If you’re like most parents, you want your kids to learn to be comfortable in their own skin, develop self-confidence, and thrive socially as they grow up. Unfortunately, some children develop in the exact opposite direction, for example being painfully self-conscious, afraid of rejection or embarrassment, and extremely uncomfortable in social settings. The anxiety they experience – known as social anxiety disorder (also referred to as social phobia) – is very intense and can potentially interfere with every aspect of their life.
Since many teens worry about rejection and feel self-conscious at times, it can be difficult to determine what’s normal and what’s not when it comes to your teen’s emotions and behaviors. This brief guide is designed to help you know the signs to watch for and the steps to take if you suspect your teen is suffering from social anxiety disorder.
Social Anxiety Disorder Statistics and Facts
Following are several statistics and facts pertaining to social anxiety disorder:
- Social anxiety disorder is one of the most common psychiatric disorders, impacting over 15 million adults in the U.S.
- Social anxiety disorder impacts nearly 5% of children and teens
- Although social anxiety disorder can develop in childhood or adulthood, it often develops in early to mid-adolescence (typical age of onset is 13)
- Learned behavior (often from parents), genetics, and the environment all likely play a role in the development of social anxiety disorder
- At any given time approximately 7% of the population is suffering from social anxiety disorder
- Globally, social anxiety disorder is the third most prominent mental health issue
Individuals with social anxiety disorder often have or go on to develop other co-occurring psychiatric disorders. The most common disorders are:
- Other anxiety disorders
- Substance use disorders (alcohol is often used to boost confidence in social settings)
Following are several risk factors for the development of social anxiety disorder in teens:
- Being female (social anxiety is more common in females than males)
- Having a close family member with social anxiety or another anxiety disorder
- Being shy, withdrawn, or hesitant to try new things
- Having any kind of noticeable physical or health issue, such as a deformity, speech impediment, or large scar or birthmark may lead to the development of social anxiety
- Painful or traumatic experiences, such as being bullied or sexually abused
Looking for and Recognizing the Signs of Social anxiety disorder
Knowing what to look for and how to recognize the symptoms of social anxiety disorder in your teen will enable you to intervene sooner than later. Pay close attention to any changes from your teen’s normal personality or behavior. With social anxiety disorder, these changes may develop gradually or suddenly.
Signs to watch for include:
- Sudden or increased avoidance of social situations
- Significant reluctance or refusal to go to school
- Fear that others will reject or make fun of them
- Drops out of or never participates in extracurricular activities
- Depressed mood
- Experiences intense anxiety if social situations can’t be avoided
- Blushes or gets embarrassed easily
- Difficulties talking to, speaking up, or making eye contact with people they don’t know well
- Fear of doing or saying something others might consider “stupid”
- Intense anxiety if called upon in class or required to give a presentation at school
- Fear they’ll say the wrong thing
- Frequent worry that others may be watching and judging
- Extremely self-conscious
- Isolates socially
- Has panic attacks specific to social anxiety
- Difficulties making friends / having none or very few friends
- Intense worry about an upcoming social event that may be days, weeks, or even months away
- Goes out of the way to be “invisible” or stay in the background during social interactions
- Won’t go anywhere without a family member or friend to accompany him or her
- Suicidal thoughts and behaviors*
*Suicidal thoughts or behaviors should never be ignored. Don’t assume your teen is just being “dramatic” or manipulative. The risk of suicide increases for teens suffering from social anxiety disorder. Alcohol and drug use may increase this risk even more.
Knowing the First Steps to Take
If you have reason to suspect your teen is struggling with social anxiety disorder, the first steps to take towards handling the situation are:
1 – Talk to your teen. Let your teen know about your concerns regarding the things you’ve observed. Don’t lecture. Don’t judge. Be compassionate and open, and let your teen know you’re willing and available to listen if he or she wants to talk – about anything.
