So, what are the causes of social anxiety disorder?
Researchers have been preoccupied with this question for decades
and it turns out to be a tough one to answer.
There has been a lot of progress in identifying its possible causes over the years, however
and a number of influential factors have been uncovered.
There is emerging evidence that there are several pathways that can lead to the development of SAD.
Current literature also points out that it is likely that an individual suffering from it has been affected by a combination of these factors.
But this is not to be the case for everyone.
Even though researchers have not been able to associate specific genes with social anxiety, data point toward familial links.
The children of socially anxious parents are more likely to suffer from it than the children of non-socially anxious people.
Thus, it has a tendency to run in families, and therefore
it can be concluded that there seems to be a moderate genetic component to it.
One way through which our genes influence our reactions to certain stimuli is temperament.
When thinking of temperament, we usually picture uncontrollable outbursts of anger
But in the case of social anxiety disorder, it is a different type of temperament playing a causal role for many people.
In comparison to most individuals who can engage with new people and situations more or less easily,
this subgroup displays rather precautious and avoidant behavior and tends to react with increased sensitivity when faced with unfamiliar stimuli.
There is an increased risk of developing SAD for people who exhibit a stable childhood temperament of behavioral inhibition.
Another factor that has been found to have an influence on the development of social anxiety is the attachment style of a person.
In a famous study conducted by Mary Ainsworth, a young child and her primary caregiver are brought to a lab,
separated for a short period of time, and then reunited again.
Of special interest is the behavior of the child in this process.
A securely attached child will display distress on separation from her or his mother but calms down relatively easily when reunited with her.
While about 60% of people account for this group, three types of insecure attachment styles have been described as well:
the insecure ambivalent style, the anxious avoidant type, and the disorganized type.
An insecure attachment style has been found to increase the chances of developing social anxiety disorder.
Many people suffering from SAD report having been raised by parents that are overprotective, controlling, insensitive, rejecting and emotionally distant.
Therefore, a controlling and rejecting parenting style is believed to be another predisposition for the development of social anxiety.
Parents of people suffering from SAD may also:
overemphasize the opinion of others, socially isolate their offspring when they are children, or use shame as a disciplinary procedure.
Many people suffering from social anxiety can recall an experience
which seemed to cause the onset of the disorder in their lives or which worsened their symptoms drastically,
such as struggling when reading out loud in front of class and being laughed at as a result.
In a survey conducted in 1985,
58% of people suffering from social anxiety reported a traumatic experience being responsible for the outbreak of their problem.
It can be concluded therefore
that direct conditioning through traumatic experiences accounts for another possible cause.
Experiments with non-human primates have demonstrated the powerful impact of observational learning of fear responses,
which leads to speculations about the causation of social fears by observing another human being experiencing a traumatic social event.
Especially for individuals who have socially anxious parents this might be a relevant cause.
Another way children can acquire a fearful attitude from their parents
is by observation and interpretation of their parents’ verbal and non-verbal behavior.
It has been speculated that this also accounts for socially fearful behavior,
as children witness their parents being anxious around others or avoiding certain social situations.
Thus, the child learns to be socially anxious by so called information transfer.
Negative life events and stressors, especially in childhood, also seem to be able to set the stage for the development of SAD.
Literature names things such as: moving various times during childhood
being sexually abused, parents’ divorce, child illness, psychopathology of a parent, and family conflict.
SAD seems to be associated with poor social performance,
although there are many people suffering from social anxiety who don’t seem to lack social skills.
A vicious cycle was proposed, in which SAD sufferers show poor social performance,
which results in negative social experiences.
These experiences lead to more anxiety, which in turn leads to avoidance of social situations.
Avoiding social situations, they are less likely to gain better social skills,
which reinitiates the cycle by letting them perform poorly in future social interactions.
Another, well researched trait of people suffering from social anxiety are so called “errors in thinking”.
There are many, but among the most typical ones are focusing on threatening cues instead of positive ones
and interpreting ambiguous social situations in a negative way;
anticipating negative social outcomes and having lower expectations for ones own social performance.
And overestimating the likelihood and cost of negative social outcomes.
It is important to keep in mind that it is not clear
whether cognitive biases form part of the causes or simply are a result of social anxiety.
Even though there is not enough evidence to prove the existence of structural abnormalities in SAD,
there have been some interesting findings that suggest certain biological differences.
It has been found that people with SAD show a stronger cortisol response when performing in front of an audience.
People with generalized social anxiety seem to show a low dopamine system activity;
and SAD seems to be associated with hypersensitive, postsynaptic 5-HT receptors.
The specific subtype of SAD shows a clearly higher heart rate activity in public speaking tasks;
and the amygdala, which is also called “the fear center of the brain”, tends to show greater activation for certain stimuli.
We got to be careful here as well, since we don’t know whether these are causes or manifestations of social anxiety disorder
and if they are specific to SAD or also account for other anxiety disorders.
There are other possible causes for social anxiety which are very difficult to be determined by science,
because they are highly specific to each individual.
An example could be the development of SAD in order to protect the individual from overwhelming situations,
because she has never learned to take into account her own needs and desires when being around others.
The anxiety symptoms, in this case,
could be an unconscious strategy to stay away from others and be able to meet her own needs, which otherwise would never be met.
Another very interesting factor is the culture an individual grows up in.
While in Western countries, such as Germany, France and the United States,
being socially reserved and shy is seen as a negative personality trait,
in East Asian countries such as Japan and China, people show much more positive attitudes towards these features.
This, of course, not only causes big differences in the suffering the disorder provokes,
but also leads to less prevalence in East Asian countries and higher prevalence in Western culture,
where the disorder has a more negative impact on the quality of life.
Wrapping up:
even though research is ongoing and much remains unknown to us so far
we already have a good idea of the possible causes of social anxiety disorder.
Not all of them have to play a role for each individual,
and it is likely that a combination of some of these factors
plays a causal role in the development of SAD for most affected people.