Fearful Attachment, Trauma, Social Anxiety, and Depression
Emerging research on depression, with and without social anxiety, guides care.
KEY POINTS
Social anxiety is common, correlated with childhood trauma, and predicts future depression.
Depression with and without social anxiety is different in symptom presentation, severity, and treatment.
Addressing underlying factors is likely to improve treatment outcomes and quality of life for those with combined social anxiety and depression.
By Grant H. Brenner
Social anxiety disorder (SAD) and major depressive disorder (MDD) are often co-present, up to 20 percent of the time, higher in some groups. Social anxiety starts earlier in life, affecting nearly 5 percent of people, foreshadowing future depression with a five-fold risk of depression for those with prior social anxiety (Ohayon & Shatzberg, 2010). Combined, they are more difficult to treat as the symptoms of each synergize with the other.
For example, anxiety and avoidance of social interactions in SAD worsen social withdrawal seen with depression. Negative feelings about oneself and often others in depression reinforce negative perceptions in social anxiety. The vicious cycle of negative perceptions of oneself, others, and the world can make recovery challenging, undermining relationships, including therapeutic ones.