Post-Traumatic Stress Disorder (PTSD) and Social Anxiety Disorder (SAD) are two mental health conditions that often co-occur. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SAD is characterised by a frequent and unending fear of social situations or situations where the individual is expected to perform in some way. In these situations, the person comes into contact with unfamiliar people or experiences the possibility of scrutiny by others. The fear of appearing anxious or acting out in a way that will bring about embarrassment or humiliation can be overwhelming. The upcoming contact with a feared situation almost always causes anxiety, maybe even in the form of a panic attack.
Individuals with SAD recognise that the fear they experience in response to social situations is unreasonable or greater than it should be, and they avoid situations they fear. If they have to be in those situations, they do so with high levels of anxiety and distress. These symptoms interfere considerably with many aspects of their lives (work, relationships, etc.) and are not due to medication, a substance (i.e., alcohol), a medical condition, or other disorder.
Several factors contribute to the development of SAD, including environmental, biological, and psychological factors. Studies vary in the rates of SAD found along with PTSD, ranging from 14% to 46%. This percentage is variable because it depends on the group of people a study is examining. For example, research shows that populations with the highest rate of both SAD and PTSD are veterans with PTSD and people who seek out treatment for PTSD.
A number of theories have been proposed to explain why PTSD and SAD are related. First, the symptoms of PTSD may make a person feel different, as though they can't relate or connect with others. A person with PTSD may have difficulties communicating or interacting with others for fear of coming into contact with trauma-related reminders. All of this may feed the development of SAD. In addition, many people with PTSD feel high levels of shame, guilt, and self-blame, and these feelings may lead to SAD. Finally, there is evidence that SAD among people with PTSD stems from depression. People with PTSD often experience depression, which may lead to social withdrawal, isolation, and a lack of motivation that could contribute to the development of SAD.
Overall, research suggests that the link between PTSD and SAD is complex, stemming from multiple factors including a person's genes, history of trauma, and psychological vulnerabilities, like fear of being negatively evaluated by others. Further studies will hopefully help experts tease apart the precise relationship between PTSD and SAD.
Fortunately, there are many effective treatments for SAD, such as cognitive-behavioral therapy (CBT), exposure therapy, and medication. In addition, there are treatments for PTSD that have been shown to be successful in reducing symptoms, such as prolonged exposure therapy, cognitive processing therapy, and eye movement desensitisation and reprocessing (EMDR). By getting treatment for PTSD, individuals may also notice that their symptoms of SAD are lower as well.
At ACTS3, we offer a range of evidence-based psychotherapeutic interventions for individuals who have experienced trauma and have mental health conditions such as PTSD and SAD. Our programs are designed to address the complex interplay of biological, psychological, and environmental factors that contribute to the development and maintenance of mental health conditions. Our team of mental health professionals is committed to providing personalised, compassionate, and culturally sensitive care that addresses the unique needs of each individual. We encourage anyone who is struggling with PTSD, SAD, or any other mental health condition to reach out to us and learn more.
References: Bomyea, J., Risbrough, V. B., & Lang, A. J. (2012). A consideration of select pre-trauma factors as key vulnerabilities in PTSD. Clinical Psychology Review, 32(7), 630-641;
Furmark, T. (2002). Social phobia: Overview of community surveys. Acta Psychiatrica Scandinavica, 105(2), 84-93; Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36(4), 193-209; Hofmann, S. G., & Barlow, D. H. (2014). Evidence-based psychological interventions and the common factors approach: The beginnings of a rapprochement? Psychotherapy, 51(4), 510-513.; Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27(5), 572-581.
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