Social Anxiety Disorder

Social anxiety disorder, also called social phobia, is characterized by excessive self-consciousness that goes beyond being shy. Children with social anxiety disorder are so worried about being judged negatively by others that they are terrified of doing or saying anything that may humiliate them. The fear feels uncontrollable, even though older children often realize it’s unreasonable. Social anxiety disorder mostly affects adolescents, but can begin in childhood. Undiagnosed and untreated, it can lead to isolation and depression.

Children with social phobia fear criticism, a fear that’s out of proportion to the actual risk of judgment. They may ask, “What if I do something stupid?” or “What if I say the wrong thing?” Young children sometimes throw tantrums and cry when confronted with certain situations. Their fears can trigger shaking, sweating, and shortness of breath, and can interfere with daily life. The anxiety may show long before the dreaded situation.

There are two types of social anxiety disorder: performance – speaking in public, ordering in restaurants, shopping in stores; and interactional, pertaining to social situations not in the public spotlight. Children with interactional social anxiety can fear going to school, eating in public, and using public restrooms. Most people with interactional social anxiety also have performance social anxiety.

To be diagnosed with social anxiety disorder, a child’s fear of being humiliated during social encounters must be severe enough to interfere with daily life. Children with the disorder avoid anxiety-inducing situations or else suffer through them. Their anxiety may result in a panicked reaction (shaking, sweating, shortness of breath) or, among young children, tantrums and crying. Children may also be worried about being judged for appearing anxious. The anxiety must occur in peer group settings, not just with adults, and last for 6 months or more. A clinician will often interview parents, teachers, and other caregivers to more accurately understand symptoms.

Social anxiety disorder responds well to therapy. A clinician may start cognitive behavioral therapy (CBT) to improve a child’s social and coping skills during anxiety-provoking situations. CBT teaches kids to control their anxiety and unwanted behaviors. Through therapy they learn to overcome their fear and change anxious thought patterns. Exposure therapy, requiring gradual, carefully controlled exposure to a feared situation, is also successful in reducing anxiety.

Medications can alleviate symptoms of anxiety, which may make behavioral therapy more effective for some children. Selective seratonin reuptake inhibitors (SSRIs) are effective at managing some symptoms of social anxiety disorder.  Medications called beta blockers may also be prescribed to curb fear and reduce physical symptoms such as palpitations and sweating.

Social anxiety is inherited and 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.

Adolescents with social anxiety disorder may use alcohol before attending a stressful event. Social anxiety disorder rarely disappears if left untreated, and can lead to social isolation, chronic anxiety and depression. Selective mutism is sometimes caused by social anxiety disorder.