Anxiety is a regular part of daily life. From children to adolescents to adults, we all experience relative degrees of anxiety as we navigate the world. Anxiety stems from fear: fear of failure, fear of embarrassment, or fear of bad things happening at some point in the future. Despite its negative connotations, anxiety can be healthy and helpful. In the big picture, anxiety is a positive human survival adaptation. It causes us to plan ahead, avoid mistakes, and ensure we prepare for the large and small challenges we face. Anxiety only becomes a problem when it interferes with the smooth management of typical daily tasks and interactions. When anxiety disrupts life, it’s no longer productive. It becomes what mental health professionals call an anxiety disorder.
Data from the National Alliance on Mental Illness (NAMI) shows anxiety is “the most common mental health concern in the United States.” Here are the statistics on the prevalence general anxiety disorders in the U.S.:
- Around 18% (40 million) of adults have an anxiety disorder.
- Around 8% (1.1 million) of children and adolescents experience the negative effects of an anxiety disorder.
Social Anxiety Disorder (SAD) is a sub-category of general anxiety. Specific research on SAD shows an estimated 7% of adolescents (just under 1 million) experience SAD symptoms. Early identification of SAD is critical because these adolescents have a greater risk of developing other mood and anxiety disorders as adults. The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM V) defines SAD by the following criteria:
- A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be embarrassing and humiliating.
- Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.
- The person recognizes that this fear is unreasonable or excessive.
- The feared situations are avoided or else are endured with intense anxiety and distress.
- The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
- The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.
- The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.
The most important part of this definition to understand is the persistence of the symptoms. To meet the diagnostic criteria, the symptoms need to last six months or more. This distinction is crucial because typical fears and anxieties come and go. New situations can cause stress and may be difficult to deal with at first. It may take adolescents weeks—or even a couple of months—to adjust to changes in their social life, such as enrolling in a new school or a family move to a new city. Every child is different, and parents should not rush to place a psychiatric diagnosis on an adolescent. However, if your gut tells you there is a significant problem, and your teen clearly suffers from social anxiety, it’s better to get help sooner than later.
Helping Your Socially Anxious Teen
The first rule, of course, is to listen with compassion and support your child when they’re struggling. Hear them out. Sometimes they may simply need to talk through their social issues. Listen without judgment and offer a safe space to work through daily problems. However, if extreme symptoms persist and you suspect your teen has clinically diagnosable SAD, it’s best to seek the help of a mental health professional for an evaluation. The American Academy of Child and Adolescent Psychiatry is an excellent resource for locating a licensed therapist in your area. If your teen is diagnosed with SAD, standard treatments include:
- Therapy: The most common therapy for SAD is Cognitive Behavioral Therapy (CBT). CBT is talk therapy designed to help patients identify their fears, learn coping mechanisms to process them productively, and apply these coping mechanisms in real-life situation.
- Medication: In extreme cases, beta-blockers, anxiolytics (anti-anxiety medications such as benzodiazepines), or anti-depressants may be prescribed to help teens suffering from SAD.
- Social Support: Since SAD often leads to isolation, peer-support groups can help teens work through their anxieties by creating a strong social support network that’s difficult to find in school or the world-at-large. These groups can be particularly effective since they offer the opportunity for teens to talk openly with others who have direct, personal experience with the issues they’re facing.
- Complementary Therapies: For families reluctant to use medications or traditional talk therapy, alternative approaches like Mindfulness Based Stress Reduction (MBSR), yoga, tai chi, meditation, and exercise can also help alleviate the symptoms of SAD.
The Tools for Success
Adolescents who struggle with anxiety disorders need to know they’re not alone. Their fears and anxieties may seem trivial to parents, teachers, and other adults in their lives—and even to their peers—but to them, they’re far from trivial. They can be debilitating. SAD is sometimes known as the silent disorder because teens are afraid to say anything about what they’re going through. They don’t want the perceived stigma of a diagnosis, they don’t want the extra attention, and often, they don’t understand what’s going on inside themselves. Rather than reach out, they retreat, which exacerbates the problem. As a parent, your first step is to offer unconditional support and understanding. Your second step is to seek the help of a skilled professional, who can help your teenager develop the skills necessary to handle fear and anxiety productively. With time, patience, and effort, it’s possible for your child to manage and overcome the symptoms of SAD, and move on to the business of being a typical teenager.