Based on the World Health Organization (2017), depression is ranked as the greatest source of disability worldwide (with 7.5% of individuals in 2015 having depression) and anxiety disorder globally ranked as the sixth causing significant impairment (among 3.4% of individuals in 2015). The National Comorbidity Survey (Kessler et al., 2005) found that social anxiety is presented as the third communal disorder among individuals followed by depression and alcohol dependence.

What are the etiologies of social anxiety disorder?

Genetics factors

Several twin studies disclosed that there is a significant genetic influence of 30-40% on the emergence of social anxiety disorder (Beatty et al., 2002). Anxiety disorders are known to be transgenerational and passed on to individual’s offspring (Allain et al., 2022).

Biological and environmental factors

Studies show that social anxiety disorder likely results from a compound interaction of biological and environmental influences, like many other mental health illnesses (Allain et al., 2022).

People who were socially anxious consistently underperformed, had more negative self-evaluative views, and consistently underestimated their abilities (Stopa & Clark, 1993). There is a component in the brain responsible for eliciting fear when in danger called the amygdala. When an individual with social anxiety feels unsafe or threatened in a social event, their brain tends to trigger the fear response and increase cortisol levels, which results in them feeling anxious.

Neurobiological factors

Research studies indicated that the “extended amygdala” plays a crucial role in anxiety disorders (Rose & Tadi, 2022). When exposed to unfavorable or frightening facial expressions, those with social anxiety disorder have higher amygdala activity and frontal-striatal cortex. The white matter connection between the amygdala and orbitofrontal cortex was found to be lower than that of the medial prefrontal cortex. However, in several investigations of brain structure and functional connectivity in people with social anxiety disorder, the medial prefrontal cortex was found to be higher (Nagata et al., 2015).

Developmental Aspects

Children with social anxiety disorder are often found to have parents that are more likely to have a social anxiety condition (Rose & Tadi, 2022). Authoritarian parents may induce invasive and controlling parenting skills that have shown to result in withdrawn temperament in children leading to increased risk of social anxiety disorder (Rose & Tadi, 2022). The behavior is stated to be learned by classical conditioning (social stimulus is associated with a negative outcome) and through expectancies.

What theories say about intervention and treatment?

CBT compared to psychodynamic psychotherapy is regarded as an effective ascribed treatment and the best intervention for the initial treatment of social anxiety disorder (Rose & Tadi, 2022). However, SSRIs show the most consistent evidence of benefit for individuals who show a decline in psychological intervention (Hjorth et al., 2022). Medication can help in regulating neurotransmitter imbalance. CBT alone may not be sufficient in treating individuals with social phobia (Pearcey et al., 2021). Therefore, the combination of medication and CBT have complementary benefits (Nagata et al., 2015).

Conclusion

The article discusses three theories of psychopathology explaining social anxiety disorder. The first theory suggests that genetics factors play a significant role in the emergence of social anxiety disorder. Twin studies reveal a 30-40% genetic influence on social anxiety disorder. The second theory suggests that social anxiety disorder is likely the result of a compound interaction of biological and environmental influences. Individuals with social anxiety disorder consistently have negative self-evaluative views and trigger the fear response in their amygdala when feeling unsafe in a social situation. The third theory suggests that social anxiety disorder has developmental aspects, and children with social anxiety disorder often have parents with a social anxiety condition. Invasive and controlling parenting skills may lead to withdrawn temperament in children, increasing their risk of social anxiety disorder. Regarding intervention and treatment, cognitive-behavioral therapy (CBT) is regarded as an effective treatment for social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) show the most consistent evidence of benefit for individuals who show a decline in psychological intervention. Medication can help regulate neurotransmitter imbalance. While CBT alone may not be sufficient in treating individuals with social phobia, the combination of medication and CBT have complementary benefits. In summary, the article provides insight into the etiologies of social anxiety disorder, including genetic factors, biological and environmental influences, and developmental aspects. The article also suggests that a combination of medication and CBT may be an effective treatment for individuals with social anxiety disorder. The article also has clinical utility in providing healthcare professionals with a better understanding of the underlying causes of social anxiety disorder and effective treatment options.

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Ray Kaidbay

Ray Kaidbay is a current Psy.D. Clinical Psychology student at the Michigan School of Psychology. She completed her BA in Psychology at the American University of Beirut, and her MSc in Clinical Applications of Psychology in Kingston University London. She also co-founded a mental health initiative, after the August 4, 2020 explosion, called Be Brave Beirut that provides remote, free, and anonymous emotional support. She is the current Vice President of the Inclusion, Diversity, and Equity Alliance (IDEA), a member of APA and Psi Chi Society. Her aim is to keep raising awareness in populations that are primarily apathetic to mental health issues and to chip away at their stigmas.