Social Anxiety Disorder (SAD)

SAD is a risk factor for addiction

Posted Oct 14, 2014

Social anxiety disorder (SAD) is the most common psychiatric disorder after major depression and alcohol abuse, with an estimated lifetime prevalence rate of 12%.  Extreme shyness is one way to think of SAD. Social anxiety exists along a continuum, ranging from normal shyness to high degrees of social anxiety, and ultimately to SAD. Social anxiety is characterized by fear of negative evaluation, heightened self-focus, and avoidance or escaping social situations. When they are among strangers at a cocktail party, business meeting, or dinner dates, they will feel a sudden panicky need to flee for home. Other feared situations include fear of being observed while eating in public, writing, or urinating in public in crowded men’s room.

Socially anxious people are unusually attentive to other people’s feelings, but they misread them. That is, they tend to overinterpret anything that could be taken as a negative reaction. They are oversensitive to criticism or negative comments. They use impression management strategy in an attempt to hide the self. This strategy includes attempt to tightly monitor and control one’s behavior, over-preparation (rehearsing what to say before and during social interaction), and faked friendliness. The purpose is to present themselves favorably to avoid rejection. Consequently, they appear inauthentic that actually elicits negative reactions from others. This negative response serves to confirm their fears.  

Social anxiety builds during anticipation as they anticipate social events. This anticipatory anxiety sets the stage for feeling intense anxiety (such as racing heart, difficulty speaking, and shortness of breath) even before they encounter the social situation. They get further anxious by the worry that their interpersonal awkwardness or blushing will somehow reveal them to be incompetent (“if they notice I am sweating they will reject me”). After the encounter, they engage in rehashing and overanalyzing a social encounter (How did I perform?) and they overestimate probability and severity of negative evaluation. These distorted behaviors prevent socially anxious persons the opportunity to learn that what they fear are not necessarily true. These beliefs also influence how past social events are remembered (“My presentation was terrible”).

In a nutshell, SAD can be viewed as distorted information processing, and this attitude is reflected visibly in the body movements and behaviors. They keep greater interpersonal space, avoid eye contact, and show anxious behaviors, such as trembling, sweating, blushing, fidgeting, laughing nervously, or speaking fast. SAD can cause loneliness (having fewer friends or romantic relationships) and professional impairment, including less assertive and more conflict avoidant and interpersonally dependent.

SAD is associated with a significant increase in risk of substance abuse and dependence (tension-reduction motives). For example, rates of smoking are doubled among individuals with SAD. A significant number of adult smokers (81.3%) indicated onset of their anxiety disorder prior to initiation of smoking. SAD is predictive of increased risk of cannabis dependence (approximately 60%). Reliance on drugs to cope with social anxiety increases the likelihood that these individuals will be vulnerable to addiction problems.

SAD is also a risk factor for eating disorder. Approximately 20% of individuals with an eating disorder also met criteria for SAD, whereas the lifetime prevalence rate of SAD in the general public has been reported at 12.1%. Evidence suggests that anxiety tends to precede the development of eating disorders. Fear of negative evaluation is a risk factor to be thin, dietary restriction, negative affect, and overall eating disorder over time. As a result of conditioning (e.g., frequent binging during negative mood states), negative mood may become a cue that triggers cravings for binge eating.

Thus, the knowledge of why SAD serves as a risk factor for addiction could have important implications for the development of prevention and treatment programs for at-risk individuals.