Social
anxiety disorder (SAD), otherwise known as social phobia, is a persistent fear
of social situations despite the desire for social encounters, causing the
individual to become distressed, inhibited and timid in social contexts (Morris
& March, 2004). In unfamiliar situations or upon meeting new people, “shy”
or “inhibited” children typically withhold responding or interrupt ongoing
behavior, show vocal restraint, and withdraw from the situation (Elizbeth et
al., 2006). Those individuals experiencing SAD have a difficult time
experiencing social situations positively, often resulting in social
withdrawal. Though it may not seem like many people have this problem,
according to Wetherell nearly twelve percent of the general population develops
SAD at some point in their lives (as cited in Comer, 2007, p. 128). The
American Psychological Association states that SAD typically begins in late
childhood or adolescence and continues into adulthood (as cited in Comer, p.
128).
Causes
of SAD
There are many possible factors in
the development of SAD but some of the correlating causes include: genes,
behavioral inhibition, parent-child interactions, traumatic conditioning, peer
relationships, social skills deficits, social cognition and information
processing, and parental psychopathology (Elizabeth et al., 2006). More often
than not, a single specific event that initiated the onset of SAD cannot be
identified among individuals with the disorder; however, a combination of
events (either biological, environmental, or a combination of both) can usually
be determined with some knowledge of what to look for.
Biological. The root of SAD
could very well lie in the genes that make an individual who they are. It has
been said that genes account for around one-third of the variance in most
measures of anxiety, and that first-degree relatives of people with anxiety
were found to be ten times more likely to be diagnosed with generalized SAD
than anyone else (Morris & March, 2004; Elizabeth, 2006). The results of
various researches conducted on SAD indicate that genes linked to anxiety can
possibly be passed along to offspring, predisposing them to the affects of SAD.
There are, however, individuals whose parents experience anxiety yet they,
themselves, do not experience any symptoms. This inconsistency within the genes
theory tells us that other factors may be at hand.
Environmental. Although some
parents may increase the likelihood of their children developing SAD through
the passing of genes, there are also non-genetic factors to be considered. For
example, a parent affected by anxiety may model poor coping skills and engage
in behavior that promotes heightened states of arousal and hypervigilance,
which can cause the child to, in turn, imitate the same behavior (Morris &
March, 2004). More direct parent-child interactions, such as child abuse, are
also major factors in causing a child to develop SAD. According to Rodriguez
(2003), physically abused children are more likely than nonabused children to
demonstrate characteristics such as oppositionality, behavior problems,
depression, fearfulness, social withdrawal, and lower self-esteem. Children
with abusive parents feel less in control of their lives, often leading them to
develop a model of the “self “as unloved and rejected, and a model of the
“other” as unloving and rejecting (Rodriguez, 2003; Muris, 2007). Once a child
develops this “self” and “other” model to asses the social world, anyone could
be considered the “other” and perceived as a threat, causing the child to shut
down and withdrawal from society.
Aside from family, a child’s peers
also play a very significant role in life and learning, often providing
opportunities for learning specific skills that are not attainable through
adult-child interaction (Morris & March, 2004). Positive interactions with
peers can benefit a child greatly, providing them with skills necessary to develop
relationships later on in life; however, negative peer interactions can
increase a child’s odds of developing SAD. Physical abuse from peers, as well
as any other form of peer victimization, has been linked to the development of
anxiety problems in children (Muris, 2007).
How SAD
Affects Development
As a child withdrawals himself or
herself from social situations, that child distances themselves from other
people who could potentially provide the skills necessary to overcome anxiety
before it develops into a bigger problem. As a child withdraws from social
situations, he or she can become easily forgotten and neglected in group and
school contexts (Adalbjarnardottir, 1995). Neglect from teachers and other
influences will most likely result in the child not receiving the help needed
to excel in academics or any other situation requiring assistance from others. Withdrawing
from others can also interfere with the development of social skills and
interpersonal relationships, which will inevitably perpetuate, possibly
exponentially, as the child grows older. By the time the child is an adult and
has developed a socially crippling problem such as SAD, that individual may
experience problems with obtaining higher education at larger schools, holding
a career, finding a spouse, or having many friends; essentially, SAD has the
potential to decrease a person’s quality of life in general. As the virtues of
life become increasingly limited to the person suffering from SAD, depression
could take hold and cause further problems (in severe cases maybe even
suicide).
Solutions
for SAD
Since SAD has been found to have an
early onset, an early detection and intervention could help avert a lifetime of
personal distress and social maladjustment, and also special attention should
given to interpersonal work with children while they are still in their early
elementary years (Morris & March, 2004; Adalbjarnardottir, 1995). There are
two paths (or a combination of) that one can take to help alleviate problems
associated with SAD: one that relieves and helps cope with situational problems
(cognitive-behavioral therapy) and one that relieves physical causes and
symptoms (medication).
Cognitive-Behavioral Treatment.
