Social anxiety disorder

Pretty much every classroom has at least one child who is painfully shy. This is the little boy or girl who sits in the corner and doesn't talk much, whose face turns beet red at the prospect of giving a class presentation and who often stands alone on the playground.

Shyness is a very common condition that has likely been around for as long as the human race. But this characteristic is more than simple introversion and researchers are now starting to plumb its depths to find out what causes shyness and how to help those afflicted with the more extreme form of shyness that is social anxiety disorder.

Once recent study in Europe examined third and fourth grade children for shyness. Researchers showed the children pictures of faces with different emotional expressions on them. Interestingly, the shyest children had a consistently hard time discriminating between neutral and angry faces.

This study found that shy children may simply be less able to understand and read facial expressions, which can be important in human interaction.

Shy individuals also show lower levels of activity in the cortex of the brain, where sophisticated thought occurs, but have higher activity in the amygdala- the centre for anxiety and alarm.

Behind these differences lie genetic predictors of shyness. Individuals who are shy tend to have shorter copies of a gene that regulates the neurotransmitter serotonin- known to play a role in anxiety, depression and other mood states.

If a child is born with this shortened gene, it is more likely he or she will exhibit shyness. But having the shorter gene doesn't necessarily mean a life of retreat from others. Environment also plays a role in shy behaviour. One study followed shy children from the age of two until young adulthood. Although two thirds of the children were still shy as adults, the other third overcame their inhibitions, suggesting that nurture can make a difference.

Parents of shy children can now be encouraged that it is possible to help a child learn to be less afraid in social situations. This is good news as children who resist new situations tend to internalize their feelings and are more likely to develop depression and anxiety later in life.

Building a child's self esteem and showing empathy regarding shyness are helpful. Also, letting your child know you understand and want to help can be soothing when new situations are encountered. It is also very important to encourage approach behavior in the face of anxiety rather than enabling avoidance, while at the same time not doing anything to make the child feel inadequate or guilty about his or her inhibitions.

Although you may be able to help your child to better cope in social situations, don't expect an entire personality change. A little shyness is not entirely bad, it can have a protective factor as shy children tend to do better in school and are less likely to get involved in violence, crime or gangs.

On the extreme end of the shyness spectrum is social anxiety disorder (SAD). This is a serious and persistent fear of social situations that can be crippling. SAD typically develops in young adulthood and involves more than simply being a little red-faced and self-conscious in front of a crowd.

This disorder affects almost 10 per cent of the adult population and causes dysfunction in the lives of sufferers. Individuals with SAD believe people are watching and judging them and are particularly fearful that others will notice their anxiety.

Common situations that cause distress for SAD sufferers include public speaking, writing, working or eating while others are watching, social gatherings, using public washrooms or being the centre of attention.

Often, a person with this disorder will go out of his or her way to avoid these situations and would rather fail or drop out of school than give an oral presentation.

By avoiding fearful situations, people with SAD typically do not perform to their potential in their careers or in building and maintaining personal relationships.

Fortunately, treatment is available for this condition. Cognitive behavioural therapy can be very helpful and there are a number of medications that can also alleviate symptoms.

At Okanagan Clinical Trials we are currently doing a study examining a new treatment for SAD. If you think you have social anxiety disorder and are between the ages of 18 and 65 call our office for more information.


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