physical and psychological symptoms in affected individuals"
"Effects on education, development, and substance abuse risk"
"Clinical frameworks and parental involvement in treatment"
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