Recognising the difference between a shy child and a child with social anxiety disorder is key to addressing this mental health issue

We’ve all come across teenagers who aren’t very social - often standing in the corner at get-togethers or trying to avoid conversation by pretending to be on their phones. This behaviour often gets excused (and even ignored) by labelling them shy or calling it a “phase”. But where does it stop being a personality trait and turn into mental illness? Research shows that the incidence of social anxiety disorder is higher in schoolchildren from urban India. [caption id=“attachment_7478671” align=“alignleft” width=“380”] Representational image. Image by Wokandapix from Pixabay[/caption] Writing in the  Delhi Psychiatry Journal  in 2009, Dr Vishal Chhabra et al. said that while 10.3% of children aged 14-15 years (middle adolescence) had social anxiety, about 34.2% of children were in the pre-syndromal stage and required psychiatric help.

Why is social anxiety more prevalent in 14 to 15-year-olds?

• Puberty brings with it a host of changes, both physical and hormonal, that may cause anxiety. Some kids can have a hard time coping with changes like increasing height/weight, change in body shape, acne, the onset of menstruation.
• Bullying in schools has become one of the major reasons for social anxiety in kids.
• Excessive and persistent fear of social or performance situations such as at school, parties, athletic activities, and more could lead to anxiety in kids.
• Authoritative parenting is another major cause of anxiety in kids. In this style of parenting, parents are usually demanding and keep a “strict and stern” approach which creates a stressful environment for the child.

Prevalence of mental health problems in India

According to the National Mental Health Survey of India 2015–2016, 10.6% of Indians have some sort of mental health issue, and 13.7% of Indians will live with deteriorated physical and psychological health at some point in their life (lifetime mental morbidity). The types of anxiety that have been reported in India by researchers are:

• Generalized anxiety disorder: excessive ongoing anxiety throughout the day while carrying out routine tasks.
• Panic disorder: fear of loss of control and a persistent feeling of observing oneself from outside one’s body (depersonalization).
• Social anxiety: fear of social situations that involve interaction with other people.
• Phobic disorder: fear related to animals, ghosts, deep waters, the dark, imaginary things, and supernatural things (mostly reported in India).
• Dhat syndrome: Semen-loss syndrome, where a person believes that he is losing semen during nocturnal emission, urination, and masturbation.
• Koro syndrome: It manifests as a fear of one’s genitals retracting into the abdomen.

What is social anxiety?

The late Dr James W. Jefferson, professor-emeritus of psychiatry at the University of Wisconsin, US, wrote in “Social Anxiety Disorder: More Than Just a Little Shyness” (2001) that social anxiety is the marked and persistent fear of social or performance situations. Its symptoms include sweating, the rapid pounding of the heart (palpitations), shaking and breathing distress.

How can social anxiety be diagnosed in children?

Several tests have been included for diagnosing social anxiety:

• Liebowitz Social Anxiety Scale for children and adolescents
• The Social Phobia and Anxiety Inventory for Children
• Primary Care Evaluation of Mental Disorders

Diagnostic and Statistical Manual of the American Psychiatric Association  (DSM-IV, 1994) has set out four main criteria for diagnosing a person as socially phobic:

• When a person is exposed to unfamiliar people or to possible scrutiny by others, he or she fears that they will act in a way that will be humiliating or embarrassing.
• Exposure to the feared social situations almost invariably provokes anxiety.
• The person recognizes that the fear is excessive and unreasonable.
• They avoid the feared social or performance situations altogether or deal with them with intense anxiety or distress.

Signs and symptoms

In his book  Overcoming Social Anxiety And Shyness, Gillian Butler gave signs and symptoms of social phobia: Effects on thinking:

• Worrying about what others think of them.
• Finding it difficult to concentrate, or remember what people say.
• Being painfully aware of what they say or do.
• Dwelling on things you think you did wrong, after the event.

Effects on behaviour:

• Speaking quickly or quietly, mumbling, getting words mixed up.
• Avoiding eye contact while speaking.
• Keeping safe: staying in “safe” places, or talking only to “safe” people, about “safe” topics.
• Avoiding difficult social occasions or situations.

Effects on the body:

• Signs of anxiety that others can see, such as blushing, sweating or trembling.
• Feeling tense; the aches and pains that go with being unable to relax.
• Panicky feelings: heart-pounding, dizziness or nausea, breathlessness.

Treatment

Dr Jefferson proposed a few treatment options for social anxiety in his study:

• Psychotherapy: With the help of well-trained therapists, psychotherapy can turn out to be very effective. It involves: a) Social skills training: It teaches the patient the essential skills to have a good conversation which is simultaneously comfortable for them. b) Exposure therapy: The patient is continuously exposed to fearful situations which make them habitual of dealing with such situations without anxiety. c) Cognitive therapy: It focuses on removing irrational thoughts or beliefs that contribute to inappropriate social anxiety. d) Cognitive behaviour therapy: It blends the best of exposure therapy, cognitive therapy and homework assignments which helps in building confidence.
• Pharmacotherapy: Drug therapy goes hand in hand with psychotherapy for extensive treatment of social anxiety. As the disorder is mostly chronic, treatment should be continued for a year before an attempt is made to stop or decrease the medication. The different types of drug therapy are: a) Anxiolytic Pharmacotherapy: Doctors may prescribe a benzodiazepine like clonazepam for social anxiety. b) Antidepressant Pharmacotherapy: Selective serotonin reuptake inhibitors like citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline are sometimes prescribed for treating social anxiety. c)Anticonvulsant Pharmacotherapy: Gabapentin and pregabalin are the only two anticonvulsants that have been reported to help in social anxiety cases.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please read our article on   Anxiety _._ Every day until World Mental Health Day, myUpchar will publish stories on the most pressing mental health concerns in India on Firstpost. This is the third story in our series on mental health conditions.