Don’t be surprised or hurt if your teen pushes you away, denying there’s a problem or attempting to convince you that you’re worrying too much or being over-protective. If this happens it may be because your teen is ashamed of the anxiety he or she is experiencing.
2 – Set up an appointment for an evaluation. One place to start is with your teen’s pediatrician or your family doctor. He or she can perform an initial evaluation, including a physical examination to determine if any underlying medical issues are present that may be causing or contributing to your teen’s anxiety.
With social anxiety disorder, it’s important to have your teen thoroughly evaluated by a mental health professional – preferably a psychologist or psychiatrist. Look for someone who specializes in treating children and adolescents. These professionals have the specialized training to identify and understand the unique challenges and potential complications of social anxiety disorder in teens. Ask your doctor for a referral or recommendation.
3 – Get your teen into treatment. Early intervention is crucial with adolescent anxiety disorders, as they often become chronic and continue into adulthood without treatment. Social anxiety disorder is typically treated with a combination of psychotherapy and medication.
- Individual psychotherapy – Psychotherapy can help your teen understand the intense anxiety he or she experiences, and find healthy ways to cope and, hopefully, overcome it.
Cognitive Behavioral Therapy (CBT) – This is the most common type of therapy used to treat social anxiety. This type of therapy focuses on identifying, challenging, and changing underlying beliefs and negative thoughts that fuel the social anxiety. A specific type of CBT known as exposure and response prevention can be very beneficial for social anxiety. It involves progressively exposing your teen to anxiety-provoking social situations while he or she learns to manage the anxiety in the process.
Social Effectiveness Therapy for Children and Adolescents (SET-C) – This is a behavioral therapy designed to treat social anxiety disorder in children and teens. It utilizes a combination of exposure therapy, peer generalization, and group social skills training. Therapy goals include decreasing social anxiety, improving social skills, and helping your teen improve and expand his or her friendships.
- Medication – Depending on the severity of your teen’s symptoms, medication may be prescribed in addition to psychotherapy to treat his or her social anxiety.
SSRIs / SNRIs – The medications most frequently prescribed for social anxiety disorder are selective serotonin reuptake inhibitors (SSRIs) including paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), or fluvoxamine (Luvox). Venlafaxine (Effexor XR), a serotonin and norepinephrine reuptake inhibitor (SNRI) is also sometimes prescribed for social anxiety disorder.
Benzodiazepines – These medications, also known as minor tranquilizers, may sometimes be prescribed to treat social anxiety disorder. Examples of benzodiazepines include clonazepam (Klonopin) and lorazepam (Ativan). Unlike SSRIs and SNRIs, these medications are fast acting. Extreme caution must be used because they can lead to dependence.
Beta blockers – These medications are sometimes prescribed for performance anxiety. They work by reducing physical symptoms, such as a racing heart, trembling hands or voice, or sweating.
If your teen requires medication for his or her social anxiety, it’s highly recommended that the medication be managed by a psychiatrist. Costs (e.g. side effects, risk of dependence) versus benefits of medication should always be carefully weighed.