Therapy is often the best solution for those individuals with SAD that simply
lack the skills necessary to navigate through social life. This type of
treatment focuses on two aspects of the individual: the way one thinks and the
way one acts. For example, an individual with SAD may have a difficult time in
social situations because they see the “other” as threatening (as mentioned
earlier); in this instance, the therapist may walk through the reasons why the
client portrays the “other” as threatening and try to change those attitudes
with various techniques. Another example
could be that the individual with SAD is so nervous about social situations
that they tend to stutter or have other obvious nervous ticks which, in turn,
affects their confidence in the social situation; the therapist would then
concentrate on these issues and aid the individual in developing coping
strategies to reduce or eliminate the bothersome behavior.
A variation of this type of
treatment comes in the form of family therapy. Morris and March (2004) describe
family intervention as including both parents and focusing on training in
reinforcement and contingency management strategies, coping techniques to deal
with parental emotionality, and communication problem solving skills. In family therapy, not only is the individual
suffering from anxiety taught coping strategies but also the nuclear family.
This family approach has proven quite helpful when preventing normal anxiety in
children from developing into SAD. As mentioned earlier, parents of children
who develop SAD tend to also have anxiety, thus the family therapy approach can
also teach parents essential skills that, in turn, will increase the likelihood
of that parent to display proper modeling in presence of the child.
Medication. Sometimes behavior-cognitive
therapy alone (or at all) does not help the individual with all the problems
associated with SAD. Medications such as selective serotonin reuptake
inhibitors (SSRIs) are usually considered the first-line pharmacological agent,
the most common include: fluvoxamine (Luvox), fluoxetine (Prozac), sertaline
(Zoloft), and paroxetine (Paxil) (Morris & March, 2004). The basic function
of these medications is to help alleviate symptoms of anxiety and depression.
Many psychologists and psychiatrists feel that once a person can physically
feel better (or more upbeat) then that person will have more confidence in
themselves and a significantly better chance of overcoming problems associated
with SAD.
Which Treatment is Best? Most
commonly, a single treatment method does not have the capacity to eliminate the
condition all on its own. For these reasons it has become commonplace for a
therapist to recommend a combination of medication and therapy for a longer
lasting positive effect. The idea is that the medication will help the client
overcome any physical obstacles (such as a deep feeling of helplessness) that
therapy may not be able to alleviate, giving the client an opportunity to
regain enough confidence in themselves to have success with therapy. The key to
a drug and therapy combination is that the therapy is intended to make the
client less dependant on medications. There is a risk for medication abuse if
the individual does not attend therapy as well.
My
Thoughts on SAD
I believe that SAD is a combination
of biological and environmental factors; however, I feel that the environment
may have a little more significance. For example, say a child is predisposed
genetically to be anxious in a social contexts -- more specifically, afraid of
not being as good as his or her peers in a given situation. I believe that
whether or not that child receives appropriate attention will determine if they
will develop SAD. For instance, if that anxious child is scolded by authority
figures or peers for not performing just right then that child’s anxious
feelings are being reinforced, giving that child a reason to not even try next
time. On the other hand, if that child is praised for his or her good efforts
regardless if they performed exceptionally or not, then that child will feel
good about himself or herself and have a reason to participate again.
Individuals with SAD are often
misjudged, perceived as snobbish, or “too good to hang.” These misjudgments
make it even more difficult for someone with SAD to face the world, let alone
defend themselves against such allegations.
This lack of social acceptance for some individuals with SAD also
prolongs the issues they face in everyday life. What many fail to realize is that those with
SAD want to be accepted and want to have relationships, but for
whatever reasons (biological or environmental) they just cannot bring
themselves to accept others. SAD is a problem among children because once they
reach adulthood they may be socially incompetent and unable to fend for themselves
in such an intimidating world. The virtues of social life that others take for
granted are not readily available to those faced with SAD, and could eventually
decrease quality of life altogether if not attenuated to some degree. SAD can
be reduced among individuals; it takes an effort on everyone’s part to see that
the children are given the attention and love they deserve. After all, it’s not
as if children asked to come into this world, so why give them a reason to be
afraid of it?
References
Adalbjarnardottir,
S. (1995) How schoolchildren propose to negotiate: The role of social
withdrawal, social anxiety, and locus of
control. Child Development, 66 (6), 1739-1751
Comer,
R. J. (2007). Abnormal psychology
(6th ed.). New York: Worth Publishers
Elizabeth,
J., King, N., Ollendick, T. H., Gullone, E., Tonge, B., Watson, S., &
Macdermott, S.
(2006). Social anxiety disorder in children and
youth: A research update on aetiological factors. Counseling Psychology Quarterly. 19 (2), 151-163
Morris,
T. L., March, J. S. (Eds.). (2004). Anxiety
disorders in children and adolescents
(2nd ed.). New York: Guilford P
Muris,
P. (2007). Normal and abnormal fear and
anxiety in children and adolescents. New
York: Elsevier
Rodriguez,
C. M. (2003). Parental discipline and abuse potential affects on child
depression,
anxiety, and attributions. Journal of Marriage and Family. 65 (4), 809-817
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