social anxiety disorder comorbidityThere is a high degree of comorbidity with other psychiatric disorders.

Social phobia often occurs alongside low self-esteem and clinical depression, due to lack of personal relationships and long periods of isolation from avoiding social situations.

To try to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to substance abuse. It is estimated that one-fifth of patients with social anxiety disorder also suffer from alcohol dependence.

The most common complementary psychiatric condition is unipolar depression.

In a sample of 14,263 people, of the 2.4 percent of persons diagnosed with social phobia, 16.6 percent also met the criteria for clinical depression.

Besides depression, the most common disorders diagnosed in patients with social phobia are panic disorder (33 percent), generalized anxiety disorder (19 percent), post-traumatic stress disorder (36 percent), substance abuse disorder (18 percent), and attempted suicide (23 percent).[27] In one study of social anxiety disorder among patients who developed comorbid alcoholism, panic disorder, or depression, social anxiety disorder preceded the onset of alcoholism, panic disorder and depression in 75 percent, 61 percent, and 90 percent of patients, respectively.

Avoidant personality disorder is also highly correlated with social phobia.

Because of its close relationship and overlapping symptoms with other illnesses, treating social phobics may help understand underlying connection in other psychiatric disorders.

There is research indicating that social anxiety disorder is often correlated with bipolar disorder.

Some researchers believe they share an underlying cyclothymic-anxious-sensitive disposition.

In addition, studies show that more socially phobic patients treated with anti-depressant medication develop hypomania than non-phobic controls.

This can be seen as the medication creating a new problem, and also has this adverse effect in a proportion of those without social phobia.

Causes and perspectives

Research into the causes of social anxiety and social phobia is wide-ranging, encompassing multiple perspectives from neuroscience to sociology.

Scientists have yet to pinpoint the exact causes.

Studies suggest that genetics can play a part in combination with environmental factors.

Genetic and family factors

It has been shown that there is a two to threefold greater risk of having social phobia if a first-degree relative also has the disorder.

This could be due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning or parental psychosocial education.

Studies of identical twins brought up (via adoption) in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30 percent and 50 percent more likely than average to also develop the disorder.

To some extent this ‘heritability’ may not be specific – for example, studies have found that if a parent has any kind of anxiety disorder or clinical depression, then a child is somewhat more likely to develop an anxiety disorder or social phobia.

Studies suggest that parents of those with social anxiety disorder tend to be more socially isolated themselves (Bruch and Heimberg, 1994; Caster et al., 1999), and shyness in adoptive parents is significantly correlated with shyness in adopted children (Daniels and Plomin, 1985);

Adolescents who were rated as having an insecure (anxious-ambivalent) attachment with their mother as infants were twice as likely to develop anxiety disorders by late adolescence, including social phobia.

A related line of research has investigated ‘behavioural inhibition’ in infants – early signs of an inhibited and introspective or fearful nature.

Studies have shown that around 10-15 percent of individuals show this early temperament, which appears to be partly due to genetics.

Some continue to show this trait in to adolescence and adulthood, and appear to be more likely to develop social anxiety disorder.

Coping and support

Coping with social anxiety disorder can be challenging.

Having social anxiety disorder can make it difficult for you to go to work or school, to interact with other people, or even to visit the doctor.

But maintaining connections and building relationships are key ways to help cope with any mental disorder.

Over time, treatment can help you feel more comfortable, relaxed and confident in the presence of others. In the meantime, don’t use alcohol or illicit drugs to try to get through an event or situation that makes you anxious.

Some positive coping methods include:

* Banishing negative thoughts about yourself
* Practicing relaxation exercises
* Adopting stress management techniques
* Reaching out to people you do feel comfortable around
* Joining a support group
* Engaging in pleasurable activities, such as exercise or hobbies, when you feel anxious
* Getting enough sleep
* Eating a well-balanced diet
* Setting realistic goals

As difficult or painful as it may seem initially, don’t avoid situations that trigger your symptoms.

By regularly facing these kinds of situations, you’ll continue to build and reinforce your coping skills.

Over time, doing this can help control your symptoms and prevent a relapse of your condition.

Remind yourself that you can get through anxious moments, that your anxiety is short-lived, and that the negative consequences you worry about so much rarely come to pass.


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