Is social anxiety disorder caused by traumas and bullying?

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 doesn’t mean just sending them off to school and saying, “go make some friends!” That’s not going to work for every child. For some? Sure. Kids who are more motivated, who have already built some emotional muscle in overcoming social anxiety, who have some measure of social support — they may be able to simply push through it. But lots of kids need help with skills building.

You can reach out to the school counselor and ask them about social opportunities. Some will have groups — a lunch bunch or a more formal group — that the child can attend. Some may have ideas about getting the child more involved with extracurriculars that interest them and might feel safe. They may be able to connect the child with appropriate peers.

You can also look for social opportunities that are a better fit for your child. Girl Scouts, a church group, 4H. If your child has a special interest you could see about connecting them to peers that way. If you’ve got a child or teen who does a lot of online activities, head to the local comic book store and see if you can get your gamer nerd to open themselves to other nerdoms like D&D or Magic the Gathering. Our little neighborhood library used to host gamer meet-ups to get the kids off-line and talking to each other while still honoring that gaming was an important interest to them. You can try that, too. 

The reason I bring up computer games, is that kids who are social anxious are more likely to have what the researchers call problematic internet usage. That is to say, avoiding real world social interaction by increased used of online social interaction.

I do want to pause here and say that I believe that online relationships are real and important and they matter. But they are not a substitute for real world relationships. It’s great to have good social keyboarding skills. But we also need to be able to interact with people off-line. It doesn’t need to be one or the other and we can encourage real world friendships without denigrating online friendships. This is important when we’re talking about supporting our kids since many will feel rightfully defensive if we turn it into an either/or discussion instead of a both/and. 

If you can’t find the right social environment, you could consider creating one. Social media makes it easier to network with other local parents and perhaps you can find or create the social group that would feel welcoming to your child. It doesn’t have to be a large group. It can just be a couple of kids who are willing to hang out.

You can also talk to counseling practices and occupational therapy practices, which sometimes host social skills groups. Sometimes these are specific to a diagnosis — for example, for autistic kids. But some are open to any child who is needing opportunity and practice in learning how be with other kids. The leaders of these kinds of structured groups know and expect that the kids may be awkward and may struggle. Talk to the facilitators and see if your child is a good fit for the group and that the group is a good fit for the child. Some of the will organize around a particular theme. 

Getting intervention sooner rather than later is important. Sometimes we figure middle school is just awkward and they’ll grow out of it but social anxiety leads to depression if it continues through the teen years. Social anxiety tends to create dependence as children increasingly rely on their parents’ support and intervention. Parents naturally start assuming their kids can’t function on their own, which leads to more parental control, which leads to greater social anxiety. It’s basically an echo chamber. As in all things, parents need to recognize when what they’re doing is hurting more than helping — always a tricky thing with anxiety — and learn to step back.

If you need help with that, I encourage you to check out my program.

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