In my practice, I’ve worked with many teenagers and young adults whose primary presenting concern is social anxiety. That may not be why they come to seek treatment, however. Often, it is because of the consequences of the disorder – depression, inability to be successful in the world, feelings of isolation, increased anxiety, inability to engage with people in a meaningful way, etc.
It may be difficult to distinguish between the teen who is more shy and introverted, and the one who literally panics every time s/he has to leave the house and go meet people. In times when school avoidance and refusal have become a major problem for students, teachers, social workers and parents, I thought it would be appropriate to zero in on the difference between “normal” shyness and the more serious psychological problem of social anxiety disorder, otherwise known as social phobia.
In this post, I want to stick to the basics of the disorder and raise awareness rather than confuse you with psychoanalytic theories and explanations of what it might mean to struggle with social anxiety. It is only within each individual treatment that we can speak of the meaning of a psychoanalytic symptom and suffice it to say that social anxiety can be precisely that, a psychoanalytic symptom.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for social phobia include:
- a “marked fear or anxiety about one or more social situations, in which the individual is exposed to possible scrutiny by others” such as meeting new people, having a conversation or interacting with people in a large group setting
- “social situations are avoided or endured with intense fear or anxiety”
- the individual fears that s/he will act in a way that will be embarrassing or humiliating, which is often out of proportion to the actual threat posed by the social situation
- the fear, anxiety and/or the avoidance of social situations causes a significant disturbance to the person’s daily functioning such as frequent absences from school, decrease in academic performance and impairment in social functioning in general
- If the fear and anxiety are only exhibited in relation to speaking or performing in public, the social anxiety is diagnosed as performance social anxiety only.
Social anxiety is different from normative shyness in that it is a disorder that causes a significant disturbance to the person’s social, occupation or academic functioning. In adolescents, if unaddressed, social anxiety can result in school drop out, social isolation, and depression.
Shyness is a temperamental or personality trait that does not lead to the same intense, persistent and overpowering fear of social situations as it does in cases of people, who struggle with social anxiety.
Social anxiety usually begins in the adolescent years with 75% of people experiencing onset between 8 and 15 years of age. It may be the case that the disorder is triggered by a real-life incident such as being bullied, made fun of or embarrassed in public. But this is not a necessary condition for the disorder to occur. In most cases, social anxiety is hereditary although there are environmental factors that could also contribute to the disorder.
Adolescents with the disorder struggle with social interactions and have inadequate eye contact, may have a rigid body posture, or may appear awkward, unusually quiet or withdrawn. They may avoid dating or big groups of peers, choosing to be by themselves out of fear of being judged as “crazy, stupid, anxious, boring or unlikable.” It is not uncommon for teens with social anxiety to exhibit psychosomatic symptoms as well, leading to frequent doctors visits and physical complaints.
In the company of people they know and are familiar with, people with social anxiety typically feel comfortable enough that the disorder may not be as apparent. In most cases, family members tend to collude with the teen’s social anxiety by speaking for him/her in social settings, communicating with strangers or other adults for him/her or taking care of logistical details such as setting up doctor appointments, emailing teachers, etc.
For this reason, in addition to individual therapy and medication management, family therapy is often helpful in treating the disorder in adolescence. With the right supports in place, socially anxious kids can be both academically and socially successful people.
Are you someone, who struggles with social anxiety? Please, share with us in the comments section below what’s been your experience and what has been helpful for you to overcome or manage it.
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