The Link Between Behavioral Inhibition And Social Anxiety Disorder

Behavioral inhibition (BI) is a temperament trait common in children, though it can continue into adulthood. BI is characterized by shyness, social withdrawal, discomfort, and anxiety. Many consider BI a behavioral indicator for developing anxiety disorders later in life, particularly social anxiety disorder. If you recognize BI or social anxiety in your child, a loved one, or yourself, evidence-based steps are available to help reduce symptom severity and decrease the likelihood of worsening social anxiety.

What Is Behavioral Inhibition?

Behavioral inhibition is a temperament type often identified in early childhood and is seen in approximately 15% to 20% of children. Individuals with BI are characterized as being:

• Fearful of novel situations and people
• Shy
• Prone to avoidant behavior in social situations
• Vigilant
• Uncomfortable in social situations
• Withdrawn

Behavioral inhibition is not the same as being shy or reserved. While children who experience shyness experience social discomfort, those with BI experience inhibition in novel social and non-social situations. It is believed that an overactive amygdala (the center of the brain that processes fear and threat detection) may be responsible for heightened fear responses to novel situations.

Certain parenting styles can reduce behavioral inhibition. For example, parents can slowly and methodically expose children to novel situations while providing reassurance, thus helping them reduce reliance on avoidance to cope with fear. Research shows that parents who utilize similar parenting methods can successfully help their children transition from behavioral inhibition to a more uninhibited temperament. 

What Is Social Anxiety Disorder?

Social anxiety disorder (SAD), also called social phobia, is a mental illness characterized by a fear of social interactions. Individuals with SAD describe a fear of being judged, and they may experience self-consciousness, embarrassment, or anxiety in social settings. Social anxiety disorder sometimes leads to avoidant behaviors, which can impact daily life and functioning. 

The symptoms of social anxiety disorder include but are not limited to:                 

• Worrying about being embarrassed in social settings
• An overwhelming fear of talking to unfamiliar people
• Fear of looking anxious in social settings 
• Fear of being judged
• Worrying about physical manifestations of anxiety in social settings, including sweating, blushing, stuttering, or shaking
• Avoiding certain situations, such as public speaking, being the center of attention, or going to work parties
• Evaluating performance after social interactions
• Pessimism and catastrophism about the potential outcomes of engaging in social situations 
• Blushing
• A racing heart
• Sweating
• Muscle tension

Social anxiety disorder is common, with approximately 12% of adults in the United States experiencing it at some point in their lives. Though SAD can disrupt daily life, some people find that they can address their symptoms with psychiatric medications and psychotherapy. 

How Are Social Anxiety And Behavioral Inhibition Related? 

Research consistently demonstrates that behavioral inhibition predicts anxiety later in life. However, many children who experience behavioral inhibition do not develop social anxiety disorder. Those with stable BI personalities that persist through adolescence and young adulthood are most likely to be diagnosed with social anxiety disorder. 

However, BI is not the only predictor of social anxiety. Other risk factors can make an individual more likely to develop social anxiety disorder, including the following: 

• Parental overcontrol and psychopathology
• Trauma and other adverse life events
• A family history of social anxiety disorder
• The existence of other mental health conditions
• Visible injuries or physical differences
• Substance use 
• A low socioeconomic status
• Cultural differences
• Gender roles and differences in parental interactions based on gender

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Addressing Behavioral Inhibition And Social Anxiety Disorder

Behavioral inhibition can decrease social behavior, encourage avoidant coping mechanisms, and make anxiety and depression more likely later in life. An unaddressed anxiety disorder may develop, sometimes resulting in serious consequences. These consequences may include loneliness, social avoidance, low self-esteem, poor work or school performance, depression, and excessive substance use. 

Loneliness and social isolation can increase the risk of stroke, heart disease, depression, and premature death. Addressing BI and SAD can improve mental health and overall well-being. The following steps may also help you manage behavioral inhibition and social anxiety: 

Try To Identify BI Early 

Behavioral inhibition interventions in childhood may reduce the risk of social anxiety disorder, with one study reporting a 25% reduction in anxiety disorder development. If you are concerned that your child is experiencing behavioral inhibition, contact their pediatrician or a child psychologist. Adapting parenting methods can often reduce fear and encourage uninhibited childhood temperament. 

Effective strategies may encourage confidence and independence through exposure to new situations. A child psychologist can also help you determine if overprotective parenting contributes to your child's condition.  

Enroll In Social Skills Training

Studies show that social skills training alone may not effectively reduce social anxiety symptoms. However, it may provide additional benefits when combined with exposure therapy. 

Effective Medications

If you believe you have social anxiety disorder symptoms, you can contact a medical practitioner or psychiatrist for guidance. They can provide you with a diagnosis, and medical doctors (including psychiatrists) can evaluate whether medications may help reduce your symptoms. 

Some people experience side effects with certain medications, so your doctor may increase your dosage slowly to reduce that risk. They may try several different medications to find the one that works best for you. Always consult a doctor before starting, changing, or stopping a medication. 

Consider Professional Support 

Cognitive-behavioral therapy (CBT) is an effective therapeutic modality for reducing the symptoms of social anxiety. During exposure-based CBT sessions, therapists often help clients practice gradual exposure to social situations that cause fear. This type of therapy is shown to instill self-confidence in social settings. 

For individuals who have not sought support due to fear or discomfort associated with face-to-face therapy, online therapy may be an effective alternative. In a 2018 study, researchers studying the effectiveness of online-cognitive behavioral therapy found that social anxiety symptoms were significantly reduced in most participants. 

Platforms like BetterHelp offer online CBT that addresses SAD symptoms and avoidant behaviors. In addition to the efficacy of online platforms, online therapy can be flexible and cost-effective. Through a platform, you can often match with a therapist within 48 hours and choose between phone, video, or chat sessions, depending on your preferences.