Is social anxiety disorder caused by traumas and bullying?

First let’s talk about what social anxiety is and how it’s diagnosed.

Social anxiety is not being introverted and it’s not being shy. Social anxiety is when a child struggles to function in social situations. An introvert may prefer their own company and a child who is shy is a child who is slow to warm up in social situations but they’re able to get there. In social anxiety, the child’s anxiety prevents them from participation. 

There are two aspects to social anxiety. The first is what you might call stage fright where the child’s anxiety is centered around the fear of performance. This isn’t just being afraid of being on stage or public speaking, this is fear of raising their hand in school or ordering at a restaurant or answering the phone or being at an event where they will be seen. The focus here is on the performative aspect of being observed. Most of us don’t want to be the first person on the dance floor, right? Perhaps you can imagine how that feels. The stage fright part of social anxiety is that feeling — that feeling of being first on the dance floor — in any aspect of social performance. So these kids might have trouble getting up in class to sharpen a pencil. They may have bathroom accidents because they can’t ask the teacher to be excused. They might struggle in sports of gym class because they have to practice in front of their classmates or team members. You know, like when your coach lines you up and you take turns running up to kick the soccer ball into the goal. 

The second aspect to social anxiety is about the interaction. This can be present with the performative aspect or may show up on its own. In this case, there is intense worry about disappointing other people or making people mad or having people judge them. They may have trouble making eye contact (and this is separate from children who are on the autism spectrum — social anxiety is often co-diagnosed with spectrum disorders but lack of eye contact is not always an indicator of social anxiety). We all have had those middle of the night worries about having said something stupid after a social event. Most of us can shrug it off; we know people are forgiving and also most people aren’t paying that close of attention to us. But when social anxiety is present, those ruminations about possible social gaffes can be overwhelming. 

Kids with social anxiety fear negative judgment. Their avoidance is around this perceived negative judgment. To avoid it they may limit their socializing or withdraw from social interactions, basically going along to get along. 

In severe cases of social anxiety, the child might also meet criteria for a diagnosis of selective mutism where the child’s anxiety is so great that they are unable to speak to people outside of a select few, usually family members. The child is able to speak — they have no physical limitations — but their fear stops them from speaking.

Our children may ask us to reassure them that no one is mad. They may need to process the event over and over. They may apologize for perceived slights or insults, taking responsibility for things that aren’t an issue.

As an aside, I see so much of this in middle schoolers — such a socially anxious age — where conversation between two kids may halt entirely because they are both so caught up in apologizing for each other. Of course middle schoolers can also be incredibly thoughtless and cruel to each other. It’s a complicated age and the same child who is ultra sensitive in one social context may be clueless in another. There are estimates that up to 30% of adolescents experience some measure of social anxiety — I think it might be under diagnosed since I meet lots of adults who don’t realize that they have social anxiety but instead report that they are just very introverted. 

Which brings us to the original question. Is social anxiety disorder caused by trauma and bullying? The answer is yes, it may be but it isn’t always. 

Some children have a difficult experience in school and this contributes to their understandable fear of continued bullying and unkindness, i.e., social anxiety.

Other children develop social anxiety without a clear precursor. Although there is research showing that children who have separation anxiety when younger — that is struggle to separate from caregivers for longer than is developmentally expected — are more likely to develop social anxiety. 

Interestingly some children with social anxiety who do not have bullying in their background may still perceive some of their social interactions more negatively than they actually were. This is not because they are liars; it is because some children are more sensitive to negative reactions — real or perceived. What this means is that a child may tell you that someone doesn’t like them and even have examples but this is more about their perception than what really happened. So another child might casually say, “Wow, your shoes are really bright blue.” And the child may hear that as critical or mean when the other child was simply making an observation.

All right, so what do you do for a child with social anxiety? 

Remember that anxiety gets worse with avoidance so we want to encourage those children to have more social interaction. Now this d