The Telltale Signs
An uncomfortable flutter of the heart…sweaty palms…an uneasy turning of the stomach... Although they present with similar symptoms, experiencing anxiety and having an anxiety disorder are two different things. For example, someone might experience a jolt of nervousness when standing in a large, bustling crowd - but not every person who feels that jolt will have social anxiety disorder. While there are a variety of specific differences that set the two conditions apart, one of the main determinants is how frequently and consistently one’s anxiety is experienced. For a person to be diagnosed with social anxiety disorder (SAD), their anxiety surrounding social situations must persist for at least six months and cause them significant distress or impairment; they must also show other qualifying symptoms, such as fear that their behavior will be judged or cause them humiliation, and that social situations are either avoided or endured with great fear.[1] Notably, recent studies have found that the number of people meeting this criteria/who do have social anxiety disorder has been steadily increasing.
THE RISE OF SOCIAL ANXIETY DISORDER
Not only is social anxiety disorder becoming increasingly common each year, its prevalence is growing fast. Approximately 15 million adults in the United States are diagnosed with social anxiety disorder every year, totaling about 7.1% of the population.[2] As staggering as that number is, it’s likely that the number of individuals afflicted with social anxiety disorder is even higher than the number of those officially diagnosed. While the afore-mentioned statistic only represents adults, social anxiety disorder is actually more common among teens and adolescents. According to the Anxiety and Depression Association of America (2022), in most cases of social anxiety disorder, the individual began experiencing symptoms when they were only around 13 years old.[3] Furthermore, 36% of those who have social anxiety disorder report that they experienced symptoms for ten years or more before seeking help.[4] Combined with the fact that many people never get their social anxiety disorder diagnosed,[5] it’s likely that the number of people with social anxiety disorder is much higher than currently on record.
Jeffries and Ungar (2020) conducted a self-reported study of nearly 7,000 individuals, aged 16-29, across seven countries selected for their cultural and economic diversity: Brazil, China, Indonesia, Russia, Thailand, the United States, and Vietnam. They found that 36% of participants met the threshold for social anxiety disorder.[6] Despite previous research showing the U.S. had a 12% lifetime prevalence rate of SAD in 2005,[7] just fifteen years later Jeffries and Ungar found that participants in the U.S. reported the highest rate of this disorder - nearly 58%. Conversely, participants in Indonesia reported the lowest rates in the study, at 22.9% (which is still remarkable at nearly 1/4 of that cohort).[8]
It’s necessary to emphasize that Jefferies and Ungar’s study did not only ask participants whether or not they had social anxiety; they were also asked to rank statements describing common thoughts and fears experienced by those with SAD, based on how true the statement was for them. For example, statements participants were asked to rank included:[9]
“I get nervous if I have to speak with someone in authority.”
“I feel tense if I’m alone with just one other person.”
“I feel I’ll say something embarrassing when talking.”
As such, they were not only able to consider the amount of people who recognized themselves as having SAD, but also determine how many people did not consider themselves as having SAD yet still met the benchmarks to qualify. According to their findings, 18% of those interviewed claimed that they did not have SAD, but still exceeded the threshold needed to qualify. This statistic highlights the prevalence of SAD and how people may be experiencing it, but don’t recognize it, or view themselves as someone who does not have it.[10] Possible universal reasons for this situation include: 1) a lack of understanding what SAD is and/or how it presents and 2) cognizance of a perceived lack of societal acceptance of the disorder and subsequent denial of the condition.
WHY IS IT RISING?
There is no simple answer for what’s causing social anxiety disorder to increase in prevalence the way it has been, as dozens of factors are at play. One of the most prominent among these is the rise of social media. Because social media inherently offers us so many methods for connection that don’t require any face-to-face interaction, our over-reliance on it is causing us to become more socially anxious every year.[11] This is especially relevant when it comes to younger generations, who have increasingly liberal access to social media at younger and younger ages. With this shift toward virtual interaction during stages of life where we are developing our social functioning skills and abilities, the growing prevalence of social anxiety disorder in children and adolescents seems to be a natural consequence.
Fischler (2021) notes that another potential contributor to the rise of social anxiety disorder is that, for much of the population, there is less of a pressure for survival than there have been in previous generations. While not true in every case, it is generally (comparatively) easier to access food, water, and other necessities than it has been within the last few generations. Because of this, people’s attention has tended to shift more toward material goods, since there is, at large, less concern about where the essentials will come from.[12] Fischler adds this higher emphasis on material goods, money, and social appearance have a documented link to anxiety and depressive symptoms, and thus can be linked to the increase in SAD.[13]
The recent pandemic has also contributed to the growing prevalence of SAD. Much like the increasing commonality of social media, extended quarantine situations enacted during the pandemic resulted in people either not being able to normally socialize, or having to socialize through technology, such as via Zoom meetings or social media. People have grown accustomed to not having to interact in person; now that the public is starting to open again and business are returning to on-ground work policies, many are struggling to acclimate.[14] This is especially true of children who have, to some degree, grown up in the pandemic, since they had less opportunity to socialize than children in the generations before them.[15] Medina (2021) notes it is expected that young students who are experiencing in-person education for the first time will have much higher levels of anxiety about their schooling than previous generations, mainly because of the increased socialization required.[16]
WHO DOES IT AFFECT?
