Social anxiety is a discomfort or a fear when a person is in a social interaction that involves a concern of being judged or evaluated by others. It is typically characterised by an intense fear of what others are thinking about them (specifically fear of embarrassment, criticism, or rejection), which results in the individual feeling insecure and not good enough for other people, and/or the assumption that peers will automatically reject them. Developmental social anxiety occurs early in childhood as a normal part of the development of social functioning and is a stage that most children grow out of, but it may persist or resurface and grow into chronic social anxiety. People vary in how often they experience social anxiety, and in which kinds of situations they experience it.
A psychopathological (chronic and disabling) form of social anxiety is called social phobia or social anxiety disorder, and is a chronic problem that can result in a reduced quality of life. Roughly 40 million American adults ages 18 and older (18.1%) have an anxiety disorder. The difference between social anxiety and normal apprehension of social situations is that social anxiety involves an intense feeling of fear in social situations and especially situations that are unfamiliar or in which one will be watched or evaluated by others. The feeling of fear is extremely intense in these types of situations, occasionally causing a person to become so worried that he or she feels anxious just thinking about them and will go to great lengths to avoid them.
Overcoming social anxiety depends on the person and the situation (the place where the person is most vulnerable). In some cases it can be relatively easy — just a matter of time for many individuals — yet for some people social anxiety can become a very difficult, painful and even disabling problem that is chronic in nature. The reasons are unknown. Social anxiety can be related to shyness or anxiety disorders or other emotional or temperamental factors, but its exact nature is still the subject of research and theory and the causes may vary depending on the individual. Recovery from chronic social anxiety is possible in many cases, but usually only with some kind of therapy or sustained self-help or support group work.
- 1 Stages
- 2 Disorder
- 3 Prevalence
- 4 Causes
- 5 Prevention
- 6 Communication apprehension
- 7 Diagnosis
- 8 Treatment
- 9 See also
- 10 References
- 11 External links
Social anxiety first occurs in infancy and is said to be a normal and necessary emotion for effective social functioning and developmental growth. Cognitive advances and increased pressures in late childhood and early adolescence result in repeated social anxiety. Adolescents have identified their most common anxieties as focused on relationships with peers to whom they are attracted, peer rejection, public speaking, blushing, self-consciousness, and past behavior. Most adolescents progress through their fears and meet the developmental demands placed on them. More and more children are being diagnosed with social anxiety and this can lead to problems with education if not closely monitored. Part of social anxiety is fear of being criticized by others, and in children social anxiety causes extreme distress over everyday activities such as playing with other kids, reading in class, or speaking to adults. On the other hand some children with social anxiety will act out because of their fear. The problem with identifying social anxiety disorder in children is that it can be difficult to determine the difference between social anxiety and basic shyness.
It can be easier to identify social anxiety within adults because they tend to shy away from any social situation and keep to themselves. Common adult forms of social anxiety include performance anxiety, public speaking anxiety, stage fright, and timidness. All of these may also assume clinical forms, i.e., become anxiety disorders (see below).
Criteria that distinguish between clinical and nonclinical forms of social anxiety include the intensity and level of behavioral and psychosomatic disruption (discomfort) in addition to the anticipatory nature of the fear. Social anxieties may also be classified according to the broadness of triggering social situations. For example, fear of eating in public has a very narrow situational scope (eating in public), while shyness may have a wide scope (a person may be shy of doing many things in various circumstances). The clinical (disorder) forms are also divided into general social phobia (i.e., social anxiety disorder) and specific social phobia.
Extreme, persistent and disabling social anxiety may be diagnosed as social anxiety disorder. The experience is commonly described as having physiological components (e.g., sweating, blushing), cognitive/perceptual components (e.g., belief that one may be judged negatively or looking for signs of disapproval), and behavioral components (e.g. avoiding a situation).
The essence of social anxiety has been said to be an irrational or unreasonable expectation of negative evaluation by others. One theory is that social anxiety occurs when there is motivation to make a desired impression along with doubt about having the ability to do so. Although the "official" clinical name for the disorder, as listed in the DSM and ICD, is Social Phobia or Social Anxiety Disorder, support groups for people who have the disorder (whether through clinical diagnosis or self-diagnosis) often refer to it as simply "social anxiety" or even "SA".[unreliable source?]
