What causes Social Anxiety Disorder?

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Sam is a college student who struggles with many aspects of attending school. He has a passion for his major and he enjoys researching the subject; however, when it comes to interacting socially, Tim feels horribly anxious. He often skips his class lectures out of a fear of being called on. Even though he knows the material, the thought of addressing that many people terrifies him. He has difficulty asking questions of and talking to his peers. He fears that they may find him boring or uninteresting. Class presentations are impossible for Tim, and more than once, he has made up excuses to avoid them. In the past, when he has attempted to make a presentation, he has experienced physical issues such as shortness of breath, dizziness, tunnel vision, shaking hands, and trembling lips. Tim has always been shy, yet he feels that his fears are taking over his life, and he worries that he won't be able to accomplish his goals unless something changes.

Tim suffers from Social Anxiety Disorder. Though many people feel varying degrees of anxiety when relating to others, those with Social Anxiety are often incapacitated by certain aspects of social interaction. Social Anxiety extends beyond shyness; it can limit the social lives, education, and even the career choices of those who suffer from it. The unifying characteristic in social anxiety disorder is a fear of performing poorly in social situations and suffering from embarrassment or humiliation. By definition, social situations mean interacting with or performing for other people and being under their potential scrutiny. If a socially anxious individual's performance is found 'lacking' in some way, he often says to himself, "How embarrassing" or "How humiliating." This fear of embarrassment or humiliation causes these individuals to either avoid those situations altogether, or suffer extreme anxiety as they endure them.

Their lives can be further complicated by anticipatory fear of upcoming social encounters. As socially anxious individuals anticipate or become involved in social encounters, they experience an increase in troublesome physical symptoms which may include heart palpitations, trembling, sweating, and flushing or blushing. These indicators of anxiety may often repeat in an uncomfortable cycle that is difficult to control.

In addition, social anxiety sufferers worry that their anxiety or awkwardness will become even more obvious, and this, in turn, leads to feelings of shame as well as further embarrassment and humiliation.

How common are Social Phobias?

* About 3.7 percent of the U.S. population ages 18 to 54--approximately 5.3 million Americans--has social phobia in any given year.

* Social phobia occurs in women twice as often as in men, although a higher proportion of men seek help for this disorder.

* The disorder typically begins in childhood or early adolescence and rarely develops after age 25 .

While most people can attest to being nervous or shy in certain social situations (i.e., walking into a party, giving a presentation, or meeting someone for the first time), those who suffer from social anxiety are often completely unable to function in certain social settings. The onset for this disorder varies from person to person. Some people will report increasing shyness as they get older. Others will find their social anxiety brought on by a certain challenge or life change. The rate of recognition of social anxiety disorder is often extremely low. One reason may be that many people know very little about it -- which makes it difficult to discern where shyness ends and social anxiety begins.

What causes Social Anxiety Disorder? The exact cause of Social Anxiety Disorder is under investigation. Like many other emotional disturbances, Social Anxiety Disorder is a complex issue with many possible contributing factors. The following are several theories regarding the causes of Social Anxiety Disorder.

Genetic predisposition

Just as physical features such as hair and eye color are inherited, sensitivity to criticism or social scrutiny may be passed on from one generation to the next. It's possible that the child of one or two shy parents may inherit genetic code that amplifies shyness into social anxiety disorder. Through his research at Harvard University, Jerome Kagan, Ph.D., found evidence of this genetic predisposition. He studied children from infancy through early adolescence. He found 10-15% of children to be irritable infants who become shy, fearful and behaviorally inhibited as toddlers, and then remain cautious, quiet and introverted in their early grade school years. In adolescence, they had a much higher than expected rate of social anxiety disorder.

Kagan also found a physiological accompaniment of anxious temperament in these children: a high resting heart rate. Their resting heart rates rose even higher in the presence of mild stresses. Additionally, when exposed to new situations, these children exhibited substantial behavioral restraint -- becoming quiet, avoiding interaction and even retreating from the scene. Parents of these children have increased rates of social anxiety disorder and other anxiety disorders.

Development

Social anxiety emerges at different developmental stages. Babies develop a fear of strangers at seven months, not before. Separation anxiety is quite clear in some children--perhaps more obvious in three-year-olds we take to daycare than in five-year-olds going off to kindergarten. Being alone is difficult for children ages six to eight, but actually becomes desirable as they approach puberty and adolescence. Solitude becomes more important as anxiety about physical appearance and performance in school increases. We also know that traumatic or stressful life events occurring at an early developmental stage may increase the risk of social anxiety disorder.

Chemical Imbalances

Individuals with social anxiety disorder (and other emotional disorders) probably have abnormalities in the functioning of some parts of their anxiety response system. Most often, the symptoms of long-term social anxiety disorder can be attributed to an improper chemical balance in the brain. There are several key neurotransmitters, namely Serotonin, Norepinephrine and Gamma-aminobutyric acid (GABA), which are produced in the brain and directly affect the way we feel about a given thought or situation. Scientists believe that at least four brain areas are critical to our anxiety-response system:

* brain stem (cardiovascular and respiratory functions)

* limbic system (mood and anxiety)

* prefrontal cortex (appraisals of risk and danger)

* motor cortex (control of muscles) These structures are richly supplied with these three important neurotransmitters: norepinephrine (NE), found in neurons arising primarily from a part of the brain stem called the locus ceruleus; serotonin (5-HT), found in neurons beginning in the raphe nuclei of the midbrain; and gamma aminobutyric acid (GABA), found in neurons that are widespread throughout the brain.

In terms of emotive response, this neurochemical process is vital to sustaining a sense of emotional well-being. Examples of brain regulation include control of thinking, control of physiologic functions, and control of behaviors. For example, thoughts can range from safe to dangerous, serious to humorous, etc. Physiologic functions, such as regulation of blood flow, the nervous system and the muscular system, fluctuate from resting states to initial arousal, then to marked arousal/anxiety and finally to extreme anxiety or panic. Behaviors from deep sleep to moderate activity to extremes of fighting, fleeing or freezing are all played out endlessly in each of us.

Many factors can contribute to a chemical imbalance, but treatment is essential in order to experience complete relief from those symptoms.

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