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 withdraw, discomfort, and anxiety. Many consider BI to be a behavioral indicator for the development of anxiety disorders later in life, and particularly social anxiety disorder. If you recognize BI or social anxiety in your child, a loved one, or yourself, there are evidence-based steps available to help reduce symptom severity and decrease the likelihood of worsening social anxiety.  

What Is Behavioral Inhibition?

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

• Fearful of novel situations and people

• Shy

• Avoidance behavior in social situations

• Vigilant

• Uncomfortable in social situations

• Withdrawn

Behavioral inhibition is not the same thing as being shy or reserved. While children who experience shyness experience social discomfort, those with BI experience inhibition in novel social and nonsocial 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 psychiatric disorder characterized by a fear of social interactions. Individuals with SAD describe a fear of being judged, and they may feel extremely self-conscious, embarrassed, or anxious in social settings. Oftentimes, social anxiety disorder leads to avoidant behaviors, which can dramatically impact daily life and functioning. 

Some of the symptoms of social anxiety disorder include: 

• Worrying about being embarrassed in social settings

• 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, work parties, etc. 

• Evaluating performance after social interactions

• Pessimism and catastrophism about the potential outcomes of engaging in social situations 

• Blushing

• Racing heart

• Sweating

• Muscle tension

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

How Are The Two Related?

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

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

• Parental overcontrol and psychopathology

• Trauma and other negative life events

• Family history of social anxiety disorder

• The existence of other mental health conditions (particularly generalized anxiety disorder, depression, bipolar disorder, and panic disorder)

• Visible injuries or physical differences

• Substance or alcohol use problems 

• Low socioeconomic status

• Cultural differences

• Gender roles and differences in parental interactions based on gender

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. Unaddressed, social anxiety disorder may develop, which can sometimes result in serious consequences. These 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 wellbeing. 

The following steps can help you manage behavioral inhibition and social anxiety: 

• Try To Identify The Problem Early

Behavioral inhibition interventions in childhood can 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, you can reach out to their pediatrician or a child psychologist. Oftentimes, adapting parenting methods can effectively reduce fear and encourage uninhibited childhood temperament. 

Effective strategies may focus on encouraging confidence and independence through exposure to new situations. A child psychologist can also help you determine if overprotective parenting may be a contributing factor to your child's BI. 

• Therapy Can Help

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

For individuals who have not sought out help due to fear or discomfort associated with face-to-face therapy, online therapy may be a good 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 focuses on addressing SAD symptoms and avoidant behaviors. 

• Social Skills Training

Studies show that social skills training, on it’s own, may not be effective for reducing SAD symptoms. However, it may provide additional benefits when combined with exposure therapy. 

• Effective Medications

If you believe you have symptoms of social anxiety disorder, you can reach out to a medical practitioner or an in-person mental health professional. They can provide you with a diagnosis, and medical doctors (including psychiatrists) can evaluate whether medications may be helpful for reducing your symptoms. 

Common medications used to treat social anxiety disorder include selective serotonin reuptake inhibitors (SSRIs) like paroxetine and sertraline, or your medical practitioner may recommend other types of antidepressants, anti-anxiety medications, or beta blockers. 

Some people experience side-effects with certain medications, so your doctor will likely increase your dosage slowly to reduce that risk. They may need to try several different medications to find the one that works best for you. 

Takeaway

Behavioral inhibition is a common behavior trait in 15-20% of children. It is characterized by shyness and fear of novel situations and unfamiliar people, which parents can sometimes address through positive exposure to new situations. Though not everyone with BI will go on to develop social anxiety disorder, it is still a strong predictor of anxiety disorders. 

Many people can manage social anxiety disorders with exposure-based psychotherapy and/or psychiatric medications. Online cognitive behavioral therapy can effectively reduce symptoms of SAD in most people.