Social Anxiety Disorder Social Anxiety Disorder Guide Social Anxiety Disorder Guide Symptoms & Diagnosis Causes Treatment Living With In Children Understanding the Causes of Social Anxiety Disorder By Arlin Cuncic Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." Learn about our editorial process Updated on February 19, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Genetic Environmental Societal Brain Structure/Biological Next in Social Anxiety Disorder Guide Treating Social Anxiety Disorder If you have been diagnosed with social anxiety disorder (SAD), you may wonder what caused you to develop the illness. Rather than there being a single causative factor, it is likely a complex interplay of variables that result in the disorder. Illustration by Brianna Gilmartin, Verywell Genetic If you are diagnosed with SAD, you probably have specific genes that made you more prone to developing the disorder. If you have a first degree relative with SAD, you may also be two to six times more likely to develop the disorder. The genetic component of social anxiety disorder is also known as the “heritability” of the disorder. Although heritability rates can vary a great deal in studies, it has been estimated at around 30 to 40 percent, meaning that roughly one-third of the underlying causes of SAD comes from your genetics. Heritability is the proportion of variation in a phenotype (trait, characteristic, or physical feature) that is thought to be caused by genetic variation among individuals. The remaining variation is usually attributed to environmental factors. Studies of heritability typically estimate the proportional contribution of genetic and environmental factors to a particular trait or feature. So far, researchers have not found a particular genetic makeup linked to SAD. They have, however, found certain genes linked to other anxiety disorders such as agoraphobia and panic disorder. Environmental The psychosocial causes of social anxiety disorder (SAD) include factors in the environment that influence you as you grow up. If one of your parents has social anxiety disorder (SAD), then you are more likely to develop the disorder yourself. This could be due to both genetic and environmental influences. Psychologists have developed theories about how children may become socially anxious through learning. Ways Children Learn Social Anxiety Direct conditioning: Did you forget your lines in the class play? Did other kids make fun of you or were you the victim of constant teasing or bullying? While it is not a necessary trigger, going through an early traumatic event may have an impact on the development of social anxiety, sometimes years later.Observational learning: If you did not experience a traumatic event yourself, did you see someone else in a traumatic social situation? For those already vulnerable to the disorder, this may have the same impact as going through the situation firsthand.Information transfer: Fearful and socially anxious parents unknowingly transfer verbal and non-verbal information to their children about the dangers of social situations. If your mother worries a lot about what other people think of her, chances are you have developed some of this same anxiety yourself. Your upbringing can also impact the likelihood that you will develop SAD. You are more likely to develop the disorder if: As a child, you were not exposed to enough social situations and were not allowed to develop appropriate social skills.One or both of your parents was rejecting, controlling, critical, or overprotective. Children that do not form a proper attachment to their primary caregiver are at greater risk because they can't calm and soothe themselves when in stressful situations. Behavioral Inhibition in Childhood Do you know a toddler or young child who always becomes extremely upset when confronted with a new situation or unfamiliar person? When faced with these types of situations does the child cry, withdraw, or seek the comfort of a parent? This type of behavior in toddlers and young children is known as behavioral inhibition. Children who show behavioral inhibition as a toddler are at greater risk for developing SAD later in life. Because this temperament shows up at such a young age, it is likely an inborn characteristic and the result of biological factors. If you are concerned that your child is excessively withdrawn or fearful in new situations, it may be helpful to discuss your worries with a professional. Since we know that behaviorally inhibited toddlers are more likely to become socially anxious children and socially phobic adults, any kind of early intervention may help prevent more serious problems later in life. Societal Societal factors that can influence the development of social anxiety include growing up in a culture with a strong collectivistic orientation, such as Japan or Korea. The syndrome taijin kyofusho in these cultures involves a fear of making other people uncomfortable and reflects a culture in which concern for how you fit as part of the larger group is emphasized. What Is Taijin Kyofusho? Brain Structure/Biological Just as x-rays are used to “see inside” your body, the same can be done for your brain. Medical researchers use a technique called “neuroimaging” to create a picture of the brain. Newer techniques can look not only at brain structure but at types of functions in specific regions of the brain. For mental disorders, researchers may look differences in blood flow in specific areas of the brain for people who are known to have a particular disorder. We know that four areas of the brain are involved when you experience anxiety. Brain Areas Involved in Anxiety The brain stem (controls your heart rate and breathing)The limbic system (effects your mood and anxiety level)The prefrontal cortex (helps you to appraise risk and danger)The motor cortex (controls your muscles) A study of blood flow in the brain published in 2001 found differences in the brains of social phobics when speaking in public. For this study, they used a type of neuroimaging called “Positron Emission Tomography” (PET). The PET images showed that people with social anxiety disorder had increased blood flow in their amygdala, a part of the limbic system associated with fear. In contrast, the PET images of people without SAD showed increased blood flow to the cerebral cortex, an area associated with thinking and evaluation. It seems that or people with social anxiety disorder, the brain reacts to social situations differently than people without the disorder. Neurotransmitters If you have social anxiety disorder, there are likely imbalances of certain chemicals in your brain, known as neurotransmitters. These neurotransmitters are used by your brain to send signals from one cell to another. Neurotransmitters Involved in Anxiety Norepinephrine Serotonin Dopamine Gamma-aminobutyric acid (GABA) People with social anxiety disorder have been shown to have some of the same imbalances of these neurotransmitters as people with agoraphobia and panic disorder. Understanding how these brain chemicals relate to social anxiety disorder is important to determine the best medications for treatment. A Word From Verywell There is no single cause of SAD. In most people, the disorder is the result of a combination of factors. When receiving a diagnosis or treatment for social anxiety disorder, your doctor or mental health professional should discuss with you possible contributing factors to your social anxiety. Best Treatments for Social Anxiety Disorder 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author; 2013. Villafuerte S, Burmeister M. Untangling genetic networks of panic, phobia, fear and anxiety. Genome Biol. 2003;4(8):224. doi:10.1186/gb-2003-4-8-224 Muris P, van Brakel AM, Arntz A, Schouten E. Behavioral Inhibition as a Risk Factor for the Development of Childhood Anxiety Disorders: A Longitudinal Study. J Child Fam Stud. 2011;20(2):157–170. doi:10.1007/s10826-010-9365-8 Tillfors M, Furmark T, Marteinsdottir I, et al. Cerebral blood flow in subjects with social phobia during stressful speaking tasks: a pet study. AJP. 2001;158(8):1220-1226. doi:10.1176/appi.ajp.158.8.1220 Martin EI, Ressler KJ, Binder E, Nemeroff CB. The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. Psychiatr Clin North Am. 2009;32(3):549–575. doi:10.1016/j.psc.2009.05.004 By Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Social Anxiety Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.