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Social Anxiety Disorder in Teens

By Matthew Dobbertin, D.O.

​​​Social anxiety disorder also known as social phobia is when an individual has a severe fear of being watched and judged in social or performance situations. Your child or adolescent may fear looking foolish and may become embarrassed causing disruptions from normal daily life such as making friends or going to school.

The disorder is not just about being shy where typically an individual will relax after a few minutes. The disorder causes extreme shyness, making the individual feel tense and on edge around others, and difficult to maintain social relationships. The individual may panic when thinking about social situations and worry for hours afterwards. A person with social anxiety may feel powerless, alone or even ashamed, which can lead to lack of self-confidence, self-esteem and depression.

Social anxiety usually starts in the teen years around 13 years of age but can begin during childhood. According to the Anxiety and Depression Association of America (ADAA) about 15 million American adults have social anxiety disorder and as many as 36 percent of individuals wait around 10 or more years before seeking help. Without treatment, social anxiety disorder can last a lifetime but with proper treatment, the disorder can be managed.

Cause

The exact cause is not known but the brain makes chemicals that affect thoughts, emotions and actions. Without the proper chemical balance, there may be problems with the way an individual thinks, feels or acts.

  • Social anxiety tends to run in families although it is not known if this is caused by genetics passed from parent to child. Children could be learning the behavior from watching their parents and adapting the same fears.
  • Social anxiety may occur after a frightening or hurtful experience such as being bullied or abused. Being very self-critical can also be a factor.

Symptoms

  • Trembling voice, fast or irregular heartbeat, hot and flushed skin, sweaty palms, nausea, headaches or stomachaches
  • Anxiety when the individual is the focus of attention, even for a short time
  • Fear of being judged, rejected or that other people will notice the nervous state
  • Fear of being embarrassed so severe that the individual excludes themselves from school or social activities
  • Fear of unfamiliar places

Diagnose and Treatment

Working with a mental health therapist who specializes with anxiety disorders could help differentiate and target the different kinds of anxieties the individual may have. Your child's healthcare provider will ask about symptoms, medical and family history, study your child and any medicines the child may be taking.

The first step to begin treatment is to understand the disorder. Cognitive behavior therapy (CBT) helps individuals learn what causes anxious feelings and how to control them. CBT might also include social skills training, role-playing and learning relaxation skills.

Exposure and response prevention therapy (ERPT) helps individuals face fears by learning ways to control their body's response to anxiety such as breathing exercises. Sometimes medicine may be used as well as therapy. Your child’s healthcare provider will work with you and your child to select the best medicine.

Managing and Helping as a Parent

  • Support your child by listening and letting him/her express their feelings. Do not try to force him/her to share and do not criticize after listening to his/her story. Instead, let your child know that you are there to support him/her.
  • Make sure your child’s providers such as babysitters and teachers know the situation so they know how to approach your child properly.
  • Help your child learn to manage stress by using relaxing tactics such as deep breathing when feeling stressed. Help your child find ways to relax with a hobby, listening to music, reading or taking walks.
  • Take care of your child’s physical health by eating a healthy diet, getting enough sleep and exercise every day. Try to avoid unnecessary stimulants such as alcohol, caffeine and drugs.
  • Check and help manage your child’s medicine and always check-in with your healthcare provider to make sure everything is up-to-date and used properly.

Contact your healthcare provider if you have any questions or your child’s symptoms seem to be getting worse and seek immediate attention if your child or teenager has ideas of suicide or harming others.