While there is no one clearly defined profile for the type of person who will develop social anxiety disorder, research has found that certain demographics have a higher likelihood of developing this disorder than others. Jefferies & Ungar (2020) note that those who are unemployed, have lower educational levels, and/or live in rural areas are more-likely to present with SAD. Conversely, the prevalence rates of social anxiety disorder are the lowest in low-income countries, and the highest in high-income countries,[17] despite the fact that it’s more common in individuals who are unemployed and have lower educational levels.
Gender, too, can play a role in the development of social anxiety. Females are more likely to qualify for social anxiety disorder than males[18] and report a higher number of social fears.[19] Further, the ways in which social anxiety manifests are often also affected by gender. Women are more apt to experience social anxiety in a professional setting than men are; they’ll be more likely to be anxious about speaking to authority figures or going through the process of interviews.[20] Men, on the other hand, are more likely to have social anxiety around issues such as dating.[21] There is also a difference in comorbidity based on gender, with men more likely to have comorbid externalizing (observable) disorders, while women are more likely to have comorbid internalizing disorders.[22]
However, possibly the clearest trend in the increase in prevalence of social anxiety disorder is age. On average, younger demographics, such as children and teens, are more likely to meet the benchmark for social anxiety disorder than older adults. Jefferies & Ungar (2020) found that 90% of new cases of social anxiety were reported to have occurred by the time the individual reached 23 years old,[23] with additional contributing factors comprising a higher reliance on the individual’s family unit as well as greater emphasis on peer acceptance.[24]
HOW CAN WE TREAT IT?
In most cases, social anxiety disorder is treated through talk therapy, medication, or a combination of the two. Most commonly, cognitive behavioral therapy (CBT) is used as the primary method of treatment.[25] Through CBT, the individual learns different ways of thinking about the difficulties that they face and find different (generally more productive) ways of behaving and reacting to troubling situations. Although it isn’t a quick-fix solution, CBT is considered to be the most effective treatment option for those with social anxiety disorder. In cases where an individual is prescribed medication to help mitigate symptoms of their social anxiety, they will be in the form of antidepressants, beta blockers, or anti-anxiety medications.[26]
If you are experiencing symptoms of anxiety or social anxiety, please reach out to a licensed mental health professional for guidance and treatment options.
Contributed by: Jordan Rich
Editor: Jennifer (Ghahari) Smith, Ph.D.
1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
2 Anxiety and Depression Association of America. (2022, October 28). Anxiety Disorders - Facts and Statistics. https://adaa.org/understanding-anxiety/facts-statistics
3 Ibid.
4 Ibid.
5 Jefferies, P., & Ungar, M. (2020). Social anxiety in young people: A prevalence study in seven countries. PLoS ONE, 15(9), 1–18. https://doi-org.baypath.idm.oclc.org/10.1371/journal.pone.0239133
6 Ibid.
7 Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62(6), 593-602.
8 Jefferies & Ungar (2020)
9 Ibid.
10 Ibid.
11 Ibid.
12 Fischler, S. (2021). The Rise Of Anxiety Over The Past 100 Years. CBT Baltimore.
https://www.cbtbaltimore.com/the-rise-of-anxiety-over-the-past-100-years/
13 Ibid.
14 Medina, E. (2021). How Young People’s Social Anxiety Has Worsened in the Pandemic. The New York Times. https://www.nytimes.com/2021/09/27/us/social-anxiety-pandemic.html
15 Ibid.
16 Ibid.
17 Stein, D. J., Lim, C. C. W., Roest, A. M., de Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E. J., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., Yanling He, Hinkov, H., Horiguchi, I., Chiyi Hu, & Karam, A. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15, 1–21. https://doi-org.baypath.idm.oclc.org/10.1186/s12916-017-0889-2
18 Jefferies & Ungar (2020)
19 Asher, M., & Aderka, I. M. (2018). Gender differences in social anxiety disorder. Journal of Clinical Psychology, 74(10), 1730–1741. https://doi-org.baypath.idm.oclc.org/10.1002/jclp.22624
20 Ibid.
21 Ibid.
22 Ibid.
23 Jefferies & Ungar (2020)
24 Ibid.
25 National Institute of Mental Health. (2022). Social Anxiety Disorder: More Than
Just Shyness. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness
26 Ibid.