Let's continue learning about this debilitating disorder by exploring some of its possible causes.
When considering the causes of any mental health disorder, the field of clinical psychology currently uses a framework called the biopsychosocial perspective. That might sound complicated, but it's easy to understand when you break down the word biopsychosocial:
bio: the biological dimension of people (for example, the brain, neurotransmitters, hormones)
psycho: the psychological dimension of people (for example, our thoughts, emotions, behavior/choices)
social: the social dimension of people (for example, our positive or negative experiences in relationships)
The biopsychosocial perspective considers the biological, psychosocial, and social dimensions of any mental health disorder. I like to consider the cultural and spiritual dimensions of mental health disorders as well!
Now that we understand these dimensions, let's take a look at how they might help us understand the cause(s) of social anxiety.
Genetics: Social anxiety--like anxiety overall--may run in families. If you have a family member who suffers from social anxiety, you may be more likely to suffer from social anxiety yourself.
Neurotransmitters: These are like the chemical messengers within the brain. One neurotransmitter that may be involved in the social anxiety is serotonin. Recent research has suggested that people who experience social anxiety may generate too much serotonin in their brain (Frick et al., 2015). Another chemical messenger that may be involved is dopamine. Other recent research suggests that people experiencing social anxiety may actually have an imbalance in the serotonin and dopamine levels in their brain (Hjorth et al., 2019).
Brain regions: The amygdala (uh-MIG-duh-luh) is a part of the brain that regulates our response to fear. People who experience social anxiety may have an amygdala that is over-responding to social situations, which leads to anxiety. This is interconnected with serotonin and dopamine levels in the brain, as we just discussed.
Conditioning: This is another way of saying learning. We can learn (be conditioned) to fear certain things, including social situations. Perhaps we grew up in an environment where we were encouraged to stick by our parents' side no matter what, and that dynamic did not diminish as we grew older; we were discouraged from interacting socially and thus learned to fear social situations. Perhaps we learned vicariously by witnessing a parent/caregiver fear and avoid social situations due to their own social anxiety. This vicarious conditioning can be contagious, causing us to fear social situations ourselves over time.
Cognitive patterns: All of us have thoughts that run through our minds every day, but there may be some specific thought patterns that underlie social anxiety. One example is spotlighting--we may think about social situations as though we are under a spotlight, such that everyone and their mother is looking at us and only us! Another example is social perfectionism--thinking that we need to behave perfectly in social situations and those situations need to unfold perfectly as well. If we feel any nervousness or awkwardness, we may perceive the social interaction as less than perfect and therefore intolerable. (Pssst: the truth is that most people are not paying that much attention to us or anything for that matter... and most human interactions are normally a little awkward or make us a little nervous, and that's totally normal!)
Prepared learning: This is a fancy way of talking about evolution. There may be ways in which humans have adapted over time to fear certain things because avoiding them helped us survive. People with social anxiety are more likely to misinterpret people's faces as angry or critical; but this avoidance of angry or critical faces has served an evolutionary purpose and helped us survive as a species.
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Stressful life events: People who experience stressful or traumatic life events are more prone to experience anxiety, in general. With social anxiety, in particular, people may have a history of embarrassing or unpleasant social situations. Sometimes this can involve a history of being bullied, criticized, or rejected by others.
A global pandemic?: It's too soon to say, since we haven't had a chance to see a lot of research yet on the COVID pandemic as it relates to social anxiety (as of my writing this in March 2021). It stands to reason, however, that spending more than a year in social isolation has affected people's orientation to social situations. It might be the case that more people struggle with anxiety around social situations as they try to eventually reintegrate themselves into society over time.
Social skills: All of us have social skills, and we only have them because we've practiced them and will continue to do so for the rest of our lives! Sometimes, people with social anxiety have not had as many opportunities to practice social skills, or they weren't provided with gentle and respectful coaching of their social skills while they were growing up.
Parenting and attachment patterns: If you grew up with parents/caregivers who had a controlling or overprotective style of caring for you, this might relate to the development of social anxiety. This makes sense, when you think about it: that control or overprotection did not give you opportunities to develop confidence in your own ability to navigate social situations and solve problems.
The potential cultural causes of social anxiety are as many and varied as there are cultures of the world! Consider your own cultural context and aspects of your experience that may relate to social anxiety. If you're thinking, "this doesn't apply to me"--I would challenge you that we all have a cultural context and cultural identity. We all have a racial/ethnic identity as well. This relates to our own individual life experiences as well as those of the generations past to which we are connected.