- Dual diagnosis treatment – This is usually necessary if your teen also has a substance use disorder – see more below
- Residential treatment – See below
- Hospitalization – See below
Supporting and Encouraging Your Child
One of the best things you can do for your teen with social anxiety disorder, in addition to getting him or her into treatment, is to learn how to effectively provide support and encouragement. Following are several tips for doing this:
- Learn everything you can about social anxiety disorder. This will help you have more empathy for your teen and the challenges he or she faces daily
- Remember that your teen has a serious mental health disorder; it’s not a character flow or weakness, nor is it something he or she can just overcome with more determination or willpower
- Don’t judge or criticize what your teen’s experiencing. The intense anxiety and irrational thoughts of those with social anxiety disorder may seem strange and even ridiculous to someone who’s never experienced it
- Be careful to not enable your teen’s avoidant behavior by lowering your expectations or constantly “rescuing” him or her from uncomfortable situations. It’s okay if your teen experiences some anxiety. If you keep trying to protect him or her, you’ll reinforce your teen’s lack of confidence in being able to handle it
- Be mindful of how you handle your own fears and anxiety. Model appropriate coping skills for your teen. If you’re suffering from an anxiety disorder, seek treatment for yourself as well
- Strive to remain calm when your teen is feeling anxiety; if you become anxious or frustrated it will feed into your teen’s anxiety
- Talk about and role play with your teen to help him or her figure out ways to handle difficult social scenarios
- Celebrate and praise your teen’s progress and accomplishments, no matter how small they may seem to you
- Avoid nagging or lecturing your teen; if you have concerns, talk to your teen in an open, honest, and respectful manner
What to Do When Things Escalate
Teens with social anxiety disorder have an increased risk for suicide, especially if they’re also suffering from depression, bipolar disorder, or another anxiety disorder. If they’re going through a stressful time, or if they’ve recently experienced something traumatic, their psychiatric symptoms may get worse, making it more difficult to cope than ever.
Some teens with social anxiety disorder and other anxiety disorders attempt to cope in self-destructive and potentially dangerous ways. They may start using alcohol or recreational drugs to ease the emotional pain or make themselves feel less anxious (or more confident) in social situations. They may also engage in non-suicidal self-harm behavior such as burning or cutting themselves.
If things escalate and your teen’s safety or wellbeing is at risk, don’t hesitate to reach out for help. You can:
- Contact your child’s treatment provider asap
- Enlist the help of a close family member or friend for immediate support or assistance
- Call an emergency hotline
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
Teens battling social anxiety disorder often respond well to individual psychotherapy alone, or a combination of psychotherapy and medication. Of course, this isn’t always the case. If your teen has severe social anxiety disorder or is also struggling with another disorder, then he or she will likely need a higher level of treatment, at least temporarily. If your teen:
- Has social anxiety disorder symptoms that are severe enough to hinder his or her ability to go to school or function in other areas of life
- Is experiencing mania, severe depression, or other psychiatric symptoms that require a higher level of care
- Is actively suicidal – threatening or planning suicide, and / or engaging in suicide gestures or attempts
- Is abusing alcohol or drugs
then a more intensive level of treatment is usually required. Higher levels of treatment include:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Dual Diagnosis Treatment
- Residential treatment
- Inpatient psychiatric treatment
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go. These programs are typically the next step up from regular outpatient treatment.
Dual diagnosis treatment is often necessary if your teen has a substance use disorder in addition to social anxiety disorder. Alcohol or drug abuse almost always hinders the effectiveness of individual therapy alone. A dual diagnosis program addresses the substance use issue as well as your teen’s social anxiety disorder (and any other psychiatric issues) simultaneously. Dual diagnosis treatment may be part of a residential treatment program or an outpatient program.
Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with anxiety disorders and other mental health issues. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.
Inpatient psychiatric treatment in a hospital setting is the highest and most intensive level of treatment for adolescents with anxiety disorders such as social anxiety disorder. Often, this level of treatment is used to treat symptoms of severe depression, mania, anorexia, and / or suicide risk rather than social anxiety disorder alone. Patients are monitored 24/7. Hospitalization is usually relatively brief.
Taking Care of Yourself
Parenting a teen with social anxiety disorder can be very challenging and even exhausting at times, especially if the symptoms are on the more severe end of the continuum. Since your teen will be relying on you for emotional support, guidance, and advice on his or her journey of recovery, it’s imperative to make self-care a priority as well. A few tips:
- Surround yourself with ample support, such as through a local support group for parents of teens with anxiety disorders, as well as family and close friends
- Get sufficient rest
- Manage your stress in healthy ways, such as practicing yoga or exercising regularly
With proper treatment, support, and encouragement, your teen can learn to manage his or her anxiety and have a brighter, happier future!