This document discusses social anxiety disorder and its effects. It begins by providing background on social anxiety, including prevalence rates and common symptoms. It then explores several causes of social anxiety, such as perceived social skills deficits, uncertainty, and fear of intimacy. The diagnostic criteria for social anxiety from the DSM-5 is outlined. Finally, it notes that social anxiety can have long-lasting effects, particularly on one's ability to form intimate relationships.
This document discusses social anxiety disorder and its effects. It begins by providing background on social anxiety, including prevalence rates and common symptoms. It then explores several causes of social anxiety, such as perceived social skills deficits, uncertainty, and fear of intimacy. The diagnostic criteria for social anxiety from the DSM-5 is outlined. Finally, it notes that social anxiety can have long-lasting effects, particularly on one's ability to form intimate relationships.
This document discusses social anxiety disorder and its effects. It begins by providing background on social anxiety, including prevalence rates and common symptoms. It then explores several causes of social anxiety, such as perceived social skills deficits, uncertainty, and fear of intimacy. The diagnostic criteria for social anxiety from the DSM-5 is outlined. Finally, it notes that social anxiety can have long-lasting effects, particularly on one's ability to form intimate relationships.
This document discusses social anxiety disorder and its effects. It begins by providing background on social anxiety, including prevalence rates and common symptoms. It then explores several causes of social anxiety, such as perceived social skills deficits, uncertainty, and fear of intimacy. The diagnostic criteria for social anxiety from the DSM-5 is outlined. Finally, it notes that social anxiety can have long-lasting effects, particularly on one's ability to form intimate relationships.
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Social Anxiety and its Effects1
Running Head: SOCIAL ANXIETY
SOCIAL ANXIETY AND ITS EFFECTS ON INTIMACY
Caitlin A. Meleski Glen Allen High School Social Anxiety and its Effects2
Introduction
Social Anxiety Disorder, otherwise known as SAD, is nationally recognized as the third
most prevalent emotional disorder among all age groups today (Mekuria, et al., 2017). A review
of epidemiological studies found that the lifetime prevalence of social phobia in adults varied
between 2% and 5% with a female:male ratio of 2.5:1.2 Patients typically do not consult their
family doctor until they have had the condition for many years, therefore receiving little to no
treatment. The chronic course increases the risk of comorbid conditions, which may mask the
social anxiety and lead the diagnosis to another mood disorder such as depression. The lifetime
prevalence of social phobia in young adults (mean age 18 years) was found to be 23% (Den
Boer, 1997). This disorder is thought to have a long list of lifelong effects, most of which the
general public is unaware of. These effects can include physical, cognitive, and behavioral
symptoms, all of which greatly affect a person’s development later on in life even if they were
able to overcome the severity of the disorder. Effects can be declared as simple and less
noticeable such as blushing or sweating, however they can range to much more severe
implications such as paresthesia and disorientation. Multiple effects (and combinations of
effects) are possible and depend specifically on the patient themselves, but one of the most
hypothesized detrimental and long lasting is its effect on the ability to adequately form and
maintain intimate relationships with others (Zaider, Heimberg, & Iida, 2010). The only way to
properly understand the true effects this disorder can have, it is crucial to have an understanding
of what the definition and diagnosis of the disorder is, as well as the environmental factors that
contribute to its influence. In this paper, levels of distress in intimate relationship for either party
– not just the diagnosed – will be discussed as the overall quality of both romantic and platonic
relationships are assessed through the relationship satisfaction scale (Zaider, Heimberg, & Iida, Social Anxiety and its Effects3
2010). The effects of social anxiety, while having already proven serious in generalized terms,
strongly affect the basic ability of a diagnosed patient to form strong, intimate relationships that
people strive for.
