What are the different types of social anxiety disorder?
Not all people suffering from social anxiety are alike.
And although there are several things most sufferers have in common,
they can differ significantly in the amounts and types of situations they fear, their personality traits, and the areas they are functionally impaired in.
Not keeping these specific differences in mind is one of the reasons why therapy seems to work for only a certain proportion of socially anxious people,
and why some individuals can only make little improvements despite great efforts.
For this reason, it is crucial to recognize those differences and to divide socially anxious people into various subgroups.
The most common way of differentiating SAD sufferers is based on the number of situations they fear.
The generalized SAD subgroup is defined by fear in most social situations and it accounts for roughly half of all sufferers who seek help.
The nongeneralized subtype also fears most social situations but displays one area of normal functioning without anxiety;
and the specific subtype only fears a few specific social scenarios, with public speaking being the most common feared situation.
We can regard social anxiety disorder along a continuum, locating the specific subtype at one end of it
and placing the nongeneralized and generalized subtypes along it as the number of feared situations and functional impairment increase.
Generalized SAD also seems to differ from the other two subtypes by the earlier age of onset with under ten years of age,
compared to an average of sixteen years for the other two.
Generalized SAD has been shown to have a stronger genetic component related to it;
and, interestingly, the other two subtypes show stronger physiological reactions in performance situations, such as public speaking.
Another suggestion for discriminating SAD sufferers is based in the type of situation they fear.
The situations can be divided into three groups: performance situations, interaction situations, and observation situations.
Being afraid of performance situations is very common among people suffering from SAD,
and some actually only fear situations related to performance.
In fact, around twenty percent of outpatients account for a subgroup that only fears public speaking.
People with specific performance fears tend to show a greater heart rate reactivity in public speaking scenarios than other SAD sufferers
and are more likely to have experienced traumatic conditioning experiences.
Fears related to interaction and observation situations are not easy to separate since they tend to be intertwined.
Fears of interaction usually come along with fears of performance and observation situations;
and fears of being observed, such as when writing, or eating and drinking at public places, in most cases come along with performance and/or interaction fears.
Yet another way of distinguishing between individuals suffering from SAD is by looking on the focus of their social fears.
Besides the obvious and most commonly mentioned fear of behaving in an inept and unacceptable fashion,
there are two other subgroups that are crucial to keep in mind:
the subgroups whose focus lies on the physical symptoms of anxiety, and the subgroup that is especially afraid of offending others.
Those individuals who have their fear focused on the physical signs of anxiety
are particularly afraid of displaying observable symptoms of anxiety.
More than forty percent of SAD sufferers report it as their primary fear.
These people often have good social skills, but simply struggle with the fear of displaying physical symptoms of anxiety.
Another subgroup tends to have their fear focused on offending other people and can therefore be described as the offensive subtype.
They are mainly concerned with the fear of causing discomfort to others,
and this subtype is predominantly found in Japan, where the phenomenon has its own name: Taijin Kyofusho.
These concerns are thought to relate to collectivist cultural norms and individual tendencies to value interdependence and social harmony;
but in Western culture these fears seem to be frequent as well.
Regarding the personality traits of SAD sufferers, we can also distinguish between subgroups,
while the typical profile of a socially anxious person tends to be the following:
overregulated behavior, such as thinking rather twice before making a comment.
Low risk-taking and behaviorally inhibited,
which means being precautious, avoidant and displaying increased sensitivity, especially when faced with new stimuli;
and low aggression, with the features of being rather interdependent and social harmony-seeking.
Another, fundamentally different subgroup, displays rather aggressive tendencies,
tends to be impulsive, and is high novelty-seeking.
These characteristics come along with risky behaviors, such as unsafe sexual conduct and often substance abuse.
The typical profile of this subgroup are young males who experience an early onset of the disorder and have worse treatment outcomes in standard treatment.
In recent years there have been findings that suggest
that socially anxious people are actually pretty high in aggressive tendencies,
but only with certain people such as their family members.
Others, in contrast, might experience a lot of anger, but don’t allow it to manifest externally.
Differences between sufferers also emerge when looking at the functional impairment in different life domains.
The further we move from the specific subtype towards generalized SAD, the greater the functional impairment gets.
People suffering from generalized SAD tend to have fewer romantic relationships and friends,
and they are less satisfied with the quality of their relationships.
With less intense social anxiety, chances of having a romantic partner increase.
The stronger the anxiety, the more concerned the individuals tends to become about how his or her partner is perceived by others.
Also, higher levels of social anxiety seem to increase the tendency of wanting to be alone when with individuals one does not know well,
of being less assertive and of being more conflict avoidant;
and people with higher social anxiety also avoid conveying a lot of personal information about themselves.
With lower intense social anxiety people earn higher wages on average and are generally more satisfied with their lives.
Wrapping up:
There have been various proposals for the division of SAD sufferers into different subgroups.
One way of dividing is based on the number of situations feared by the individual,
ranging from generalized SAD, over nongeneralized SAD to the specific subtype which represents the subgroup with the least feared social situations.
Another attempt of dividing SAD sufferers focuses on the type of feared situations,
differentiating between performance situations, interaction situations, and observation situations.
And a third way of subgrouping takes a look at the focus of the social fears,
which relate to behavior, the physical signs of anxiety, and concerns about offending others.
When looking at the personality traits of SAD sufferers, we can find some typical traits, such as:
behavioral inhibition, demonstrating overregulated behavior, accompanied by low risk-taking and keeping a non-aggressive profile.
But there is another, fundamentally different subgroup,
that displays rather aggressive tendencies, is impulsive and high novelty-seeking.
What is more, some findings suggest that MOST SAD sufferers have aggressive tendencies,
which seems to come as a surprise, but can be explained by selective aggressive behaviors towards only certain individuals such as one’s family members,
by not manifesting the aggression outward or by repressing it in the first place.
And the functional impairment seems to be less intense when looking at individuals with the specific subtype
and more intense as we start speaking of individuals suffering from generalized social anxiety disorder.