Mental illness is often the result of a complicated interaction between our genetic makeup, lived experiences and the environment we inhabit. Scientists have yet to precisely identify the root of the difficulties 1 in 5 Americans face in a given year (National Alliance on Mental illness, 2017). Advances in the area of mental health research are vitally important as they can help to inform new treatments. Researchers at the Institute of Human Genetics at the University of Bonn in Germany recently discovered that a gene called “SLC6A4” was strongly correlated with someone’s chances of suffering from social anxiety disorder (SAD). Initial findings have been published online in the journal of Psychiatric Genetics. SLC6A4 is involved in transporting serotonin in the nervous system. Serotonin is sometimes referred to as the “happiness hormone” as it is involved in feelings of positivity and wellbeing.​The fact that some people are born with an innate disposition towards suffering from SAD is extremely interesting, particularly given its high prevalence rates in the American population. Anxiety disorders are amongst the most common mental illnesses affecting up to 18% of the population (Anxiety and Depression association of America, 2017).

SAD is often minimized by people confusing it with “shyness” or simply being introverted. In reality, SAD is an intense and persistent fear of social situations. Those with SAD may experience bouts of anxiety over simple everyday things such as answering the phone or being asked directions on the street. Whilst many of us may experience mild anxiety over social situations, those with SAD will experience chronic worry before, during and after the social scenario. They particularly fear embarrassment or social rejection. SAD is often apparent from an early age and first manifests itself in childhood or adolescence. It is also almost twice as common in women as men, with prevalence particularly high in Europe and North America. Scientists are not fully sure why women are more prone to anxiety but some have theorised that this propensity may be linked to differences in brain chemistry and hormone fluctuations. Women are also more prone to stress and tend to mull over stressful situations more than men, who tend to pursue more active coping strategies. So what does Social Anxiety Disorder look like and how is it diagnosed? Here are some of the signs:

• Teens and adults with SAD may dread everyday situations such as: Starting conversations, speaking on the phone and going normal outings such as shopping or eating with others.
• Those with SAD often have very low self- esteem.
• They may be insecure in relationships, fearing rejection and overthinking dynamics.
• They may avoid eye contact
• Those with SAD fear criticism
• They may turn to substance abuse in an attempt to keep anxiety at bay

​Some individuals who suffer from SAD also experience panic attacks. Panic attacks result from fear of social situations that becomes overwhelming, leading up to a physical response. Although panic attacks usually only last a few minutes, they are extremely unpleasant. The individual may feel nauseous and experience trembling, palpitations and a shortness of breath. Although panic attacks don’t lead to any long- term physical difficulties they are extremely alarming. SAD often co- occurs with other disorders such as depression, generalised anxiety disorder and post- traumatic stress disorder. ​

As previously discussed SAD is the result of a combination of genetic and environmental factors. Although certain genes may significantly increase the likelihood of SAD, this may not be enough for the disorder to manifest itself. ​Researchers have linked parenting styles to the likelihood of developing SAD. As SAD may have a genetic root, parents may be more worried or anxious, translating poor coping styles to their children.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is the tool most commonly used to diagnose mental conditions including SAD. Criteria includes:

• Persistent fear of and/ or intense anxiety about social scenarios in which you believe you may be  judged or act in a way that’s embarrassing.
• Avoidance of social situations and/or intense anxiety when present in social situations
• Anxiety that’s out of proportion to the situation
• Anxiety or distress that impedes your daily living
• Fear or anxiety that cannot be explained by a different medical condition, medication or substance problem

These criteria should be present for 6 months or more.

SAD may be treated with medications and/ or psychotherapy. Psychological counselling is highly effective for those suffering from SAD. It can help the individual learn ways to deal with stress in social situations and build self- confidence. One of the more commonly used treatments is CBT (Cognitive Behavioural Therapy). CBT may help the individual to see that their fears are irrational and help them to gradually work up to facing the social situations they fear the most. One tactic that is often employed is role- playing, whereby the individual can practice being in social situations and build up confidence in a safe and secure environment. SAD can be all- consuming for the sufferer, as being crippled regarding ones social life and interactions limits our ability to form relationships, push our personal boundaries and live a happy and fulfilling life. It has a remarkably high prevalence rate and many suffers stay under the radar undiagnosed. SAD responds remarkably well to treatment, however, and if you suspect you may have SAD, please seek out a local mental health professional and learn to tame the anxiety you face daily. ​ References: ​American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association. ​Turk, C. L., Heimberg, R. G., & Hope, D. A. (2001). Social anxiety disorder. Clinical handbook of psychological disorders: A step-by-step treatment manual, 3, 114-153.