Are There Different Types of Social Anxiety Disorder?
Not all people with social anxiety are alike. In fact, there are important differences to keep in mind, especially if treatment is to be successful.
If you have ever attended a meetup for people with SAD, you have probably noticed that the number of social situations people struggle with can differ significantly. Some may fear only a few specific scenarios, such as public speaking or dating, while others experience social anxiety symptoms in virtually all social situations.
The same accounts for the main concerns related to these situations. Whereas many affected people fear behaving in a way that makes them look foolish or socially inept, others are primarily concerned about displaying observable anxiety symptoms that would reveal their insecurity to others.
Therefore, experts have proposed several ways of classifying affected people into different types of social anxiety.
Since these subgroups differ from each other in certain aspects, a classification seems appropriate, especially when it comes to therapeutic approaches.
A person that is socially anxious in almost every situation, for instance, is likely to have different necessities and might choose an approach that differs in duration and therapeutic focus, compared to a person who only experiences public speaking anxiety.
Explainer Video: The Different Social Anxiety Types
Classifying Social Anxiety Into Categories
In the scientific realm, experts do not always agree upon everything. That’s also true for dividing socially anxious people into different types.
There have been numerous proposals by different research teams. Here, we will have a look at 3 different categories that can be used to classify people with SAD into different types.
- Classification according to the number of feared social situations
- Classification according to the types of feared social situations
- Classification according to the focus of the social fears
Category I: Number of Feared Social Situations
The idea this category is based on is to differentiate between social anxiety types by identifying the number of social situations a person fears. By doing that, we end up with 3 different types of social anxiety:
Generalized Social Anxiety Disorder
People affected by generalized social anxiety experience fear in virtually all or most social situations (APA, 2013). This type of social anxiety usually starts in early childhood, before the age of 10 (Mannuzza et al., 1995), and is characterized by behavioral inhibition (BI).
BI refers to a reserved, shy and anxious temperament, especially when confronted with new situations, experiences and people (Kagan, Reznick, & Snidman, 1988).
Generalized social anxiety is associated with a greater comorbidity than the other subtypes (Kessler, Stein, & Berglund, 1998). This means that it often comes along with additional psychological problems, such as depression or generalized anxiety disorder.
People with this type of social anxiety usually display greater difficulties living a “normal” life and the genetic component is believed to have a greater influence than it has for the other subtypes (Stein et al., 1998).
Nongeneralized Social Anxiety Disorder
People with nongeneralized social anxiety also fear most social situations, but they exhibit at least one area of normal social functioning without anxiety (Heimberg, Holt, Schneier, & Spitzer, 1993).
While this may facilitate things a little compared to those suffering from generalized SAD, as professional or personal life can still be sources of well-being and self-esteem, many affected people experience significant functional impairment and hardship.
Circumscribed / Specific Social Anxiety Disorder
Circumscribed social anxiety (also: specific social anxiety) is experienced by people who fear one or very few specific social scenarios only.
Among people with SAD, public speaking anxiety is the most common phenomenon. Individuals who are only concerned about scenarios of this type would qualify for this type of SAD.
Compared to generalized SAD, the genetic component associated with specific social anxiety is not as eminent. It also tends to start a little later, usually throughout puberty (Mannuzza et al., 1995).
It is also more likely that people with this type of social anxiety report a specific traumatic social experience that marked the start of their social phobia. People with circumscribed SAD may even seem socially confident and their friends and acquaintances often describe them as outgoing and sociable.
Category II: Types of Feared Social Situations
Another suggestion for distinguishing between SAD sufferers is based on the types of situations people fear.
Here, the quantity of feared social scenarios is not a determining factor (Spokas & Cardaciotto, 2014). This category differentiates between the following three types of social anxiety.
Social Anxiety in Performance Situations
Performance fears are very common in people with social anxiety disorder (Eng et al., 2000). Some affected people appear to suffer from performance fears only, such as public speaking anxiety.
This subgroup of SAD sufferers exhibits little to no social anxiety in observation and interaction situations (Spokas & Cardaciotto, 2014). It has been reported that people with performance fears only are less impaired, experience fewer additional psychological disorders and are socially-speaking less avoidant (Knappe et al., 2011).
There have been some findings that suggest that people with performance fears only experience more anxiety and stronger physiological reactions when faced with a speech task compared to those with generalized SAD (Tran & Chambless, 1995; Boone et al., 1999).