Criteria in the DSM and ICD attempt to distinguish clinical versus nonclinical forms of social anxiety, including by intensity and levels of behavioral and psychosomatic disruption: The validity of the "disorder" diagnosis has been challenged, however, on scientific and political grounds; people satisfying DSM social phobia criteria may simply be temperamentally high in social anxiety rather than suffering from a disorder, although such problems in living in society may still deserve attention as a matter of social justice.
Clinicians and researchers continue to struggle with definitional problems regarding the constructs of shyness, social anxiety, and social anxiety disorder. Each shares similarities, yet each has been used to define distinct aspects of psychological life as it relates to interpersonal functioning and how easy or difficult different cases of social anxiety are to overcome. A continuum describes some of the distinctions yet there is no absolute consensus yet as to where one disorder begins and another ends, although it is widely agreed that there are differences.
Social anxiety disorder may sometimes be symptomatic of an underlying medical disorder, such as hyperthyroidism.
||The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. (November 2012)|
According to the US National Comorbidity Survey, social anxiety has a 12-month prevalence rate of 6.8%, placing it as the third most common mental disorder in the U.S. An estimated 19.2 million Americans suffer from social anxiety disorder and it can occur at any time but most often presents in adolescence, early adulthood, or even early childhood. Statistically it is also more common in women than in men.
The exact causes of social anxiety are contested. Research into the genetic roots of physical and mental health suggests that the tendency toward feelings of anxiety, in social situations in particular, has a moderate probability of inheritance.
Another potential cause of social anxiety can be found in the nervous system. Medications that are prescribed to treat social anxiety affect the levels of neurotransmitters, chemical messengers that are responsible for transmitting signals in the brain. However, researchers are still unsure if the differences in these chemicals cause social anxiety. Several studies have found that certain areas of the brain, such as the amygdalae, can be more active in individuals with social phobia.Research has also shown that children may be born with a lower threshold for arousal to unexpected or novel stimuli and have difficulty appraising such stimuli. [full citation needed] 
Also, life experiences can be another cause of social anxiety. Negative experiences in life such as divorce or death, and the way one handles and reacts to them, can also lead to the development of social anxiety. If one is consistently put in situations that make him or her feel inferior or fear the judgment of other people, he or she can begin to develop negative beliefs about himself or herself and the world that can cause social anxiety. This then promotes avoidance of situations that may provoke anxiety, which causes one to miss the opportunity to prove their negative assumptions about themselves wrong.
Social anxiety is difficult to detect because of how early it shows up in children. Symptoms can often begin in children as early as five and six years of age. These symptoms include shyness, crying, and severe separation anxiety. These symptoms aren’t always abnormal, but it is the consistency of these symptoms that make them abnormal. For example if a child consistently gets stomachaches before school this is a major sign of potential social anxiety.
Self-esteem is how a person evaluates their self, based on the qualities they possess. Children with low self-esteem tend to dwell on unfavorable attributes, rather than focusing on their strengths. The evaluation children have of themselves can have a huge impact on their psychological well-being and their actions, thus leading to disorders like social anxiety. A child that has insecure attachments to their caregiver can also develop low self-esteem. These attachment problems can have a bigger influence on the child when they grow up as well. At around 8 years old, the child's self judgements start reflecting what other people think of them. Social anxiety can develop from other's perceptions of one's self; thus having peer groups, caregivers and influential people around can impact the thoughts individuals have about themselves.
Social anxiety, and depression, have been linked to one's explicit and implicit self-esteem. "Explicit self-esteem would reflect deliberate self-evaluate processes whereas implicit self-esteem would reflect simple associations in memory." An experiment using Implicit Association Tests, Child Anxiety and Depression scales, and the Rosenberg Self-esteem Scale was done on adolescent teenagers, and found that self-evaluative thoughts and actions can come from a person's self-esteem level. The findings show that one's explicit self-esteem can be the factor leading to social anxiety and depression. The negative judgement that a person has towards themselves can be linked to unstable cognitive behavior that they possess. In this experiment it was also found that girls, rather than boys, were more likely to have symptoms of social anxiety and depression. This in turn leads to them having lower explicit self-esteem.
For children the exact cause of social anxiety is unknown. However, there is a growing consensus towards an integrated, multifactor model, in which biological, genetic, and environmental factors contribute to the development and intensification of maladaptive anxiety. Genetic vulnerabilities and/or a biological predisposition, including a temperamental style of behavioral inhibition and a family history of anxiety, may place individuals at increased risk for anxiety. Such individuals are more inclined to develop a diagnosable anxiety disorder, particularly when faced with stressful or aversive situations (e.g., peer-related difficulties,strained family relations). Also family variables such as parenting style and parent–child interaction have received increasing attention and may be particularly relevant in the development of childhood social anxiety, especially parental styles characterized by rejection and overprotection.
