Social anxiety disorder – beyond shyness

Social anxiety disorder, aptly described as "crippling shyness," usually begins in childhood or early adolescence, and the symptoms often persist for decades, a new study shows.

The study, based on data from the 2002 Canadian Community Health Survey (CCHS): Mental Health and Well-being, provides further evidence supporting the description of the disorder as an "illness of lost opportunities."

People with social anxiety disorder, also known as social phobia, go through life feeling extremely uncomfortable or paralyzed in social or work situations because of their intense fear of being scrutinized or embarrassed. They either totally avoid social encounters, or face them with dread.

According to data from the 2002 CCHS, social anxiety disorder is associated with lower educational attainment and reduced likelihood of employment, low income and dependence on welfare or social assistance, decreased likelihood of marriage or having a successful marriage, social isolation, higher rates of disability, and dissatisfaction with life and health.

The majority of people with social anxiety disorder do not seek professional help, and those who do often wait years before doing so.

Just over 2 million Canadians aged 15 or older reported a "lifetime history" of social anxiety disorder, meaning that they had symptoms at some point in their lives. This represents about 8% of the population.

In 2002 alone, about 750,000 Canadians aged 15 or older, or about 3% of the population, reported that they had had symptoms of the disorder in the past year. These individuals had a higher risk of having major depressive disorder, panic disorder and dependency on illicit drugs and alcohol than did people in the general population.

Young people aged 15 to 24 were more likely to have current social anxiety disorder than were middle-aged people, while individuals aged 55 or older were less likely. Women were slightly more likely than men to have both lifetime and current social anxiety disorder.

Early onset most striking feature

One striking feature of social anxiety disorder is its early age of onset. Symptoms typically begin appearing in childhood or early adolescence. Among individuals with a lifetime history of the disorder, the average age of onset was 13.

In contrast, the first symptoms of two other common disorders – panic disorder and depression – were evident much later, around the ages of 25 and 28, respectively.

The symptoms of social anxiety lasted an average of 20 years. This underestimates the true burden of the disorder, however, because many were still suffering from it when they were interviewed for the CCHS.

Marital status and income are major factors

The prevalence of social anxiety disorder in 2002 was higher among people who had never married, or who were divorced or separated, compared with individuals who were married.

It was also more prevalent among individuals living in lower, rather than higher, income households.

People who reported symptoms of social anxiety disorder in the 12 months before the survey were less likely to have jobs, and those who did have jobs, had lower personal incomes. This may partly result from the lower educational levels among people with social anxiety disorder, as well as difficulties remaining in jobs that demand a fair amount of social interaction.

People with the disorder were also more likely to be financially dependent. In 2002, 10% of those who had current symptoms lived in households reporting income from social assistance or welfare in the previous year. This was more than twice the proportion (4%) among people with no history of the disorder.

Sufferers tend to report lower quality of life

People with social anxiety disorder tended to report a lower quality of life, as indicated by their negative perceptions of their own health and their dissatisfaction with life.

Nearly 30% of people who currently had social anxiety disorder in 2002 rated their physical health as fair or poor. This was much higher than the 17% of those who previously had the disorder, and 13% of those with no history of it.

Some 37% of people who reported having the disorder in 2002 rated their mental health as fair or poor. This was double the proportion of 16% among those who previously had the disorder, and well above the 5% among those with no history.

More than one-fifth of people with social anxiety disorder also reported they were dissatisfied with life in general, twice the proportion of those with a past history.

Majority don't seek treatment

Only 37% of people with social anxiety disorder reported to the CCHS that they had sought treatment for their fear or avoidance of social situations from a doctor, psychologist, psychiatrist or other professional.

This was well below the rates for major depressive disorder or panic disorder; in both of these cases, about 7 out of 10 sufferers had sought professional help for these disorders.

Individuals with social anxiety disorder were far more likely to seek treatment if they had another mental health disorder.

The CCHS found that people with a lifetime history of social anxiety disorder waited an average of 14 years after the age of onset before seeking help. These low treatment rates for social anxiety disorder are consistent with findings from other studies.

In general, sufferers may just be too inhibited by their social fears to seek help. They may be reluctant or embarrassed to discuss their symptoms, even with a health professional.

In fact, the act of contacting a professional may be extremely difficult for someone with the disorder. Many are not aware they have a recognized mental disorder and attribute their intense fears to shyness.

Definitions, data sources and methods: survey number 5015.

The article "Social anxiety disorder – beyond shyness" (82-003-SIE, free) is now available online. This study is the first of several articles to be released this fall in the series How Healthy are Canadians?, an annual supplement to Health Reports (82-003-XIE, $17/$48; 82-003-XPE, $22/$63).

Future releases focus on bipolar I disorder, panic disorder, and alcohol and drug dependence. A print compendium of all articles, Focus on Mental Health, will be released in December.

For more information, or to enquire about the concepts, methods or data quality of this release, contact Margot Shields (613-951-4177; margot.shields@statcan.gc.ca), Health Statistics Division.