It is entirely normal to feel anxiety in certain social situations. For example, you are likely to experience butterflies as you go on a first date. You may even feel nervous before a presentation at work.
However, for those with social anxiety disorder, also known as social phobia, routine interactions can cause considerable stress. As a result, social anxiety disorder leads to an avoidance of social situations that disrupt everyday life and significantly impact a person’s well-being.
In this article, we explore social anxiety disorder and how trauma, particularly childhood trauma, plays a role in developing the condition in later life.
What Is Social Anxiety?
Common, everyday experiences pose a significant challenge to those suffering from a social anxiety disorder. These individuals fear being negatively perceived, judged, and scrutinised. This fear is primarily associated with unfamiliar people or strangers. However, some sufferers find social interaction immensely challenging, even with close friends and family members.
Although social anxiety typically begins in adolescence, it can sometimes arise in early childhood or develop in adults. With up to a 12% lifetime prevalence, it is one of the most prevalent anxiety disorders. This is notably high compared to 7% for post-traumatic stress disorder, 6% for generalised anxiety disorder, 5% for panic disorder, and 2% for obsessive-compulsive disorder.[1]
The types of experiences that sufferers may find hard to endure include, but are not limited to, the following:
- Attending social gatherings and parties
- Initiating or engaging in conversations
- Going to school or work
- Interacting with strangers
- Making eye contact
- Going on dates
- Meeting friends of friends
- Entering a room in which people are already seated or in conversation
- Returning items to a store
- Eating in front of others
- Using a public restroom
- Using public transport
The severe stress these social interactions cause impacts daily routines, employment, school, relationships, and hobbies. Whilst avoiding anxiety-inducing situations will ease a person’s discomfort in the short-term, long-term avoidance only exacerbates the issue.
Social anxiety disorder can become a chronic and debilitating mental health issue. Recognising the signs and symptoms of the condition and seeking early treatment is paramount for allowing the individual to find confidence and develop skills to allow for stress-free social interaction.
Symptoms of Social Anxiety
Comfort levels in social situations vary significantly from person to person. Feelings of unease, discomfort, or shyness are not necessarily signs of social anxiety. Neither is a lack of interest or enthusiasm for unfamiliar social situations or large groups of people.
Instead, our responses to situations largely depend on our personality traits, life experiences, and upbringing. Some people are naturally more reserved or introverted, whilst others are more extroverted and outgoing.
In contrast to understandable nervousness, social anxiety disorder provokes strong feelings of fear, intense anxiety, and avoidance that interfere with all aspects of a person’s life and render them powerless.
Signs and symptoms of social anxiety disorder may include:[2]
- Fear of situations in which you may embarrass yourself or be negatively judged.
- Extreme fear when talking with strangers.
- Intense anxiety surrounding social or public situations.
- Avoidance of social or public situations.
- Excessive anxiety in anticipation of an activity or event
- Catastrophising or expecting the worst possible outcome at the event
- Physical symptoms, such as trembling, shaking, blushing, sweating, upset stomach, racing heart, muscle tension, and a shaky voice.
- Poor verbal communication skills when faced with a stressful situation.
- An inability to think clearly.
- Over-analysis of performance and perceived flaws and judgements post-event.
- Reduced self-esteem, self-worth, and a lack of self-confidence.
Among children, symptoms could be displayed through extreme clinginess to their caregiver, crying, temper tantrums, or refusing to speak.
Social anxiety disorder symptoms often present differently at specific periods. They may even alter over time. If a person is experiencing stress or going through challenging life changes, the symptoms will likely flare up and escalate.
The Implications of Trauma
Research has evidenced that the development of social anxiety disorder is more prevalent among those who have experienced trauma and chronic stress. Some of the traumatic events understood to have predictive value for the onset of social anxiety include:[3]
- Childhood abandonment or neglect
- Physical, sexual, or emotional abuse
- Bullying
- Family or relational conflicts, such as divorce, custody cases, and domestic violence
- Loss of a loved one
- Postnatal depression or stress during pregnancy or infancy
Studies have demonstrated a direct correlation between childhood traumatic experiences and the onset of severe social anxiety, general anxiety, depression, and low self-esteem among individuals who struggle with social anxiety disorder.[4]
Social Anxiety and the Brain
As noted above, social anxiety emerges from a convergence of factors, including childhood experiences, genetic predisposition, trauma, and unusual brain functioning.
Studies on the brain of social anxiety disorder sufferers have shown hyperactivity in the region of the brain called the amygdala. The amygdala is responsible for the activation of our threat response system triggering fight or flight.
This automatic survival response activates an avalanche of symptoms, including increased respiratory action, rapid heart rate, muscle tension, digestive discomfort, a surge in blood sugar, and an overwhelming sense of stress and anxiety as your body prepares itself to flee or fight. [5]
Individuals with social anxiety perceive social interactions as legitimate threats triggering this evolutionary danger detection system resulting in a state of hyper-vigilance and stress.[6]
Fortunately, the brain is remarkably adaptive and can form new connections and neural pathways at any stage of life through effective treatment. [7] With effective treatment, those with social anxiety disorder can reorientate their brains to react in a calmer, more rational state during social encounters that pose no real threat.
If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
Sources:
[1] Unlocking-Potential.Co.Uk, 2021, https://www.unlocking-potential.co.uk/wp-content/uploads/2019/06/Statistics-relating-to-Social-An
[2] Purdon, Christine et al. “Social Anxiety In College Students”. Journal Of Anxiety Disorders, vol 15, no. 3, 2001, pp. 203-215. Elsevier BV, doi:10.1016/s0887-6185(01)00059-7. Accessed 3 Nov 2021.
[3] Schmidt, Louis. “Social Anxiety Disorder: A Review Of Environmental Risk Factors”. Neuropsychiatric Disease And Treatment, 2008, p. 123. Informa UK Limited, doi:10.2147/ndt.s1799. Accessed 3 Nov 2021.
[4] Kuo, Janice R. et al. “Childhood Trauma And Current Psychological Functioning In Adults With Social Anxiety Disorder”. Journal Of Anxiety Disorders, vol 25, no. 4, 2011, pp. 467-473. Elsevier BV, doi:10.1016/j.janxdis.2010.11.011. Accessed 3 Nov 2021.
[5] “What Is ‘Fight, Flight Or Freeze’?”. North West Boroughs Healthcare, 2021, https://www.nwbh.nhs.uk/healthandwellbeing/Pages/Fight-or-Flight.aspx.
[6] Sladky, Ronald et al. “Disrupted Effective Connectivity Between The Amygdala And Orbitofrontal Cortex In Social Anxiety Disorder During Emotion Discrimination Revealed By Dynamic Causal Modeling For Fmri”. Cerebral Cortex, vol 25, no. 4, 2013, pp. 895-903. Oxford University Press (OUP), doi:10.1093/cercor/bht279. Accessed 3 Nov 2021.
[7] Månsson, K N T et al. “Neuroplasticity In Response To Cognitive Behavior Therapy For Social Anxiety Disorder”. Translational Psychiatry, vol 6, no. 2, 2016, pp. e727-e727. Springer Science And Business Media LLC, doi:10.1038/tp.2015.218. Accessed 3 Nov 2021.