SOCIAL ANXIETY 1

Running Head: SOCIAL ANXIETY

SOCIAL ANXIETY AND ITS EFFECTS ON INTIMACY

Caitlin A. Meleski
Glen Allen High School
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Introduction

Social Anxiety Disorder, otherwise known as SAD, is nationally recognized as the third

most prevalent emotional disorder among all age groups today (Mekuria, et al., 2017, 2). A

review of epidemiological studies found that the lifetime prevalence of social phobia in adults

varied between 2% and 5% with a female:male ratio of 2.5:1.2 Patients typically may not consult

their family doctor until they have had the condition for many years, therefore receiving little to

no treatment. The chronic course increases the risk of comorbid conditions, which may mask the

social anxiety and lead the diagnosis to another mood disorder such as depression. The lifetime

prevalence of social phobia in young adults (mean age 18 years) was found to be 23% (Den

Boer, 1997, 797). This disorder is thought to have a long list of lifelong effects, most of which

are of little knowledge to the greater public. Several effects are possible, but one of the most

hypothesized detrimental and long lasting is its effect on the ability to adequately form and

maintain intimate relationships with others (Zaider, Heimberg, & Iida, 2010, 163). The only way

to properly understand the true effects this disorder can have, it is crucial to have an

understanding of what the definition and diagnosis of the disorder is, as well as the

environmental factors that contribute to its influence. In this paper, levels of distress in intimate

relationship for either party – not just the diagnosed – will be discussed as the overall quality of

both romantic and platonic relationships are assessed through the relationship satisfaction scale

(Zaider, Heimberg, & Iida, 2010, 164).

Causes of Social Anxiety

One of the first theories on the causation of social anxiety researched was that of

Schlenker and Leary who concluded that social anxiety arises when people are motivated to

make a “preferred impression on real or imagined audiences but doubt that they will do so”
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(Schlenker & Leary, 1982, 645). The perceived failure or inability to obtain desired outcomes in

social situations has been publicly viewed as a major antecedent of anxiety – however social

anxiety specifically focuses on the aftermath of an anxiety-causing situation and the judgement

of their peers regarding their actions during it. An existing method of literature on social anxiety

has deemed that this falls into a specific model known as the Cognitive self-evaluation model. It

states that social anxiety results not from an objective skills deficit per se but from the

individual’s perception of personal inadequacies, research has shown that socially anxious

people tend to underestimate their social skills (Schlenker & Leary, 1982, 643). Feeding into

this, uncertainty has been deemed one of the most notable causes of social anxiety – and anxiety

in general – and it has been concluded that anxiety is directly related to the degree of ambiguity

in the situation to which the individual must make some “adjustive reaction” (Schlenker &

Leary, 1982, 650). Schlenker and Leary’s research discovery of the cause of uncertainty allows

them to pinpoint the specific emotions that lead to the causation of social anxiety.

Uncertainty is also heightened when unexpected events occur, as when an

embarrassing incident happens or people are interacting with others who are
unpredictable. Unexpected events disrupt the ongoing interaction and thrust the
participants into a state of uncertainty (Goffman, 1967). Geller, Goodstein, Silver,
and Sternberg (1974) found that when others violate the implicit rules of social
interaction—by ignoring an individual, for example—the situation becomes
ambiguous and the individual reports feeling shy (Schlenker & Leary, 1982, 650).

The information provided through their research provides a constant theory of visible

understanding and causation of Social Anxiety Disorder, which in turn, will lead to an overall

understanding of the effect it has on forming intimate relationships – as the qualities triggering it

are now in the known.

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Diagnosis and Symptoms of Social Anxiety

This journal follows the research findings of Bystritsky, Khalsa, Cameron, and Schiffman

as they discuss the prevalence of social anxiety and other anxiety disorders, continuing onward

into the diagnosis and treatment of it. Anxiety disorders are present in up to 13.3% of individuals

in the U.S. and constitute the most prevalent subgroup of mental disorders. A study entitled the

Epidemiological Catchments Area Study revealed the massive extent to which their prevalence

held in the country. Despite this, however, they are extremely hard to recognize compared to

other mood and psychotic disorders. “As a result of this management environment, anxiety

disorders can be said to account for decreased productivity, increased morbidity and mortality

rates, and the growth of alcohol and drug abuse in a large segment of the population (Bystritsky,

Khalsa, Cameron, & Schiffman, 2013, 30). Diagnostic criteria for Social Anxiety Disorder is

found within the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and over the

past 10 years, epidemiological data has been used in the attempt to refine the boundaries of

diagnostic categories of anxiety disorders to a more specified description. This research shows

that there is a broad overlooking of social anxiety compared to that of other emotional and

mental disorders, allowing it to go undiagnosed and therefore worsen in years to come. Another

significant problem with the present classification of anxiety disorders is the absence of known

etiological factors and of specific treatments for different diagnostic categories. Studying the

genetic groundwork of anxiety disorders using molecular biological techniques as Bystritsky,

Khalsa, Cameron, and Schiffman have in their journal has previously failed to produce a single

gene or a cluster of genes implicated as a causing factor for any single anxiety disorder, even

though some genetic findings exist for OCD and panic disorder. In turn, there is a clear

conclusion. Understanding how emotional reactivity, core beliefs, and coping strategies interact
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in time should lead to more precise diagnoses and better management of anxiety disorders

(Bystritsky, Khalsa, Cameron, & Schiffman, 2013, 36).

