Usually to have Social Anxiety Disorder that is severe enough to come to my attention, the cause is a combination of two things, genetics and environment.
Genetics – Anxiety disorders are inherited. Many children will have one or even two parents with an anxiety disorder, but not necessarily Social Anxiety Disorder. Many people think that this inheritance is in part expressed through something called Behavioral Inhibition.
Behavioral Inhibition is a tendency to react negatively to new situations or things. Some infants and children will be very happy and curious about new people and things. However, roughly 15% of children will be shy, withdrawn, and irritable when they are in a new situation or with new people or things. Other children are just fearful in general. Often these children and irritable as infants, shy and fearful as toddlers, and cautious, quiet, and introverted at school age. Children who are consistently this way are much more likely to have biological parents with anxiety disorders. They are also more likely to develop Social Anxiety Disorder later in childhood or in adolescence. For example, if a child is not fearful and does not avoid social situations, there is only a 4-5% chance they will get Social Anxiety Disorder as teenagers. However if a child is fearful and avoids social situations when they are little, about 20-25% will have Social Anxiety Disorder as teenagers (1). At the moment it is thought these traits of Behavioral inhibition is what is inherited. This tendency towards being fearful and socially avoidant runs in families and can lead to Social Anxiety Disorder.
Environment – By this I mean everything other than genetics. Some of the environmental causes of Social Anxiety Disorder are: a Speech or language problem, a disfiguring physical illness, abuse, neglect, being raised by very nervous people and having certain extremely embarrassing experiences – vomiting during show and tell, having diarrhea in class, tripping on a stage and falling on someone during a performance at school, etc.
In most cases it is a combination of both genetics and environment. It takes a big genetic load (both parents have multiple anxiety disorders) to cause Social Anxiety Disorder in the absence of any environmental problem. Likewise, it takes a huge environmental cause (massive abuse and neglect) to cause an anxiety disorder when there is no family history of nervousness.
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