Social Anxiety in Teens: Signs, Symptoms, and How to Help

What is Social Anxiety?

Social anxiety disorder (SAD) affects 1 out of 3 adolescents between 13 and 18 years old. Over 19 million people across America suffer from social anxiety disorder (SAD) today. It is the most common anxiety disorder and third most common mental health disorder in the country.  Social Anxiety Disorder, also known as Social Phobia, is marked by ongoing and pervasive fear of social interaction and/or situations where embarrassment might occur. While it is common to experience some anxiety in new social situations, individuals with social anxiety disorder feel overwhelming self-consciousness, distress, and fear of judgement in day-to-day social interactions. SAD prevents individuals from having normal relationships and interactions. It can also negatively affect normal daily activities. Additionally, those who suffer from SAD often experience intense worry about upcoming social situations (causing distress days or even weeks in advance).

People with social anxiety disorder frequently avoid social interactions all together. This leads to diminished relationships, withdrawal and overall isolation. Like many other anxiety disorders, those with SAD may realize and acknowledge that their anxiety is often unreasonable or unwarranted, but still find themselves trapped in the cycle of anxiety and fear of social humiliation or embarrassment. Strong physical symptoms, such as nausea, trembling, sweating, or blushing, may occur in sufferers even in “normal”, everyday social situations.

How Do I Know If My Teen Has Social Anxiety?

If you are a parent, then it is likely you hope your child will grow up feeling self-assured and comfortable in their own skin, as these characteristics are some of the most vital when it comes to thriving socially, and thus, achieving an overall sense of wellbeing.  Unfortunately, there are many children who mature into socially anxious teenagers.  This can happen for a variety of reasons, and there may be multiple factors that contribute to a teen’s social anxiety.

Risk Factors

As with most mental health disorders, social anxiety disorder is not attributed to one single cause.  Nonetheless, there are certain factors that can increase a person’s likelihood of developing SAD including genetics, brain chemistry, and/or trauma. This means those who have first-degree family history, chemical imbalances in the brain, or have experienced long-term stress or trauma may have an increased risk of being diagnosed with social anxiety disorder.

Social anxiety disorder tends to emerge in adolescence and because of this trend, mental health professionals have explored additional risk factors for this younger population.

• Demeanor – a child who is inherently shy, withdrawn, and/or apprehensive to try new things may be at an increased risk for the development of social anxiety disorder as they enter into the adolescent and teenager years.
• Health or Physical Issues – if a teen has any sort of health or physical problem that is noticeable to others (like a physical deformity, large scar, birthmark, etc.) they may be more prone to suffering from social anxiety.
• Speech Problems – having a speech impediment can be challenging for many reasons, and can negatively affect a person’s confidence and self-esteem. This is especially true with teenagers.  Low self-esteem often impacts a teen’s willingness to put themselves “out there” in social situations.  Unfortunately, the more time a teen (or anyone) spends alone and isolated, the harder it becomes to re-engage with others.
• Being bullied – bullying is unfortunately a very prevalent occurrence in schools and on the Internet. Being bullied can affect many areas of a person’s life, including social relationships.
• Parenting style – . Some medical and mental health professions attribute the development of SAD in teenagers to parenting styles. Much research indicates a strong correlation between overprotective parenting styles and social anxiety disorder in the child.  This could be because overprotective parenting styles may keep children from experiencing a healthy level of social interaction, and thus, lacking the opportunity to learn the necessary social skills.

Symptoms

If you notice your teenager is struggling socially, there is a chance they may be suffering from social anxiety disorder.  Knowing the signs and symptoms of this mental health disorder is the first step in helping your teen get the necessary help.

• Anxiety about being with other people (especially people they do not know)
• Difficulty talking to and/or having “normal” conversations with others
• Feeling uncomfortable or self-conscious around other people
• Experiencing embarrassment while interacting with others
• Fear of being embarrassed
• Self-judgment and criticism after social interactions
• Fear of being judged by others
• Worry for days or weeks before a public event
• Avoidance of public places and/or social situations
• Difficulty making friends and maintaining relationships
• Blushing, sweating, shaking, or rapid heart beat when in social situations
• Stomach aches and nausea as a result of being around other people (other physical symptoms may include – confusion, diarrhea, muscle tension)

Every teen with social anxiety disorder will experience the same symptoms (or same severity).  And while the symptoms can be quite significant and impair functioning in a variety of ways, social anxiety disorder is treatable.

Treatment Options for Social Anxiety

Treatment for a social anxiety disorder often involves psychotherapy, medication, or a combination of both.  A treatment plan for SAD is typically based on the severity and frequency of symptoms.

Psychotherapy

Cognitive behavioral therapy (CBT) is the most commonly used approach to treating social anxiety disorder (and anxiety disorders overall).  Cognitive behavioral therapy is typically short-term and goal-oriented.  For teens with social anxiety disorder, this method of psychotherapy targets the unhealthy thinking patterns and behaviors that drive the social anxiety, and provides the tools and skills to manage the thoughts and choose healthier behaviors. Cognitive behavioral therapy also helps teens with SAD understand the connection between their thoughts, feelings, and behaviors.

Exposure Therapy

While not as common as CBT, exposure therapy can be an effective psychotherapeutic approach for teens with social anxiety.  Exposure therapy gradually exposes the teen to their fears (while keeping them safe), while teaching helpful strategies for managing the fear.  Exposure therapy is based in the belief that the more a person encounters their fears, the less and less scary they become.  Exposure therapy also helps teenagers learn they can feel fear, and “do it” (whatever it is they are afraid of – in this case, social situations) anyways.

Medications

Medication is often prescribed to teenagers who struggle with social anxiety disorder, especially if SAD is significantly impacting their functioning. Overall, anxiety medication targets the brain’s emotional control center and aids in the circuits functioning more efficiently.  A variety of medications, combined with therapy, may be prescribed to teenagers with social anxiety disorder, including:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Typically prescribed for individuals with depression, SSRIs such as sertraline (Zoloft, citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac), help the brain to slow the re-absorption of serotonin (a neurotransmitter that regulates anxiety and overall mood).
• Benzodiazepines: Benzodiazepines fall under the class of medications called sedatives, and while they are not the typically the first course of treatment for teens with SAD (due to the addictive nature of the drugs, and the risk of developing a tolerance), they are sometimes prescribed. Benzodiazepines such as diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax), work by affecting the activity of the brain’s neurotransmitter GABA, and as a result, tend to have a calming effect on the parts of the brain that become “excitable” (which translates to anxiety for many).