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Mental Health Guide

Social Anxiety Disorder

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What is it?

Social anxiety disorder, sometimes called social phobia, is a condition characterized by excessive self-consciousness that goes beyond common shyness. Kids with social anxiety disorder are so worried about being judged negatively by others that they are terrified of doing or saying anything that may cause humiliation. The fear feels uncontrollable, even though older children often realize that their preoccupation isn’t reasonable. Social anxiety disorder mostly affects adolescents, although it can also begin in childhood. Undiagnosed and untreated, it can lead to isolation and depression.

What to look for

Children with social phobia are often inordinately fearful of criticism. They may express their anxiety by asking, “What if I do something stupid?” or “What if I say the wrong thing?” Young children sometimes throw tantrums and cry when confronted with a situation that terrifies them, behavior that can be misunderstood as oppositional. The fear they experience may trigger physical symptoms such as shaking, sweating, and shortness of breath, and may significantly interfere with daily life. The anxiety may occur well in advance of the dreaded situation.


The fear a child with social anxiety disorder experineces is out of proportion to the actual risk of being judged negatively, or the consequences of a negative evaluation.


There are two main types of social anxiety disorder. The first focuses on performance—things like speaking in public, ordering in restaurants, shopping in stores. The second is interactional, which pertains to social situations even when you’re not in the spotlight. Children with interactional social anxiety may fear going to school, eating in public, and using public restrooms. Most people with interactional social anxiety also experience performance social anxiety.  

Risk Factors

Social anxiety is heritable; it's more common in children who have a first-degree relative with the disorder. Other risk factors are temperamental—behavioral inhibition and fear of negative evaluation—and environmental, such as socially anxious modeling by parents. 


For a diagnosis of social anxiety disorder, a child’s fear of being humiliated during social encounters must be severe enough to interfere greatly with normal functioning. Children with the disorder will actively avoid anxiety-inducing situations or else suffer through them with intense distress. The anxiety experienced will be very acute and may result in a panic reaction (shaking, sweating, shortness of breath) or, among young children, tantrums and crying.


One of the things a child may be anxious about is whether she appears anxious, and will be judged negatively for it. To meet the criteria, the anxiety must occur in settings with peers and not just with adults, and must last for 6 months or more.


Some kids downplay their symptoms or even refuse to acknowledge them in an effort to avoid embarrassing scrutiny; as a result, the diagnosing clinician will often interview parents, teachers, and other caregivers to more accurately understand symptoms. 


Social anxiety disorder responds well to therapy. The goal of treatment is behavior modification, and children beginning a concurrent program of behavioral therapy and medication usually don’t take medicine for long.


Behavioral: A clinician will likely start cognitive behavioral therapy to work on improving the child’s social and coping skills during anxiety-provoking situations. CBT teaches kids that they are in control of their anxiety and unwanted behaviors. Through therapy they will learn to take overcome their fear and change anxious thought patterns. Exposure therapy, which requires gradual, carefully controlled exposure to a feared situation, is also very successful in reducing anxiety.


Pharmacological: Medications can alleviate symptoms of anxiety, which may make behavioral therapy more effective for some children. SSRIs, or selective seratonin reuptake inhibitors, have proven effective at managing some symptoms of social anxiety disorder.  Medications called beta blockers may also be prescribed to curb the fear response and reduce physical symptoms of anxiety, such as palpitations and sweating.

Other disorders to look out for

Asolescents with social anxiety disorder may resort to using alcohol before attending a stressful event, which can give rise to substance problems in the future. The condition can also lead to depression if untreated.  Selective mutism is sometimes cued by social anxiety disorder. 

Frequently Asked Questions
Will my child grow out of it?
Parents often wait to seek professional help because they assume a child is just being shy or will outgrow her fear. Unfortunately, social anxiety disorder rarely disappears if left untreated, and it often leads to social isolation, chronic anxiety and depression.
Do drugs help?
Yes, SSRIs can be used to successfully combat anxiety and make cognitive-behavioral therapy more effective. Beta-blockers may also be prescribed to treat the physical symptoms of fear, such as palpitations and nausea.
What causes it?
Experts are unsure about the root causes of social anxiety disorder, but it seems to have both genetic and environmental causes. People with social anxiety disorder often have heightened fear responses.
Should I avoid situations that stress my child?
Avoiding stressful situations will often make your child’s anxiety and nervous anticipation even worse. Anxiety and stress are a normal part of life, and your child will benefit from learning how to manage her response.
Has my child been traumatized?
Children who have developed post-traumatic stress disorder may be more susceptible to social anxiety disorder. However, there is no direct relationship to trauma, and many diagnosed will have never experienced a seriously disturbing event.
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