Social Anxiety Disorder Basics

Social anxiety disorder is characterized by intense self-consciousness and fear of embarrassment that goes beyond common shyness, causing a child to go to great lengths to avoid social interactions. Our guide looks at how to recognize social anxiety disorder, how it is diagnosed and how it's treated.

Social Anxiety: 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.

Social Anxiety: 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.

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.

Social Anxiety: Diagnosis

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: Treatment

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 serotonin 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.


Social Anxiety: Risk For Other Disorders

Adolescents 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.