Causes of Social Anxiety
One of the first theories researched on the causation of social anxiety was that of
Schlenker and Leary who concluded that social anxiety arises when people are motivated to
make a “preferred impression on real or imagined audiences but doubt that they will do so”
(Schlenker & Leary, 1982). The perceived failure or inability to obtain desired outcomes in
social situations has been publicly viewed as a major antecedent of anxiety – however social
anxiety specifically focuses on the aftermath of an anxiety-causing situation and the judgement
of their peers regarding their actions during it. An existing method of literature on social anxiety
has deemed that this falls into a specific model known as the Cognitive self-evaluation model. It
states that social anxiety results not necessarily from an objective skills deficit, but from the
individual’s perception of personal inadequacies. Research has shown that socially anxious
people tend to underestimate their social skills (Schlenker & Leary, 1982). The inability to
believe that oneself is capable of possessing these skills can in turn lead to them believing that
they are not capable of having the relationships that stem from the usage of these skills. Feeding
into this, uncertainty has been deemed one of the most notable causes of social anxiety – and
anxiety in general – and it has additionally been concluded that anxiety is directly related to the
degree of ambiguity in the situation to which the individual must make some “adjustive reaction”
(Schlenker & Leary, 1982). Schlenker and Leary’s research discovery of the cause of uncertainty
allows them to pinpoint the specific emotions that lead to the causation of social anxiety. Social Anxiety and its Effects4
Uncertainty is also heightened when unexpected events occur, as when an
embarrassing incident happens or people are interacting with others who are unpredictable. Unexpected events disrupt the ongoing interaction and thrust the participants into a state of uncertainty (Goffman, 1967). Geller, Goodstein, Silver, and Sternberg (1974) found that when others violate the implicit rules of social interaction—by ignoring an individual, for example—the situation becomes ambiguous and the individual reports feeling shy.
In today’s society, social media has taken a large role in the development of this disorder
in adolescents. Unsettling anxiety on social media is strongly linked to fear of personal failure
when seeing others’ successes broadcasted over all social media platforms. Self-consciousness
and need for perfectionism arise first which can further manifest into social anxiety. Social
networking sites such as Facebook and Instagram can also make existing social anxiety worse for
any given victim. These sites hold the expectation that people will virtually “friend” or “follow”
other users that they know and admire in real life. However, those with social anxiety typically
lack relationships in real life, allowing for them to have a lesser number of friends or followers
compared to their classmates. The comparison of online popularity between the patient and their
classmates can lead to a worsening of their anxiety, as they will believe that they are already
placed on a lower social pedestal and will act as if this were true (McKenna & Bargh, 2009).
Additionally, included within social anxiety rests a specific fear of intimacy. It has been broken
down into two levels – the fear of losing one’s self in a relationship and depend fully on someone
else, and the fear of losing the other or the fear of fully exposing your true self and then losing a
partner’s approval. This is based off of the previously made assumption that a successful
relationship is based off of a partner’s ability to feel comfortable having the right level of
dependence on their partner as well as remaining independent (Etkin & Wager, 2007). There was
been a notable, constant theory of visible understanding and causation of Social Anxiety Social Anxiety and its Effects5
Disorder, which in turn, will lead to an overall understanding of the effect it has on forming
intimate relationships – as the qualities triggering it are now in the known.
Diagnosis and Symptoms of Social Anxiety
Anxiety disorders are present in up to 13.3% of individuals in the U.S. and constitute the
most prevalent subgroup of mental disorders. A study entitled the “Epidemiological Catchments
Area Study” revealed the massive extent to which their prevalence held in the country. Despite
this, however, they are extremely hard to recognize compared to other mood and psychotic
disorders. “As a result of this management environment, anxiety disorders can be said to account
for decreased productivity, increased morbidity and mortality rates, and the growth of alcohol
and drug abuse in a large segment of the population (Bystritsky, Khalsa, Cameron, & Schiffman,
2013). The specific difference between social anxiety disorder and generalized anxiety disorder
is also defined by a “mugging test” which is used to allow the patient to determine which
elements of a situation is causing their anxiety, therefore narrowing down which type of anxiety
they possess. The verbal test is conducted in the following method: a patient is questioned on
how they would feel if they were to be mugged. Anxiety about the act itself differs from the
social anxiety earned from the concerns about evaluation by significant others of their
competence in dealing with such situations (Schlenker & Leary, 1982). Diagnostic criteria for
Social Anxiety Disorder is found within the DSM-5 (Diagnostic and Statistical Manual of Mental
Disorders). Specific requirements to be medically diagnosed with the disorder include “the
persistent, intense fear or anxiety about specific social situations because [one] may be judged,