Social anxiety causes communication apprehension, which can be thought of as an "internally experienced feeling of discomfort". "Communication apprehension is the level of fear or anxiety associated with either real or anticipated communication with another person". In turn, communication apprehension causes ineffective communication when in a social or public situation. Early communication researchers described physiological sensations experienced while giving a public speech as "profound discomfort".[full citation needed] Patients with social anxiety typically experience embarrassment, distressing panic attacks, and self-consciousness impairing their speech. According to a study done by Robin and Mills, children experiencing social anxiety show issues in social perspective-taking ability, use fewer successful problem solving skills, and use less interpersonal problem solutions. The feelings of embarrassment, inferiority, and shame all inhibit the ability to seek help.
Imagined interactions (IIs) refer to the cognitive process of individuals indirectly experiencing themselves in anticipated future communication interactions with others through the process of imagination. IIs have their theoretical roots in symbolic interactions. The functions of IIs is to put into practice the phrase "practice makes perfect". When using IIs you can try to anticipate what is going to happen, and by doing this people with low communication skills can try to account for what is going to happen in the upcoming interaction. According to the article "Communication Apprehension and Imagined Interactions", people who practiced IIs were less likely to have nonverbal displays of apprehension. e.g. fewer silent pauses, shorter speech on set latencies, and fewer object adapters. IIs are said to increase the readiness to communicate and decrease the apprehension associated with a communication episode.
One thing that increases communication apprehension is if the partner is unknown.[full citation needed] Some things that can reduce communication apprehension is if someone is extroverted, has good self-control, high levels of self-esteem, and has high willingness to disclose information.[full citation needed] These are all things that contribute to helping reduce communication apprehension.
This disorder can be difficult to diagnose because it is easily confused with general shyness or paranoia in both children and adults. The underlying factors that cause symptoms of social anxiety are also hard to determine. It can be a combination of life, stress, drugs, and various other factors 
The two most common types of treatment are psychotherapy and medications. These two approaches may be used in combination.
Cognitive behavioral therapy
One treatment available is cognitive behavioral therapy (CBT). The goal of CBT is to guide the patient's thoughts in a more rational direction when faced with anxiety; it helps the person to stop avoiding situations that once caused anxiety and teaches people to react differently to the situations that trigger their anxiety. Cognitive behavior therapy may include systematic desensitization or controlled exposure to the feared situation. With systematic desensitization, the person imagines the anxious social situation and works through their fears in a safe and controlled environment. CBT may also include role-playing to practice social skills and gain the comfort and confidence in order to relate to others. Avoidance and safety behaviors play a main role in treatment outcome, such as avoiding eye contact, substance and alcohol abuse. Relaxation or stress management techniques may be included in a treatment plan. Acceptance and Commitment Therapy ACT is a mindfulness based third generation form of CBT, and is also demonstrating its usefulness in treating social anxiety.
There are several different types of medications used to treat social anxiety disorder, such as antidepressants like paroxetine or benzodiazepines such as alprazolam, chlordiazepoxide, diazepam, and lorazepam. Beta-blockers, which are often used to treat heart conditions, may be used to mitigate some of the physical symptoms of social anxiety, such as reducing heart rate or blood pressure.
Relaxation techniques include breathing methods and muscle relaxation strategies. When someone begins to feel anxious, breathing rhythms change from slow constant breaths to quick, short breaths (also known as hyperventilating). Overbreathing (quick short breaths) can lead to feeling more anxious and can lead to a rapid heart beat, dizziness and headaches. Calm breathing or 'diaphragmatic breathing' is a breathing technique used to slow down and control breathing. Calm breathing requires practice but can be very helpful in controlling anxiety..Meditation is another proven relaxation technique which can show considerable results in overcoming social anxiety.
- Social isolation
- Social inhibition
- Selective mutism
- Highly sensitive person
- Major depressive disorder
- Obsessive-compulsive disorder
- Social rejection
- Jacobs, Andrew M. "Social Anxiety Disorder and Social Phobia". Retrieved 14 November 2012.
