Most of us are acquainted with feelings of insecurity and concerns of being judged. We may worry about the way we come across when meeting new people, starting a new job, or going on a date.
While these concerns can be somewhat uncomfortable, they also help us make decent impressions on others and usually subside quite quickly. However, this is not the case for everyone.
A considerable part of the general population struggles with social anxiety disorder (SAD), which refers to an intense fear of being negatively evaluated, judged, or rejected.
Given the nature of the condition, most people never reach out for professional help, clinging to the hope that it will go away with age.
Left untreated, social anxiety disorder has a high risk of being persistent. It has the lowest spontaneous remission rates among all anxiety disorders, and the increased risk for co-occurring depressive episodes and substance abuse often lead to a progressive worsening of the condition.
Here, we will examine the potential consequences of leaving social phobia untreated.
The Typical Course of Social Anxiety
Most cases of social anxiety emerge during childhood and adolescence (Beidel, 1998). This means that by the time an affected person reaches their early 20s, the disorder has usually fully manifested in their lives (Wittchen, 2000).
Specific phobias during childhood and adolescence often occur when transitioning from one developmental stage to the next (such as separation anxiety). More often than not they subside by themselves.
However, the phobic fear of social interactions tends to persist over time (Achenbach, 1985; Beidel, 1998).
Many people with social phobia report phases of fluctuations (Wittchen, Stein, & Kessler, 1999). They experience less anxiety around others for some time, often because of a loving, supportive relationship (Müller, 2000).
This is followed by a sudden relapse of the previous symptoms, which are typically triggered by a major life event, which brings along new challenges.
People with SAD seem to have a certain vulnerability to react with social fear when faced with difficult and challenging situations, which usually leads to increased avoidance of the feared social scenarios (Wittchen, 2000).
This avoidance inevitably leads to a significant restriction in their lifestyle. Not only do they miss out on the direct benefits of social interaction, but they also fail to take advantage of the opportunities life has in store for them.
Graduating from high school, getting a college degree, assuming an important professional position, making friends and enjoying their company and support, as well as initiating and sustaining romantic relationships with a person they are attracted to – all of these are examples of things people with social anxiety too often miss out on.
Psychological Consequences of Leaving Social Anxiety Untreated
As one may suspect, recurrent depressive episodes often follow these significant lifestyle restrictions, with some people developing full blown depressive disorder (Wittchen, 2000).
Maladaptive coping mechanisms represent another problem, with affected people abusing legal drugs such as alcohol and nicotine to reduce their negative emotions, which often leads to dependence (Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000).
Over time, the following consequences can be expected for many affected people (Kessler et al., 1999; Wittchen, 2000):
- increased disability and functional impairment
- reduced quality of life
- additional mental disorders.
Research suggests that the chances of suffering from an additional mental disorder are about 50%. In most of these cases, social anxiety disorder develops first, and another psychological condition follows at a later point.
For example, it was found that adolescents and young adults with social anxiety disorder who did not experience any significant depressive symptoms, were 3.5 times more likely to develop a major depressive episode later in life compared to those without SAD (Wittchen et al., 1999).
Those individuals who were already experiencing depressive symptoms towards the start of this longitudinal study, were at an even higher risk of suffering from another episode of depression or of suffering from it persistently.
As suffering solely from social anxiety for an extended period is already demoralizing, it is even more so when being affected by additional depression and substance dependence.
Suicidal ideation has been shown to be elevated in people with SAD, and those who suffer from additional depression show a greatly increased risk of attempting to end their lives (Wunderlich, Bronisch, & Wittchen, 1998).
Effects on Quality of Life When Social Anxiety Is Persistent
Needless to say that social anxiety has a huge impact on a person’s quality of life.
It has been found that affected people tend to leave school earlier and are mostly dissatisfied with their personal relationships, their leisure activities, and their income (Stein, McQuaid, Laffaye, & McCahill, 1999).
When compared to the general population, socially anxious people are less likely to attend university and receive professional training, they have a higher likelihood of being unemployed, and they are more likely to be single or to be divorced (Wittchen et al., 1999).
Additionally, social phobia has been linked to decreased work productivity (Wittchen, Fuetsch, Sonntag, Müller, & Liebowitz, 1999).
How to Prevent Social Anxiety From Becoming Permanent?
As we have pointed out, social anxiety usually starts in childhood or adolescence. Without appropriate treatment, it has a significantly higher risk than other anxiety disorders of becoming permanent (with the exception of some specific childhood phobias; Wittchen, 2000).
An early recognition, diagnosis, and therapeutic intervention have the potential to prevent social anxiety from becoming persistent and the person from developing additional problems, such as depression and substance abuse.
Fortunately, treatments for social anxiety have become increasingly effective and there are several alternatives for those who do not respond to the standard approaches.
Sadly, social anxiety disorder is still underdiagnosed and undertreated, with only 20% of affected people receiving professional help at some point in their lives (Grant et al., 2005).
Therefore, raising awareness, breaking down the treatment options, and making them accessible to affected individuals should be a priority. That is what we do on this website.
Head over to our detailed treatment guide which introduces you step-by-step to the available, effective interventions for social anxiety disorder.
If you have any questions we left unanswered, please leave them in the comments section below and we will try to create the resource you are looking for.
Achenbach, T. M. (1985). Assessment of anxiety in children. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (p. 707–734). Lawrence Erlbaum Associates, Inc.
Beidel, D. C., & Turner, S. M. (1998). Shy children, phobic adults: Nature and treatment of social phobia. American Psychological Association. https://doi.org/10.1037/10285-000
Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., Goldstein, R. B., Dawson, D. A., Smith, S., Saha, T. D., & Huang, B. (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 66(11), 1351–1361. https://doi.org/10.4088/jcp.v66n1102
Kessler, R. C., Stang, P., Wittchen, H. U., Stein, M., & Walters, E. E. (1999). Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychological medicine, 29(3), 555–567. https://doi.org/10.1017/s0033291799008375
Müller, N. (2000). Frühstadien der sozialen phobie: risiken, erscheinungsformen und konsequenzen. Dissertation. University of Bamberg.
Sonntag, H., Wittchen, H. U., Höfler, M., Kessler, R. C., & Stein, M. B. (2000). Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?. European psychiatry : the journal of the Association of European Psychiatrists, 15(1), 67–74. https://doi.org/10.1016/s0924-9338(00)00209-1
Stein, M. B., McQuaid, J. R., Laffaye, C., & McCahill, M. E. (1999). Social phobia in the primary care medical setting. The Journal of family practice, 48(7), 514–519.
Wittchen H. U. (2000). The many faces of social anxiety disorder. International clinical psychopharmacology, 15 Suppl 1, S7–S12. https://doi.org/10.1097/00004850-200007001-00003
Wittchen, H. U., Fuetsch, M., Sonntag, H., Müller, N., & Liebowitz, M. (2000). Disability and quality of life in pure and comorbid social phobia: Findings from a controlled study. European Psychiatry, 15(1), 46–58. https://doi.org/10.1016/S0924-9338(00)00211-X
Wittchen, H. U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychological medicine, 29(2), 309–323. https://doi.org/10.1017/s0033291798008174
Wunderlich, U., Bronisch, T., & Wittchen, H.-U. (1998). Comorbidity patterns in adolescents and young adults with sucide attempts. European Archives of Psychiatry and Clinical Neuroscience, 248(2), 87–95. https://doi.org/10.1007/s004060050023
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