SAD starts in childhood
Oct 2, 2013 / 5:00 am
Social Anxiety Disorder is characterized by fear of social situations. It usually includes some, if not all of the following; fear of criticism and disapproval; of authority figures; being the centre of attention; being watched working, eating or writing in public; speaking in public. It can include other less common elements such as fear of urinating in public washrooms, fear of blushing or trembling in public.
At its worst people with social anxiety avoid most if not all social situations. It can make education difficult since many courses require some public speaking and it can make finding and holding a job almost impossible. First there is the requirement to go for a job interview and then the job usually involves some form of training or evaluation which is very anxiety producing. Social phobics may have difficulty joining co-workers in the lunch room or talking to customers in person or even by phone.
Most people with social anxiety will report having been this way as long as they can remember. The childhood equivalent seems to be behavioural inhibition, which is characterized by an elevated fear response to both social and non-social novelty and social reticence by school age. Extreme childhood inhibition is relatively enduring and heritable. It may represent a marker for later Social Anxiety Disorder.
Early environmental factors also play a role in the development of inhibition. Monkeys exposed to early environmental upset and negative maternal behaviours tend to develop increased stress responses and stable fear-related behaviours. Children also have elevated stress hormones in response to negative maternal behaviours such as low engagement or hostility such as sometimes occurs in the presence of maternal depression.
Other important risk factors for elevated social anxiety in later life includes family psychiatric history, specific parenting behaviours, and adverse life events. School life experiences such as humiliating experiences in the classroom or bullying by peers are also probable potential contributors in individual cases.
Children who are highly inhibited are obvious targets for early intervention to ensure that they have corrective experiences that might serve to reduce their stress responses and encourage self-confidence. Putting these children on the spot in classroom settings or embarrassing them in the gym will only serve to exaggerate their natural tendencies.
Social Anxiety Disorder in adulthood is common (2%) and can be very debilitating. Treatment can involve various methods of facilitating approach to and engagement in anxiety producing situations. Avoidance of phobic situations only makes things worse. It is quite difficult to treat in adulthood and would be much more successfully prevented in childhood.
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