- Garcia-Lopez, L. J. (2013). "Tratando...trastorno de ansiedad social/Treating...social anxiety disorder". Madrid: Piramide.
- Albano, A.M. & Detweiler, M.F. (2001) The Developmental and Clinical Impact of Social Anxiety and Social Phobia in Children and Adolescents. In Hofmann, S.G. and DiBartolo, P.M. (eds). From Social Anxiety to Social Phobia: Multiple Perspectives. Allyn & Bacon.
- Harold Leitenberg (1990) "Handbook of Social and Evaluation Anxiety", ISBN 0-306-43438-5
- The Kim Foundation (2012). Mental Disorders in America National Institute of Mental Health, The Kim Foundation
- WebMD Anxiety & Panic Disorders Health Center:Social Anxiety Disorder
- Child Development, Vol. 66, No.6 (Dec 1995) "Role of Social Withdrawal, Social Anxiety, and Locus of Control"
- Leary, M. (2001). Social Anxiety as an Early Warning System: A Refinement and Extension of the Self-Presentation Theory of Social Anxiety. In Hofmann, S.G. and DiBartolo, P.M. (eds). From social anxiety to social phobic: multiple perspectives. Allyn & Bacon.
- Social Anxiety Support, What is Social Anxiety? 2007.
- Thomas A. Richards, Ph.D., Director, Social Anxiety Institute, Why We Prefer the Term Social Anxiety to Social Phobia 2003.
- Wakefield, J.C., Horwitz, A.V., Schmitz, M.F. (2004) Are We Overpathologizing the Socially Anxious? Social Phobia From a Harmful Dysfunction Perspective. Can J Psychiatry 49:736-742.
- Connor K.M., Jonathan R.T., et al. Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry (2000) 176: 379-386
- Anthony MM., Coons MJ., et al. Psychometric properties of the social phobia inventory: further evaluation. Behav. Res. Ther. 2006 Aug;44(8):1177-85
- Henderson, L., Zimbardo, P. (2001). Shyness, Social Anxiety, Social Phobia. In Hofmann, S.G. and DiBartolo, P.M. (eds). From Social Anxiety to Social Phobia: Multiple Perspectives. Allyn & Bacon.
- Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27
- Blair et al., 2008
- Den, J.A. (1997). "Social Phobia". British Medical Journal 315 (7111): 796–800. doi:10.1136/bmj.315.7111.796.
- Shaffer, R.D., Kipp, K., Wood, E., & Willoughby, T. (2010). Developmental Psychology: Childhood and Adolescence. Toronto: Nelson Education Ltd.
- Hullu, de E., Jong, de P.J., Nauta, M.H., Sportel, B.E. (2011) Co-occurrence of social anxiety and depression symptoms in adolescence. Psychological Medicine, 42, 475-484. doi:10.1017/S0033291711001358.
- Greco, Laurie; Morris Tracy (December 2002). "paternal Child-Rearing Style and Child Social Anxiety: Investigation of Child Perceptions and Actual Father Behaviour". Journal of Psychopathology and Behavioral Assessment 24 (4).
- James McCroskey. "Reliability and Validity of the Willingness to Communicate Scale".McCroskey, 1983, p. 16
- Lomas, 1944,p. 479
- Honeycutt, James M.; Charles W. Choib; John R. DeBerry (2009). "Communication Apprehension and Imagined Interactions". Communication Research Reports 26 (3): 228–236. doi:10.1080/08824090903074423. Retrieved 7 June 2011.
- Jordan-Jackson & Davis 2005
- Daly, Caughlin, & Stafford, 1998
- Nevea, N. N., Pearson, J. C., Child, J. T., & Semlak, J. L. (2009). The Only Thing to Fear is...Public Speaking?
- de Jong PJ, Sportel BE, de Hullu E, Nauta MH (March 2012). "Co-occurrence of social anxiety and depression symptoms in adolescence: differential links with implicit and explicit self-esteem?". Psychological Medicine 42 (3): 475–84. doi:10.1017/S0033291711001358. PMID 21798114.
- Mayo clinic: Social anxiety disorder (social phobia)
- Ruiz, F. J. (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies". International Journal of Psychology and Psychological Therapy 10 (1): 125–62.
- Hayes, Steven. "State of the ACT Evidence". ContextualPsychology.org.
- "Coffee break or caffeine fix?Pros and Cons of stimulating beverages project". – via HighBeam Research (subscription required). November 1, 2000. Retrieved 21 August 2012.