Social Anxiety Disorder
Social Anxiety Disorder
Authored by: Steffi Hartanto, M.Psi., Psikolog
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
Welcome
Dear Reader,
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
Definition
Social Anxiety Disorder vs. General Shyness
It is important to note that social anxiety disorder should not be misconstrued for general shyness. Falling within the normal spectrum of human emotion, shyness is a personality trait in which people are generally reserved or timid in nature. Many individuals fear entering into, or participating in, social events and situations. For instance, it is not uncommon for people who are shy to harbour concerns about interacting with people they are not very familiar with. Further, Individuals who are shy, and even those who are generally confident, may experience anxiety when they perform or give a speech.
Individuals with social anxiety disorder differ from those who are shy by nature in a number of ways. These include their intensity of anxiety, levels of social avoidance, and duration of their symptoms. Further, the symptoms of social anxiety disorder greatly interfere with day-to-day functioning and exceed what is expected relative to their situational and sociocultural context.
What is Social Anxiety Disorder?
Most individuals are affected by how others perceive various aspects of themselves, including their physical appearance, accolades and achievements. It is not uncommon for individuals to be nervous, even fearful, when placed in certain social situations (for instance, being tasked to give a speech in public) for fear of embarrassing themselves. Whilst it is not uncommon to contemplate what others think of us and how they perceive us, individuals with social anxiety disorder possess an extreme fear of situations that may lead to social scrutiny and possible negative external appraisal. Situations that may initiate anxiety may include
- Social interactions (such as holding a conversation with authority figures, e.g. one’s boss)
- Completing an activity whilst others observe oneself (for instance, eating food in one’s school cafeteria or office space)
- Performing in front of other people (for instance, giving a toast at a wedding).
Moreover, individuals with social anxiety disorder present behaviours that are disproportionate to what is considered normal, or expected, within a given social situation or cultural context. Collectively, the symptoms of the condition last several months. Further, they are detrimental to one’s day-to-day life and may lead to considerable distress and impairment across important life domains, interfering with functioning (social, occupational or otherwise). Normal functioning is typically only maintained through conscious exertion of additional effort.
Importantly, the symptoms of social anxiety disorder are not better explained by another mental health condition.
Symptoms
For a comprehensive list of social anxiety disorder symptomatology, we recommend you visit the ICD-11 webpage.
Comorbidities
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside social anxiety disorder include but are not limited to:
- Other anxiety and fear disorders (such as generalized anxiety disorder, agoraphobia and specific phobias)
- Personality disorders
- Mood disorders (such as depression)
- Substance use
Development and Course
Below, we present findings from existing literature. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- Though the condition has been observed amongst children under the age of 10, there is a significant increase in the occurrence of the condition throughout adolescence.
- The onset of the condition may be gradual, or sudden following an adverse social encounter or humiliating event.
- Generally, the condition becomes more exacerbated during adolescence as individuals struggle to manage their social obligations and commitments.
Variability
Age-Related Features
- Existing research suggests that adolescents attempt to conceal their symptoms for fear that abstaining from social activities will undermine their social status.
Gender and Sex-Related Differences
- Whilst recent studies suggest that there are no differences between sex/ gender, other studies maintain that women are more likely to experience social anxiety disorder.
- Women typically report more severe symptoms and greater distress.
- This may be due to reporting bias, or the tendency for men to aim to conceal their symptoms.
Individual differences
- The manifestation of social anxiety varies based on individual factors. For instance, whilst some individuals may demonstrate more symptoms in the presence of members of the same sex, others may demonstrate symptoms in the presence of members of different sex.
Etiological Risk Factors
The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops.
Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis, and outcome are not definitively based upon the presence of one, or even several, of the variables.
Temperamental or personality factors
- Behavioural inhibition (the tendency to view unfamiliar situations as distressing and withdraw from novel or unfamiliar people or situations)
- Higher levels of neuroticism (specifically negative emotionality)
- The tendency for social withdrawal
- Being shy or timid
Heritability
- Although hereditary rates vary across studies, social anxiety disorder is more prevalent amongst individuals who have close relatives with the condition.
Neurobiological factors
- Individuals with social anxiety demonstrate heightened emotional reactions to anxiety-provoking stimuli. The overactivation of the amygdala has been repeatedly observed amongst individuals with the condition.
Environmental factors
- Some theorize the condition is learned due to negative past social interactions. These include past interactions that were embarrassing or led to negative social judgement.
- The condition has been commonly observed amongst individuals with overprotective and controlling parents.
- A history of abuse
- A sudden increase in responsibility
- Increasing social demands
Consequences
The symptoms of social anxiety disorder have widespread consequences across social, economic, academic, occupational domains and otherwise. These consequences may have detrimental effects on one’s quality of life. Whilst not everyone experiencing this condition will experience these disruptions, studies have highlighted various associated consequences. Individuals with social anxiety disorder have been observed to be at heightened risk for:
- Compromised mood and overall wellbeing
- Having a lack of social companions and confidants
- A greater risk of leaving school prior to graduating and having fewer or poorer academic qualifications
- Increased workplace absenteeism and more unsatisfactory occupational performance
- Being less likely to marry
- Marital strife
- Divorce
- Being less like to have children
- Substance use
- Suicide ideations, suicide attempts, and suicide
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Recommended Readings
Disclaimer
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/
Code for Social Anxiety Disorder: 6B04
Garcia, K., Carlton, C., & Richey, J. (2021). Parenting Characteristics among Adults With Social Anxiety and their Influence on Social Anxiety Development in Children: A Brief Integrative Review. Frontiers In Psychiatry, 12. doi: 10.3389/fpsyt.2021.614318
Hur, J., DeYoung, K. A., Islam, S., Anderson, A. S., Barstead, M. G., & Shackman, A. J. (2020). Social context and the real-world consequences of social anxiety. Psychological Medicine, 50(12), 1989–2000. https://doi.org/10.1017/S0033291719002022
Jefferies, P., & Ungar, M. (2020). Social anxiety in young people: A prevalence study in seven countries. PLOS ONE, 15(9), e0239133. doi: 10.1371/journal.pone.0239133
Kraus, Christoph; Lanzenberger, Rupert; Windischberger, Christian (2017). Task-dependent modulation of amygdala connectivity in social anxiety disorder. Psychiatry Research: Neuroimaging, 262, 39–46. doi:10.1016/j.pscychresns.2016.12.016