It has also been pointed out that people with sole performance fears frequently report experiencing a traumatic performance situation which led to their SAD (Stemberger, Turner, Beidel, & Calhoun, 1995).
Then again, other research teams found similarities in physiological reactions for those with performance-limited SAD and panic disorder, and identified that in many cases a panic attack preceded the onset of the performance fears (Hofmann, Ehlers, & Roth, 1995; Nardi et al., 2009).
Keep in mind that performance fears are very common among people with social anxiety. This specific social anxiety type is characterized by experiencing only performance fears and by a general absence of social fears related to other situations (Eng et al., 2000).
Social Anxiety in Interaction & Observation Situations
While some experts have proposed differentiating between fear of interaction and observation situations, there seems to be a significant overlap between the two types (Cox et al., 2008; Ruscio et al., 2008).
People who fear social interaction situations, such as conversing with co-workers or a person they are attracted to, usually endorse observation and performance fears as well (Cox et al., 2008).
The same has been reported for those suffering from fears of being observed, such as when eating, drinking, writing, or using a public restroom.
For the above reasons, we have grouped these two types into the same section. More research is needed in order to determine whether or not fears of interaction and observation situations qualify as an one single subgroup and if this specifier is helpful at all.
Category III: Focus of the Social Fears
Most people with social anxiety disorder are excessively concerned about behaving in a way that will lead to negative evaluation and rejection. However, there seem to be two important deviations from this apparent core feature of SAD (Spokas & Cardaciotto, 2014).
One of them refers to the subgroup of SAD sufferers whose predominant fear is to display observable, physical signs of social anxiety, while the other relates to those who are mainly preoccupied about the possibility of offending others.
Social Anxiety Focus: Behavior
The fear of acting in a way that may lead to negative evaluation, rejection, disapproval, or humiliation is often seen as the cardinal feature of SAD (Spokas & Cardaciotto, 2014).
Affected people may worry about saying something stupid, committing a mistake, or behaving socially clumsy, and they consider what they do the main reason for concern. Most people with SAD qualify for this social anxiety type.
Social Anxiety Focus: Physical Signs of Anxiety
A considerable proportion of people with SAD report displaying observable signs of anxiety as their primary fear (Bögels & Reith, 1999). Depending on the individual, the main concern may be physical symptoms such as sweating, blushing, or trembling.
Research is still scarce regarding this area, but there have been a couple of findings regarding erythrophobia, the excessive fear of blushing.
Compared to other SAD sufferers, those with erythrophobia show stronger blushing responses during social tasks (Voncken & Bögels, 2009). It has been suggested that increased self-focused attention exacerbates the physiological response, which has important implications for treatment (Bögels, 2006).
Individuals afraid of displaying physical anxiety symptoms often report related traumatic experiences, such as being teased for them (Mulkens & Bögels, 1999).
Others may suffer from additional medical conditions which cause the physical symptoms, such as rosacea (skin condition that causes redness), hyperhidrosis (excessive sweating), or essential tremor (involuntary shaking, often in hands; Bögels et al., 2010).
Social Anxiety Focus: Offending Others [Also: Taijin Kyofusho]
While the social anxiety types described so far are primarily concerned with the impression of the self made on others, this subtype’s main focus lies on the possibility of offending others, as well as on the pursuit of avoiding this.
In Japanese culture, a specific type of social anxiety disorder with this core feature has been described. Taijin Kyofusho (対人恐怖症) refers to an excessive fear of interpersonal relations and one of its subtypes is mainly concerned about making other people feel uncomfortable (Iwase et al., 2000). Instead of dreading to be embarrassed around others, this subtype fears embarrassing others.
It has been suggested that this phenomenon is associated with collectivist cultures which accentuate social harmony and interdependence (Rector, Kocovski, & Ryder, 2006). However, it has been found that people in Western culture who cherish the same values report symptoms of this type as well (Dinnel, Kleinknecht, & Tanaka-Matsumi, 2002).
It has been pointed out that fears of offending others could be traced back to SAD’s core fear of being negatively evaluated, as upsetting others increases the risk of being rejected and disapproved of (Magee, Rodebaugh, & Heimberg, 2006).
Be that as it may, thoroughly assessing these fears is beneficial for treatment as this allows for proper coverage in therapy (Spoka & Cardaciotto, 2014). The same accounts for the underlying causes of social anxiety.
Please keep in mind that the types of social anxiety disorder discussed in this section are merely proposals from different research teams and remain subject to discussion. Depending on your health care professional, one or the other form of subtyping may be used, if any.
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