Social Anxiety Disorder Basics

In this guide you’ll learn the signs and symptoms of social anxiety disorder, how it’s diagnosed and how it’s treated.

Social Anxiety: What Is It?

Children with social anxiety disorder struggle with excessive self-consciousness that goes beyond common shyness. Kids with social anxiety disorder worry so much about being judged negatively by others that they stop doing the things that they need (and want) to do for fear of embarrassing themselves.

Social anxiety disorder mostly affects adolescents, although it can also begin in childhood. Undiagnosed and untreated, it can lead to isolation and depression.

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Social Anxiety: What to Look For

Children with social anxiety disorder are extremely self-conscious about how they appear to others.

There are two main types of social anxiety disorder. The first focuses on performance, with kids worrying about things like speaking in public or trying out for a team. The second type involves social situations in general — not just situations when a child is in the spotlight. Kids with this type of social anxiety may fear things like going to school, eating in public, using public restrooms, meeting new people and even having conversations. Most people with more general social anxiety also experience anxiety about performing.

Children with social anxiety may experience physical symptoms such as shaking, sweating, flushing and shortness of breath. 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. Children may experience anxiety symptoms well in advance of the situation they are worrying about.

Children with the disorder tend to start noticing symptoms between the ages of 8 and 15, but if they hide how they are feeling, parents might not realize anything is wrong for some time.

Social Anxiety: Risk Factors

Social anxiety disorder is more common in children who have a first-degree relative with the disorder. There seems to be a genetic component to this as well as an environmental component, such as socially anxious modeling by parents. Some children also have different traits that predispose them to developing social anxiety disorder, such as behavioral inhibition or fear of negative evaluation.

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Social Anxiety: Diagnosis

Some amount of shyness is common to many people, and no one likes to be judged negatively. However, children with social anxiety disorder experience anxiety that is out of proportion to any potential judgment they could experience, and the anxiety that they experience is severe enough that it interferes with their ability to function socially. Children with social anxiety disorder will either actively avoid anxiety-inducing situations or suffer through them with intense distress. When their anxiety is triggered, they may experience panic reaction (shaking, sweating, shortness of breath) or, among young children, tantrums and crying.

To meet diagnostic criteria, the anxiety must occur in settings with peers and not just with adults, and must last for six 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.

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Social Anxiety: Treatment

Social anxiety disorder is treated either by behavioral therapy or a combination of behavioral therapy and medication. Children beginning a program of therapy and medication usually don’t take medication for long.

Psychotherapeutic: Children with social anxiety disorder will benefit from cognitive behavioral therapy (or CBT), which is a kind of therapy that teaches kids how to overcome their fear and change anxious thought patterns. It also teaches kids coping skills that they can rely on when they are feeling anxious. Practicing social skills may also be part of treatment.

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.

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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 abuse problems. Social anxiety disorder can also lead to depression if untreated. Some children with social anxiety disorder may also have a disorder called selective mutism.