1. What are the signs of social anxiety?

Individuals with social anxiety or social phobia will have serious anxiety when having to interact with others, being observed or when performing in front of others.

Kids will try to avoid these situations and may express themselves by crying, tantrums, clinging to their parents, and inability to speak in social situations. The fear typically last for more than six months. It is a huge suffering for these children.

For adults, they may avoid social interactions particularly in big groups and shy away from presentations or public speaking. These can affect their social life as well as limit their career prospects.

2. How is it different from shyness?

In shyness, the anxiety is not so intense and despite initial mild fear, shy individuals often warm up and are able to interact or to perform.

In social anxiety, the fear is out of proportion and extremely intense. Also, shyness does not disrupt the one’s life significantly while those with social anxiety disorder will not be able to function normally in the social situations they fear.

3. What are some causes?

Causes of social anxiety are unfortunately unknown. It is likely due to a combination of genetic and environmental factors.

In individuals with social anxiety, it is believed that there exist an imbalance in the serotonin (a neurotransmitter) levels in the brain.

Environmental stress and negative experiences like bullying and abuses have to found to be associated with social anxiety.

4. Is it more common now than before?

Social Anxiety Disorder is fairly common. As stigmatisation over mental illnesses have improved, many more people are seeking help early. I do believe that seeking help early prevents the anxiety from seeping into the personality and helps avoid chronic anxiety or anxious personality in adulthood.

5. What are some strategies family members can adopt to help patients cope and overcome their anxiety?

Should a child or an adult be diagnosed with social anxiety disorder, a treatment plan will be initiated by the psychiatrist or psychologist. Treatment may include medication and therapy, and loved ones should assist the patients in complying with the treatment plan.

Parents or spouses should avoid being punitive on the patients, and they can help by staying calm themselves when the patients refuse or avoid certain situations due to their fear or anxiety.

A gradual exposure approach will often be adopted and family members will be enlisted to help with exposing the child slowly and gradually to the feared situation.

A Case Illustration

An nineteen year old girl who has always been shy started to refuse to go to school. She feels she is under the spotlight in situations where they are many people, and worries about being judged. She experiences pounding heartbeat and shortness of breath in these situations and cannot talk. Initially, she was unable to present in front of her classmates and would be quiet during group discussions. Her fears and anxiety became worse and she could not attend school assembly or go for recess. Her condition deteriorated and she started becoming anxious about going to school, and refused to do so.

Her school teachers encouraged the family to seek help with professionals. With a combination of medication form her psychiatrist and therapy from a psychologist, she improved and was able to return to school.