How Social Anxiety Affects Intimacy

In a case study conducted by Zaider, Heimberg, and Iida, 33 married heterosexual

couples in which the female partner abided by the Diagnostic and Statistical Manual of Mental

Disorders’ criteria for a social anxiety disorder were followed and given baseline questionnaires

14 diary reports for the partners to complete separately at the end of the day regarding the quality

of their marriage. The results concluded based off of these results, 29.5% of couples in the

current sample had at least one partner who scored within the distressed range of marital

functioning. However, daily negative mood aggregated across the study period were significantly

higher for wives than husbands, which is predictable due to the wives’ disorders. Nearly 80% of

all the couples studied had one or more partner list communication as the main source of distress

in their questionnaires. Out of this percentage, over half were men. A term called ‘emotional

cognition’ was given to this, being officially defined as the tendency to “catch” another person’s

distress and troubles when emotionally intimate with them (Zaider, Heimber, Iida, 2010, 168).

This display of anxiety elicited high levels of distress, rejection, and devaluation from the

partner in the relationship and proves the hypothesis that social anxiety can directly affect the

ability to healthily maintain an intimate relationship, even with a marital partner.

Treatment for Social Anxiety Disorder

Treatment for anxiety disorders has been speculated and tested for many years in the past,

however, it has been difficult to pinpoint one specified method that works a large sum of the

time. Drug therapy has been perceived be helpful in some cases, selective serotonin uptake
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inhibitors probably being the most promising. However, treatment has often been hampered by

the presence of an additional psychological problem such as panic disorder, depression, or

substance abuse (Den Boer, 1997, 797). Selective serotonin reuptake inhibitors have been seen as

a common method of treatment for depression and panic disorder – both of which are comorbid

with social phobia – therefore allowing coexisting emotional stressors to be alleviated. Other

methods of proven treatment include monoamine oxidase inhibitors, in which many recent

studies have shown a better response in patients with social anxiety treated with phenelzine (an

irreversible monoamine oxidase inhibitor) than with alprazolam or atenolol (Den Boer, 1997,

799). Another method proven beneficial that does not affect biologic inhibition is cognitive-

behavioral therapy.

“Cognitive-behavioral therapy aims to help people to overcome anxiety reactions in

social and performance situations and to alter the beliefs and responses that maintain
this behaviour. One type of treatment, cognitive-behavioural group therapy, is given in
12 weekly sessions, each lasting about two and a half hours. It has six elements:
cognitive-behavioural explanation of social phobia; structured exercises to recognise
maladaptive drinking; exposure to simulations of situations that provoke anxiety;
cognitive restructuring sessions to teach patients to control maladaptive thoughts;
homework assignments in preparation for real social situations; and a self administered
cognitive restructuring routine” (Den Boer, 1997, 799).

This research taken from the work of literature allows for an understanding to develop in what

can aid social anxiety and, in turn, aid the process of forming and maintaining intimate

relationships. It is heavily crucial that there is awareness of this in order to be able to provide

practical treatment for this disorder. If a patient were to go untreated, the symptoms associated

with it would rapidly worsen over time, and they may lose the ability to ever regain normal

conversational abilities.
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Conclusion

The literature reviewed throughout this paper aim to support the hypothesis that social

anxiety places negative limitations on a victim’s ability to form and maintain intimacy with

others. Support has been obtained for this hypothesis, as there has been crucial information

researched regarding the development and diagnosis, direct effects on intimacy, and treatment

for these symptoms. Social Anxiety Disorder is commonly misconstrued with agoraphobia and

depression, as well as generalized anxiety disorder. By researching it separately, the effects of

the sole disorder have become clear and definitive (especially since obtaining a clear history

from the patient may be delayed by the patients' fear of social interaction) as there is clear

evidence as to the solution of reducing social anxiety and just how to do so. In conclusion, the

effects of social anxiety, while having already proven serious in generalized terms, strongly

affect the basic ability of a diagnosed patient to form strong, intimate relationships that people

strive for.

Reference List

Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current Diagnosis and

Treatment of Anxiety Disorders. Pharmacy and Therapeutics, 38(1), 30–57.

Den Boer, J. A. (1997). Social Phobia: epidemiology, recognition, and treatment. British

Medical Journal. 796+.

Mekuria, K., Mulat, H., Derajew, H., Mekonen, T., Fekadu, W., Belete, A., Yimer, S., Legas, G.,

Menberu, M., Getnet, A., & Kibret, S. (2017). High Magnitude of Social Anxiety

Disorder in School Adolescents. Psychiatry Journal, 2017, 1-5.

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Schlenker B. R., & Leary, M. R. (1982). Social Anxiety and Self-Preservation: A

Conceptualization and Model. Psychological Bulletin. 92(3), 641-669.

Zaider, T. I., Heimberg, R. G., & Iida, M. (2010). Anxiety Disorders and Intimate Relationships:

A Study of Daily Processes in Couples. Journal of Abnormal Psychology, 119(1), 163

-173.