Social anxiety in adolescents and young adults from the general population: an epidemiological characterization of fear and avoidance in different social situations

Abstract

Social Anxiety Disorder (SAD) and, more generally, social fears are common in young people. Although avoidance behaviors are known to be an important maintaining factor of social anxiety, little is known about the severity and occurrence of avoidance behaviors in young people from the general population, hampering approaches for early identification and intervention. Symptoms, syndromes, and diagnoses of DSM-5 mental disorders including SAD were assessed in a random population-based sample of 14-21-year-olds (n = 1,180) from Dresden, Germany, in 2015/2016 using a standardized diagnostic interview (DIA-X-5/D-CIDI). An adapted version of the Liebowitz Social Anxiety Scale was used to ascertain the extent of social fears and avoidance. Diagnostic criteria for lifetime SAD were met by n = 82 participants, resulting in a weighted lifetime prevalence of 6.6%. Social anxiety was predominantly reported for test situations and when speaking or performing in front of others. Avoidance was most prevalent in the latter situations. On average, anxiety and avoidance first occurred at ages 11 and 12, respectively, with avoidance occurring in most cases either at about the same age as anxiety or slightly later. In the total sample, lifetime prevalence for most DSM-5 disorders increased with the severity of social anxiety and avoidance. Results underline the need for preventive or early intervention efforts especially regarding test anxiety and fear and avoidance of speaking in front of others. These situations are particularly relevant in youth. Avoidance behaviors may also be discussed as diagnostic marker for early case identification.

Adolescent social anxiety is associated with diminished discrimination of anticipated threat and safety in the bed nucleus of the stria terminalis

“…As expected, co-morbidity was rampant, and the majority of adolescents with SAD (n=14, 58.3%) received at least one other categorical diagnosis (Koyuncu et al, 2019;Lahey et al, 2022;Tiego et al, 2023). GAD (n=12, 50.0%) and MDD (n=8, 33.3%) were the most common co-morbidities, in broad accord with recent adolescent epidemiology studies (Ernst et al, 2023;Jystad et al, 2021).…”

“…Social anxiety lies on a continuum and, when extreme, can be devastating, with functional impairment evident in many individuals who do not meet full diagnostic criteria ( Fehm et al, 2008 ; Hyett & McEvoy, 2018 ; Katzelnick et al, 2001 ; Kessler, 2003 ; Lipsitz & Schneier, 2000 ; Merikangas et al, 2002 ; Schneier et al, 2002 ). Social anxiety disorder (SAD) is among the most common psychiatric illnesses (lifetime prevalence: ∼13%), typically emerges in adolescence, and confers heightened risk for a variety of other developmental, academic, and psychiatric problems, including co-morbid internalizing disorders and substance misuse ( Angst et al, 2016 ; Beesdo-Baum & Knappe, 2012 ; Ernst et al, 2023 ; Gregory et al, 2007 ; Hyett & McEvoy, 2018 ; Jystad et al, 2021 ; Kessler et al, 2012 ; Koyuncu et al, 2019 ; Mathew et al, 2011 ; Schneier et al, 1992 ; Stein et al, 2017 ). Existing treatments are inconsistently effective or associated with significant adverse effects, underscoring the urgency of developing a more complete understanding of the neural systems governing social anxiety in the first decades of life ( Batelaan et al, 2017 ; Beidel et al, 2019 ; Cuijpers et al, 2024 ; Evans et al, 2021 ; James et al, 2020 ; Rapee et al, 2023 ; Scholten et al, 2016 ; Scholten et al, 2013 ; Singewald et al, 2023 ; Spinhoven et al, 2016 ; Strawn et al, 2021 ).…”

“…The sample was selectively recruited to encompass a broad spectrum of social anxiety—without gaps or discontinuities—and enriched for clinically significant levels of distress and impairment. Adolescent with comorbid anxiety and depressive disorders were enrolled, maximizing clinical relevance ( Ernst et al, 2023 ; Jystad et al, 2021 ; Koyuncu et al, 2019 ; Lahey et al, 2022 ; Tiego et al, 2023 ). The MSTC task takes the form of a 2 ( Valence: Social Threat/Safety) × 2 ( Temporal Certainty: Uncertain/Certain) × 2 ( Phase: Anticipation/Presentation) randomized event-related design, allowing us to separately assess EAc activation during the anticipation and acute presentation of both certain and uncertain social-threat cues ( Figure 1 ).…”

Social Anxiety Levels among Adolescents at Social Child Welfare Institutions in Pekanbaru City

“…Meanwhile, the findings of this study are slightly different from those stated in research by Ernst et al, who found that in the situational group, the social situations that most often cause anxiety and avoidance are exam situations, especially oral exams and speaking or performing in front of others. Whereas in the group with lifelong social anxiety disorder, the social condition that causes the most anxiety is having a party, and the most frequent avoidance is talking to almost unknown people (18). But the findings from this study may differ depending on the experiences experienced by the respondents.…”

Exploring the Nexus between Moderate-to-Vigorous Physical Activity, Self-Disclosure, Social Anxiety, and Adolescent Social Avoidance: Insights from a Cross-Sectional Study in Central China

“…Social avoidance is crucial in social anxiety and social phobia, serving as a major factor in maintaining anxiety [47]. Experimental investigations indicate that social anxiety and social avoidance often emerge in early adolescence, and preventive or early intervention measures significantly reduce their occurrence [48]. The onset of social anxiety in adolescents may be partly attributed to an increase in avoiding social situations during this period [49] and familial genetic factors [50].…”