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2002-12-05 01:55:05 (UTC)

Social Anxeity Disorder

What causes it?

Understanding "why" a condition occurs is often the
most difficult question to answer. Although we already
have a good grasp of the characteristics and treatment
of social anxiety disorder, our present understanding of
social anxiety disorder is incomplete.

Multiple causes are suspected, especially a
combination of genetic makeup, early growth and
development, and later life experience. Current theories
are grouped into the following categories:

* Genetic predisposition
* Ethology
* Development
* Chemical disturbances in the brain

Genetic predisposition

Just as physical features such as hair and eye color
are inherited, sensitivity to criticism or social scrutiny
may be passed on from one generation to the next. It's
possible that the child of one or two shy parents may
inherit genetic code that amplifies shyness into social
anxiety disorder.

Through his research at Harvard University, Jerome
Kagan, Ph.D., found evidence of this genetic
predisposition. He studied children from infancy
through early adolescence. He found 10-15% of
children to be irritable infants who become shy, fearful
and behaviorally inhibited as toddlers, and then remain
cautious, quiet and introverted in their early grade
school years. In adolescence, they had a much higher
than expected rate of social anxiety disorder.

Kagan also found a physiological accompaniment of
anxious temperament in these children: a high resting
heart rate. Their resting heart rates rose even higher in
the presence of mild stresses. Additionally, when
exposed to new situations, these children exhibited
substantial behavioral restraint — becoming quiet,
avoiding interaction and even retreating from the scene.
Parents of these children have increased rates of
social anxiety disorder and other anxiety disorders.

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Ethology (study of animal behavior)

"Fear of two staring eyes is widespread throughout the
animal kingdom." With this declaration, Professor Isaac
Marks begins the marvelous section on "being looked
at" in Fears, Phobias, and Rituals (Oxford University
Press, New York, 1987), his book on anxiety disorders.
He cites animal studies in which birds were found to
avoid prey associated with, or which had markings
similar to, the vertebrate eye. In some cases the
presence of an "eye-like" image (like the moth in the
photo here) caused them to escape. Even in the animal
kingdom, being under another's scrutiny is

These eyespots drove away yellow buntings in an
experiment. When the eyespots were rubbed off, the
moths were more likely to be eaten.

Dr. Marks goes on to state:

"Although staring can be a threatening behavior, it does
not always frighten humans. Ordinarily, staring arouses
and engages the person being stared at, but the
context decides what sort of engagement that is. Lovers
enjoy looking into one another's eyes. In the right
context, staring increases another person's
helpfulness. For example, if a woman carrying a load of
packages stands on a street corner and stares at a
pedestrian who is waiting to cross, that pedestrian will
cross faster than one who is not stared at. But if she
drops a package and stares, the pedestrian is likely to
approach, pick up the package, and hand it to her. The
fallen package makes the engaging stare appealing
rather than threatening."

"When the context of a stare is neutral or ambiguous, it
can be unsettling and provoke escape. In one
experiment, a bystander either stared at drivers who
stopped at a red light or gave them a quick glance of
civil inattention. When the traffic light changed, drivers
who had been stared at pulled away faster than those
who had merely been glanced at did."

Averting the gaze is common in people with social
anxiety disorder. Though exact cues and
reinforcements for these behaviors must vary widely,
their role in the development and maintenance of social
anxiety seems significant.

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Social anxiety emerges at different developmental
stages. Babies develop a fear of strangers at seven
months, not before. Separation anxiety is quite clear in
some children—perhaps more obvious in
three-year-olds we take to daycare than in five-year-olds
going off to kindergarten. Being alone is difficult for
children ages six to eight, but actually becomes
desirable as they approach puberty and adolescence.
Solitude becomes more important as anxiety about
physical appearance and performance in school
increases. We also know that traumatic or stressful life
events occurring at an early developmental stage may
increase the risk of social anxiety disorder.

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Chemical disturbances in the brain

The exact workings of the brain and its biochemistry in
normal versus pathological anxiety states have not
been fully defined. We believe that both normal anxiety
and abnormal anxiety are probably created by the same
set of brain structures, neurotransmitters (chemical
messengers) or neuromodulators (chemical
regulators). Examples of brain regulation include
control of thinking, control of physiologic functions, and
control of behaviors. For example, thoughts can range
from safe to dangerous, serious to humorous, etc.
Physiologic functions, such as regulation of blood flow,
the nervous system and the muscular system, fluctuate
from resting states to initial arousal, then to marked
arousal/anxiety and finally to extreme anxiety or panic.
Behaviors from deep sleep to moderate activity to
extremes of fighting, fleeing or freezing are all played
out endlessly in each of us.

It is probable, although not certain, that at least four
brain areas are critical to our anxiety-response system:
the brain stem (cardiovascular and respiratory
limbic system (mood and anxiety)
prefrontal cortex (appraisals of risk and danger)
motor cortex (control of muscles)

These structures are richly supplied with three major
neurotransmitters: norepinephrine (NE), found in
neurons arising primarily from a part of the brain stem
called the locus ceruleus; serotonin (5-HT), found in
neurons beginning in the raphe nuclei of the midbrain;
and gamma aminobutyric acid (GABA), found in
neurons that are widespread throughout the brain.
Other neurotransmitters and neuromodulators,
including corticotropin releasing factor (CRF) and
cholesystokinin, probably play important roles in the
regulation of arousal and anxiety.

Individuals with social anxiety disorder (and other
anxiety disorders) probably have abnormalities in the
functioning of some parts of their anxiety response

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