embarrassed, or humiliated” and “fear or anxiety that is not better explained by a medical
condition, medication, or substance abuse” (Den Boer, 1997). Over the past 10 years, data has
been used in the attempt to refine the boundaries of diagnostic categories of anxiety disorders to Social Anxiety and its Effects6
a more specific description. This research shows that there is a broad overlooking of social
anxiety compared to that of other emotional and mental disorders, allowing it to go undiagnosed
and therefore worsen in years to come. Another significant problem with the present
classification of anxiety disorders is the absence of known etiological factors and of specific
treatments for different diagnostic categories. Studying the genetic groundwork of anxiety
disorders using molecular biological techniques as Bystritsky, Khalsa, Cameron, and Schiffman
have has previously failed to produce a single gene or a cluster of genes implicated as a causing
factor for any single anxiety disorder, even though some genetic findings exist for OCD and
panic disorder. In turn, there is a clear conclusion. Understanding how emotional reactivity, core
beliefs, and coping strategies interact in time should lead to more precise diagnoses and better
management of anxiety disorders (Bystritsky, Khalsa, Cameron, & Schiffman, 2013)
How Social Anxiety Affects Intimacy
Social Anxiety Disorder triggers feelings of self-deficit in which a victim will grow to
believe that he or she is incapable or undeserving of forming and keeping intimate relationships
with others. In a case study conducted by Zaider, Heimberg, and Iida, 33 married heterosexual
couples in which the female partner abided by the Diagnostic and Statistical Manual of Mental
Disorders’ criteria for a social anxiety disorder were followed and given baseline questionnaires
14 diary reports for the partners to complete separately at the end of the day regarding the quality
of their marriage. The results concluded based off of these results, 29.5% of couples in the
current sample had at least one partner who scored within the distressed range of marital
functioning. However, daily negative mood aggregated across the study period were significantly
higher for wives than husbands, which is predictable due to the wives’ disorders. Nearly 80% of
all the couples studied had one or more partner list communication as the main source of distress Social Anxiety and its Effects7
in their questionnaires. Out of this percentage, over half were men. A term called ‘emotional
cognition’ was given to this, being officially defined as the tendency to “catch” another person’s
distress and troubles when emotionally intimate with them (Zaider, Heimber, Iida, 2010). This
display of anxiety elicited high levels of distress, rejection, and devaluation from the partner in
the relationship and proves the hypothesis that social anxiety can directly affect the ability to
healthily maintain an intimate relationship, even with a marital partner. Most forms of anxiety
elicit strong reactions of fear, and the fear of intimacy specifically is compounded by a victim’s
“inner voice” allowing for the visualization of negative events and creating a downward spiral of
worry. Especially in romantic forms of intimacy and interaction, the most basic doubts of any
undiagnosed person become emotionally amplified for someone who has been diagnosed. These
can include simple worries such as the classic, “do they like me?” which is commonly answered
with a confirmation or rejection rather early on into a romantic situation. However, a victim of
Social Anxiety Disorder will cast this question much farther along into a relationship, quickly
escalating from “do they like me?” to “how long can this last?” or “what will happen once we
break up?” and “can I really take the rejection?” (Cuncic, 2017). Some people with GAD have an
intense desire for closeness to their partners (or friend), depending on them constantly for
support and reassurance. People with social anxiety will learn to become overly dependent on
those around them as well. In addition to this, people with SAD may find themselves prone to
overthinking, planning for all worst-case scenarios, being indecisive, fearing rejection, and
seeking out constant communication. An example of this is getting anxious due to simple tasks
such as if a partner or friend does not respond quickly to a text message. These anxiety-raising
thoughts can trigger abnormal and stressing behavior among relationships, actions which not
only affect the diagnosed patient, but their partner as well. A common reaction to a person Social Anxiety and its Effects8
possessing these thoughts is to become increasingly overbearing over their partner. A strong
symptom of social anxiety is the fear of communicating feelings to a partner out of fear of being
judged for them. It is because of this lack of communication that a diagnosed partner will result
in acting out in behaviors that represent common signs of a toxic relationship. In addition to
being overbearing, these qualities include being overly clingy and demonstrating anxiety through
jealousy or being insecure, turning away and holding back feelings that in turn always hurts a
partner and harms the relationship, retribution through being passive and ignoring a partner or
being extremely aggressive and turning small disagreements into screaming matches where the
anxiety is stemming from the fact of commitment in general, and the most direct way of behavior
– ignoring. Ignoring a partner out of fear of intimacy is the most insidious way to ruin a
relationship. Ignoring is also a stronger impact as it is not easily recognizable, and relationships
with this can become reliant on illusory bonds of intimacy without actually instituting effort to
avoid the fact of dealing directly with their underlying issues and communicating properly.
