Latimer: Social anxiety disorder

Much more than shyness, social anxiety disorder is one of the most common psychiatric conditions.

Everyone knows someone who is painfully shy. More than simple introversion—but a person who seems to actually fear social situations, public speaking or being put on the spot. For some, this fear can cause a lot of difficulty in daily functioning.

Social anxiety disorder is one of the most common psychiatric conditions—affecting 18 per cent of the population. It occurs when a person experiences intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life.

Socially anxious people have a fear of criticism and disapproval, do not like to be the center of attention or to perform under scrutiny. People experiencing social anxiety disorder also often go on to develop other disorders such as depression and substance use disorder.

Although the exact causes of social anxiety are not fully understood, it is thought to be about 20 to 40 per cent genetically based with experience accounting for the rest.

Although social fear may not sound too terrible a plight, it can be a very debilitating disorder. School-age children may not want to go to school, have difficulty making friends and may have greater difficulty performing in school because of anxiety. They will feel compelled to avoid asking questions or making classroom presentations. They are also likely to resist participating in physical education or other athletic activities because of performance fears. As adolescents they may have difficulty dating or engaging in important social pursuits. Young adults may lack the confidence to go on to post-secondary education and may avoid applying for jobs because of their social anxiety.

Social anxiety disorder often begins early in life—50 per cent of those with this condition have developed it by age 11. Some of the earliest warning signs are apparent right from toddlerhood.  Children who exhibit a temperamentally anxious predisposition and who show behavioural inhibition are most likely to develop social anxiety as they grow.

The good news here is that although a child with a shy disposition will likely remain shy throughout life, it does not necessarily have to become a disabling disorder. Childhood interventions for highly anxious children have the potential to prevent the development of full-blown social anxiety and its related issues later in life.

Childhood behavioural inhibition typically emerges during the second year of life around the time of normal stranger anxiety—it involves excessive shyness and avoidance behavior in social situations. Adverse environmental experiences such as abuse, bullying, neglect or even simple lack of sensitivity to the fears of the child can have a negative impact on how this early anxiety evolves.

Similarly, supportive encouragement to social engagement could help in overcoming fears and is quite similar to what happens during cognitive therapy for adults with social anxiety disorder.

Unfortunately, many parents do not have the natural ability to respond appropriately to an anxious child. Sometimes this is because they are themselves socially anxious, depressed or overwhelmed by the other demands of life. Families living in poverty often have less opportunity for the social engagement of their children.

Social anxiety disorder can be treated with cognitive behaviour therapy and medication later in life but often only moderately so. The same fear that keep socially anxious people from school and work tend to keep them from therapy as well.

A focus on early intervention aimed at prevention is likely to be a much more effective solution than treatment after the fact. The sooner a child is helped, the less likely they are to suffer negative consequences of their anxiety including lost opportunities and the development of comorbid conditions.

If you have a toddler or young child who seems to be exhibiting more fear or anxiety than other kids, consider talking with your doctor about strategies to gently encourage social engagement and coping. It will be much better to help a young child than to attempt intervention later in life.