For example, have you lived in another part of the country or in a different country for a time? How did that affect you and your social interactions where you live now? What values does your family hold dear and how are those consistent or inconsistent with other families? Have you experienced a lifetime of prejudice, discrimination, racism? What about your immigration history or that of your family? Different people in a family can have different levels of acculturation--the degree to which they have assimilated into the mainstream cultural context in which they currently live. This can definitely affect mental health, including experiences of social anxiety. These are just a few examples, but the potential factors within this cultural dimension are endless.
Similar to how potential cultural factors are endless, I would say the same for spiritual factors. The human soul and spirit are infinite, so it's difficult to pinpoint any one spiritual cause underlying social anxiety, out of respect for this infinite complexity. People have different worldviews, often held in conjunction with their spiritual or religious beliefs and practices.
Since my own worldview is informed by the teachings of Jesus, I often look to the ancient wisdom of the Bible for perspective on mental health disorders. There are probably a million scripture verses we could relate to anxiety in general and social anxiety, specifically. An example verse that comes to mind regarding social anxiety is "for God gave us a spirit not of fear but of power and love and self-control" (2 Timothy 1:7 ESV). I experience this verse as an invitation to grow out of fear (sometimes translated "timidity") into power, love, and self-control. The word "intimidation" literally means that timidity is inside a person.
This verse also points to the hope we have in Jesus, who is able to extinguish fears and give us his Holy Spirit when we ask. This is a spirit that can live inside of us, characterized by power, love, and self-control instead of fear. For some people, they can experience an immediate overnight transformation as part of their spiritual experience of Jesus. For other people, this same process involves years of embattled transformation out of fear into freedom. All of these experiences--and anything in between--are beautiful. All of them involve hope for victory over social anxiety. People sometimes value the immediate, miraculous transformation more than the long, drawn-out battle. Is it possible, however, that the latter carries an even heavier weight of glory?
...But What Is The Root Cause of Social Anxiety?
When discussing the causes of any mental health disorder, the most tempting question to ask is "But is it biological? Is it psychological? Is it social? Is it cultural? Is it spiritual?" We want to pin-point the one root cause and have certainty when answering the question "Why?"
I encourage people to take a more multidimensional view and consider that, in most cases, there's not necessarily one clear-cut cause of any mental health disorder. Human beings are complex, and our experiences are complexly created as well. For most people, there is a combination of risk and causal factors that combine over time to give rise to their experience of a mental health disorder. As always, it's important to keep in mind that everyone's experiences of social anxiety are different, and the respective cause(s) of social anxiety can vary from person to person as well.
Part of our drive to discover the root cause of any mental health disorder is probably because we assume that, if we know the root cause, then we know the one right solution. In most cases, with rare exceptions, knowing why in mental health treatment does not necessarily change what to do. The cause does not always change the treatment. The good news in the world of mental health treatment is that there are many beneficial, evidence-based treatments that help people overcome mental health suffering--regardless of the degree to which we understand the exact cause of the disorder. This usually involves therapy, medication, or a mix of both.
If you are suffering from social anxiety, it's important to seek mental health treatment. Regardless of the cause(s) of your social anxiety, treatment can help you overcome it by bolstering your social confidence and desensitizing you to social situations so that they don't spike your anxiety as much. This is a gradual process of "turning the dial down" from a 10 to something more like a 2 or 3. Remember that all humans feel a low level of nervousness in social interactions from time to time, but mental health treatment can make life much more livable for people with social anxiety!
Here are 68 coping skills to try for anxiety or depression today
Frick, A., Åhs, F., Engman, J., Jonasson, M., Alaie, I., Björkstrand, J., Frans, O., Faria, V., Linnman, C., Appel, L., Wahlstedt, K., Lubberink, M., Fredrikson, M., Furmark, T. (2015). Serotonin synthesis and reuptake in social anxiety disorder: A positron emission tomography study. JAMA Psychiatry, 72(8):794–802. doi:10.1001/jamapsychiatry.2015.0125
Hjorth, O.R., Frick, A., Gingnell, M. (2019). Expression and co-expression of serotonin and dopamine transporters in social anxiety disorder: a multitracer positron emission tomography study. Molecular Psychiatry. https://doi.org/10.1038/s41380-019-0618-7
Dr. Parke is a licensed clinical psychologist located in southern California. She is an Associate Professor of Psychology at Vanguard University, and she also provides therapy to children, teenagers, and college-aged young adults in her private practice.
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