Treatment for Social Anxiety Disorder
Treatment for anxiety disorders has been speculated and tested for many years in the past,
however, it has been difficult to pinpoint one specified method that works a large sum of the
time. Drug therapy has been perceived be helpful in some cases, selective serotonin uptake
inhibitors probably being the most promising. However, treatment has often been hampered by
the presence of an additional psychological problem such as panic disorder, depression, or
substance abuse (Den Boer, 1997). Methods of proven treatment include monoamine oxidase
inhibitors, in which many recent studies have shown a better response in patients with social
anxiety treated with phenelzine (an irreversible monoamine oxidase inhibitor) than with
alprazolam or atenolol (Den Boer, 1997). However, drug induced behavior medications do not Social Anxiety and its Effects9
work universally for all patients of the disorder. Selective serotonin reuptake inhibitors have
been seen as a common method of treatment for depression and panic disorder – both of which
are comorbid with social phobia – therefore allowing coexisting emotional stressors to be
alleviated. Two specific inhibitors include fluvoxamine and sertraline, in which both were in
support the efficacy of these agents for this disorder (Stein, Fyer, Davidson, et al, 1999). Another
method proven beneficial that does not affect biologic inhibition is cognitive-behavioral therapy.
“Cognitive-behavioral therapy aims to help people to overcome anxiety reactions in
social and performance situations and to alter the beliefs and responses that maintain this behavior. One type of treatment, cognitive-behavioural group therapy, is given in 12 weekly sessions, each lasting about two and a half hours. It has six elements: cognitive-behavioural explanation of social phobia; structured exercises to recognise maladaptive drinking; exposure to simulations of situations that provoke anxiety; cognitive restructuring sessions to teach patients to control maladaptive thoughts; homework assignments in preparation for real social situations; and a self-administered cognitive restructuring routine.” (Den Boer, 1997).
This allows for an understanding to develop in what can aid social anxiety and, in turn, aid
the process of forming and maintaining intimate relationships. In addition to receiving
professional treatment for Social Anxiety Disorder, it is extremely beneficial for specific
precautions to be taken around diagnosed patients. In school environments specifically, there is a
lot of vulnerability for diagnosed patients. Ways to ease the anxiety in classroom settings include
having strong relationships with teachers, as the teacher can allow for the student to be excused
if facing an attack as well as offering an unconditional support system (Menzies, 1960).
Additionally, it can benefit patients strongly to build relationships with students outside of a
school environment, therefore, when the time to enter the classroom arrives, the diagnosed
student does not feel as if they are initially alone. It is heavily crucial that there is awareness of
this in order to be able to provide practical treatment for this disorder, especially for peers in high Social Anxiety and its Effects10
school social environments, where the victims are most susceptible to detrimental and long-
lasting effects. If a patient were to go untreated, the symptoms associated with it would rapidly
worsen over time, and they may lose the ability to ever regain normal conversational abilities.
Conclusion
Social anxiety places negative limitations on a victim’s ability to form and maintain
intimacy with others. Support has been obtained for this hypothesis, as there has been crucial
evidence researched regarding the development and diagnosis, direct effects on intimacy, and
treatment for these symptoms. Social Anxiety Disorder is commonly misconstrued with
agoraphobia and depression, as well as generalized anxiety disorder. By researching it
separately, the effects of the sole disorder have become clear and definitive (especially since
obtaining a clear history from the patient may be delayed by the patients' fear of social
interaction) as there is clear evidence as to the solution of reducing social anxiety and just how to
do so. Social Anxiety and its Effects11
References
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current Diagnosis and
Treatment of Anxiety Disorders. Pharmacy and Therapeutics, 38(1), 30–57.
Cuncic, C. (2017). How Social Anxiety Affects Dating and Intimate Relationships. VeryWell
