Hope for those with social anxiety disorder: You may already be someone’s best friend

Making friends is often extremely difficult for people with social anxiety disorder and to make matters worse, people with this disorder tend to assume that the friendships they do have are not of the highest quality.

The problem with this perception, suggests new research from Washington University in St. Louis, is that it's not necessarily true from the point of view of their friends.

"People who are impaired by high social anxiety typically think they are coming across much worse than they really are," said study co-author Thomas Rodebaugh, PhD, associate professor of psychology in Arts & Sciences. "This new study suggests that the same is true in their friendships."

The study, published this month in the Journal of Abnormal Psychology, finds that people with social anxiety disorder often overestimate how bad their relationships are with friends, when compared to what the friends say.

Much more than simple shyness, social anxiety disorder is a recognized psychiatric condition in which those struggling with the affliction often live in fear of meeting new people, passing up social invitations or work opportunities for fear of being rejected, embarrassed or otherwise singled out as a failure.

By some estimates, 13 percent of people in Europe and the United States experience social anxiety disorder. The disorder ranges in severity, from less severe, yet impairing fears of a single situation (most often public speaking), to fears about interacting with people in general.

Based on a battery of psychological tests designed to assess friendship quality, Rodebaugh's study involved a group of 112 participants, each diagnosed as having or not having social anxiety disorder. Each participant brought along a friend from a non-romantic relationship who agreed to take part in the testing.

"People with social anxiety disorder report that their friendships are worse, but their friends didn't see it the same way," Rodebaugh said. "Their friends seem to say something more like: 'It's different, but not worse.' "

People with social anxiety disorder reported that their friendships were significantly worse (as compared to people without the disorder). These misperceptions were stronger and more prevalent among younger study participants and in situations where the friendship was relatively new, researchers found.

"The friends of people with social anxiety disorder did seem to be aware that their friends were having trouble, and additionally saw the person with social anxiety disorder as less dominant in the friendship," Rodebaugh said.

The findings could play an important role in helping people with social anxiety disorder understand that their friendships may not be as terrible as they might imagine. Helping people form friendships is in itself important, because many studies confirm that the lack of strong social networks can leave people vulnerable to a host of problems, including disease, depression and even earlier mortality, Rodebaugh said.

The good news is that social anxiety disorder is treatable. Decades of research suggests that talk therapy, such as cognitive behavioral treatment, is as, or even more, effective than medications for long term treatment of the disorder.

"Current treatments focus, in part, on helping people with social anxiety disorder see that they come across better than they expect they will," Rodebaugh said. "Our study suggests that's true for specific friendships as well."

The study was conducted by Rodebaugh with help from a postdoctoral fellow, as well as psychology graduate students in the Anxiety and Psychotherapy Laboratory at Washington University, including Michelle H. Lim, PhD; Katya C. Fernandez, PhD; Julia K. Langer; Jaclyn S. Weisman; Natasha Tonge; Cheri A. Levinson; and Erik A. Shumaker, PhD.

Lim is now a postdoctoral research fellow at Swinburne University of Technology in Melbourne, Australia. Shumaker is now a psychology research fellow with the Veteran's Administration Healthcare System in Boston. Fernandez is now a postdoctoral scholar at the University of California, Berkeley.

The research is supported by grants from the National Institute of Mental Health (MH090308) and the National Institutes of Health (UL1 RR024992).