Social Phobia: Causes and perspectives

Research into the causes of social and 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 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 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 disorder or clinical depression, then a child is somewhat more likely to develop an disorder or . Studies suggest that parents of those with social disorder tend to be more socially isolated themselves (Bruch and Heimberg, 1994; Caster et al, 1999), and in adoptive parents is significantly correlated with 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 disorders by late adolescence, including .

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 disorder.

Social experiences

A previous negative social experience can be a trigger to . perhaps particularly for individuals high in ‘interpersonal sensitivity’. For around half of those diagnosed with social disorder, a specific traumatic or humiliating social event appears to be associated with the onset or worsening of the disorder; this kind of event appears to be particularly related to specific (performance) , for example regarding public speaking (Stemberg et al., 1995). As well as direct experiences, observing or hearing about the socially negative experiences of others (e.g. a faux pas committed by someone), or verbal warnings of social problems and dangers, may also make the development of a social disorder more likely. Social disorder may be caused by the longer-term effects of not fitting in, or being bullied, rejected or ignored (Beidel and Turner, 1998). Shy adolescents or avoidant adults have emphasised unpleasant experiences with peers or childhood bullying or harassment (Gilmartin, 1987). In one study, popularity was found to be negatively correlated with social , and children who were neglected by their peers reported higher social and fear of negative evaluation than other categories of children. Socially phobic children appear less likely to receive positive reactions from peers and anxious or inhibited children may isolate themselves.

Social/cultural influences

Cultural factors that have been related to social disorder include a society’s attitude towards and avoidance, affecting ability to form relationships or access employment or education. One study found that the effects of parenting are different depending on the culture - American children appear more likely to develop social disorder if their parents emphasise the importance of other’s opinions and use shame as a disciplinary strategy (Leung et al., 1994), but this association was not found for Chinese/Chinese-American children. In China, research has indicated that shy-inhibited children are more accepted than their peers and more likely to be considered for leadership and considered competent, in contrast to the findings in Western countries. Purely demographic variables may also play a role - for example there are possibly lower rates of social disorder in Mediterranean countries and higher rates in Scandinavian countries, and it has been hypothesised that hot weather and high-density may reduce avoidance and increase interpersonal contact.

Problems in developing social skills, or ’social effectiveness’, may be a cause of some social disorder, through either inability or lack of confidence to interact socially and gain positive reactions and acceptance from others. The studies have been mixed, however, with some studies not finding significant problems in social skills while others have. What does seem clear is that the socially anxious perceive their own social skills to be low. It may be that the increasing need for sophisticated social skills in forming relationships or careers, and an emphasis on assertiveness and competitiveness, is making social problems more common, at least among the ‘middle classes’. An interpersonal or media emphasis on ‘normal’ or ‘attractive’ personal characteristics has also been argued to fuel perfectionism and feelings of inferiority or insecurity regarding negative evaluation from others. The need for social acceptance or social standing has been elaborated in other lines of research relating to social

Evolutionary context

A long-accepted evolutionary explanation of is that it reflects an in-built ‘fight or flight’ system, which errs on the side of safety. One line of research suggests that specific dispositions to monitor and react to social threats may have evolved, reflecting the vital and complex importance of social living and social rank in human ancestral environments. Charles Darwin originally wrote about the evolutionary basis of and blushing, and modern evolutionary psychology and psychiatry also addresses in this context. It has been hypothesised that in modern day society these evolved tendencies can become more inappropriately activated and result in some of the cognitive ‘distortions’ or ‘irrationalities’ identified in cognitive-behavioural models and therapies

Neurochemical and neurocognitive influences

Some scientists hypothesize that is related to an imbalance of the brain chemical serotonin. Sociability is also closely tied to dopamine neurotransmission. Low D2 receptor binding is found in people with social .The efficacy of medications which affect serotonin and dopamine levels also indicates the role of these pathways. There is also increasing focus on other candidate transmitters, e.g. Norepinephrine, which may be over-active in social disorder, and the inhibitory transmitter GABA.

Individuals with social disorder have been found to have a hypersensitive amygdala, for example in relation to social threat cues (e.g. someone might be evaluating you negatively), angry or hostile faces, and while just waiting to give a speech.Recent research has also indicated that another area of the brain, the ‘Anterior cingulate cortex’, which was already known to be involved in the experience of physical pain, also appears to be involved in the experience of ’social pain’, for example perceiving group exclusion.

Psychological factors

Research has indicated the role of ‘core’ or ‘unconditional’ negative beliefs (e.g. I am inept) and ‘conditional’ beliefs nearer to the surface (e.g. If I show myself, I will be rejected). They are thought to develop based on personality and adverse experiences and to be activated when the person feels under threat.[49] One line of work has focused more specifically on the key role of self-presentational concerns.The resulting states are seen as interfering with social performance and the ability to concentrate on interaction, which in turn creates more social problems, which strengthens the negative schema. Also highlighted has been a high focus on and worry about symptoms themselves and how they might appear to others.A similar model emphasises the development of a distorted mental representation of their self and over-estimates of the likelihood and consequences of negative evaluation, and of the performance standards that others have. Such cognitive-behavioral models consider the role of negatively-biased memories of the past and the processes of rumination after an event, and fearful anticipation before it. Studies have also highlighted the role of subtle avoidance and defensive factors, and shown how attempts to avoid feared negative evaluations or use ’safety behaviours’ (Clark & Wells, 1995) can make social interaction more difficult and the worse in the long run. This work has been influential in the development of Cognitive Behavioural Therapy for social disorder, which has been shown to have efficacy.

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May 10, 2008 | Filed Under Mental Disorders 

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