A meta-analysis by Kohlhoff et al (2022) determined that single-nucleotide polymorphisms (SNPs) in the oxytocin receptor gene (OXTR) were likely associated with social and emotional functioning in children by conferring increased vulnerability to childhood/environmental adversity. Huang et al (2021) utilized chemogenetics to preferentially activate septal OXTR neurons in mice. Activation of these OXTR neurons, as well as their projections to the horizontal diagonal band of Broca (HDB), induced anxiety-like behaviors. These behaviors were evaluated using common mice behavioral assays such as the open field test and the elevated plus maze test, shown below.

Oxytocin receptor polymorphisms and psychopathology

There are mixed findings for the role of oxytocin in psychological disorders such as autism spectrum disorder, PTSD, and social anxiety disorder. Hoge et al (2008) found a positive correlation between anxiety and plasma oxytocin levels, while Schneider et al (2021) found that high basal oxytocin predicted less anxiety. Hoge et al hypothesize that oxytocin in individuals with anxiety may increase to compensate for dysfunctional oxytocin receptors.

Pomona College

Oxytocin is a nine-amino-acid-long hormone and neuropeptide that is synthesized in the hypothalamus and released into various brain regions as well as the circulatory system. It is involved in labor, breastfeeding, maternal care, sexual behaviors, and there is growing evidence for its role in broad social behaviors. Additionally, there is evidence linking dysregulation of oxytocin to psychopathology.

Oxytocin

Post-traumatic Stress Disorder (PTSD) is a condition where an individual experiences a collection of persistent symptoms following a traumatic or profoundly stressful event, such as combat, sexual assault, or a natural disaster. For a diagnosis, these symptoms must last for at least one month. The traumatic event can be witnessed firsthand or secondhand. Historically, PTSD was referred to by terms like 'shell shock' and 'combat neurosis' due to its frequent association with war, but it is now recognized as affecting a wider population.

Post-traumatic Stress Disorder (PTSD)

Social anxiety disorder (SAD) affects about 4% of the worldwide population and is slightly more common in women. Also known as social phobia, it is defined as a persistent,and potentially debilitating fear of meeting new people, being watched, or criticized by others. Some with social anxiety may attempt to avoid anxiety-triggering situations by self-isolating or cancelling plans. It is a profound fear of the judgement of peers, particularly public humiliation. It is NOT shyness or introversion but can sprout from childhood shyness. In a social sense, social anxiety is not just feeling nervous or shy in certain social situations like starting a new job or the first day of school. Social anxiety disorder is a disorder that interferes with everyday life and relationships due to fearing situations where you can be embarrassed or viewed negatively and intense fear of situations where a person with SAD expects the worst. 

Social Anxiety Disorder (Social Phobia)

Hoge, E. A., Pollack, M. H., Kaufman, R. E., Zak, P. J., & Simon, N. M. (2008). Oxytocin Levels in Social Anxiety Disorder. CNS Neuroscience & Therapeutics, 14(3), 165–170. https://doi.org/10.1111/j.1755-5949.2008.00051.x 

Oxytocin Levels in Social Anxiety Disorder (2008)

Kohlhoff, J., Cibralic, S., Hawes, D. J., & Eapen, V. (2022). Oxytocin receptor gene (OXTR) polymorphisms and social, emotional and behavioral functioning in children and adolescents: A systematic narrative review. Neuroscience & Biobehavioral Reviews, 135, 104573. https://doi.org/10.1016/j.neubiorev.2022.104573

Oxytocin receptor gene (OXTR) polymorphisms and social, emotional and behavioral functioning in children and adolescents: A systematic narrative review (2022)

Oxytocin has increased release when a women starts to breastfeed. During that time, women often experience thirst and hunger. Some also have a short period of decreased heartrate and bloodpressure. The release of oxytocin faciliates interactions with the baby to help make the mother less anxious. High levels of circulating oxytocin are associated with greater attachment between mother and child.

There is also the triggering of aggression and the fight-flight response. Oxytocin promotes a protective response from the mother when she is within hostile or dangerous environments with her child.

Oxytocin during breastfeeding

Oxytocin and psychopathology

To many, the COVID-19 pandemic was a traumatic life event. As such, it is possible that individuals may experience PTSD symptoms after experiencing the COVID-19 pandemic.

Effect of COVID-19 Pandemic on the Development of PTSD

Complex PTSD is a disorder resulting from prolonged trauma such as childhood abuse or neglect, abusive relationships, or political imprisonment or torture. C-PTSD includes some or all of the criteria of PTSD, as well as additional symptoms that negatively affect ones quality of life and is typically more severe and treatment resistant than classical PTSD.

Complex Post-traumatic Stress Disorder (c-PTSD)

Acceptance and Commitment Therapy (ACT) has been used amongst individuals with diagnosed PTSD after Traumatic Brain Injury (TBI) with the intent to improve mood processes, PTSD specific outcomes and related symptoms, ACT outcomes, and overall quality of life

Acceptance and Commitment Therapy Used with Individuals with PTSD after Traumatic Brain Injury

- acute stress disorder
- Adjustment disorder
- Disinhibited social engagement disorder
- Reactive attachment disorder

Related Conditions to PTSD

In this study, researchers explored the implementation of the online platform VetChange as a way to decrease Iraq and Afghanistan veterans' alcohol use and PTSD symptoms . 

Impact of Web-Based Interventions on Veterans' Alcohol Use & PTSD Symptoms 

In 2021 the FDA approved the use of 3,4-methylenedioxymethamphetamine (MDMA) for the treatment of PTSD. The compound was studied as a treatment as studies suggest it acts by binding to the presynaptic serotonin transporters inducing a release of serotonin. The trials conducted administered three doses of MDMA paired with manualized therapy during an eighteen-week treatment plan. The results of the study showed significantly reduced symptoms of depression as well as regulated amygdalar serotonergic function in comparison to the control (placebo) group. Each study conducted showed similar results which led to the approval for the regulated use of MDMA to treat PTSD symptoms.

Treatment of PTSD using MDMA (Ecstasy)

Populations exposed to major natural disasters, a form of mass trauma, often show elevated rates of PTSD. For example, research conducted one year after Hurricane Katrina found that nearly 21% of residents in the affected areas suffered from the disorder.

PTSD Prevalence Following Natural Disasters

Throughout much of the 20th century, the condition now known as Post-traumatic Stress Disorder (PTSD) was referred to by other names, such as 'shell shock' and 'combat neurosis'. These terms originated from the belief that the symptoms were a direct result of the stress experienced during active combat.

Historical Terminology for PTSD

Experiencing a traumatic event does not automatically lead to the development of Post-traumatic Stress Disorder (PTSD). The likelihood of developing the disorder is influenced by a variety of identified risk factors, explaining why some individuals are more vulnerable than others after a similar experience.

Risk Factors for PTSD Development

The symptoms of PTSD form a constellation of responses to a traumatic event. Key symptoms include re-experiencing the trauma through intrusive and distressing memories or flashbacks. Individuals often engage in avoidance of stimuli or situations connected to the event. They may also experience persistently negative emotional states, feel detached from others, exhibit irritability and proneness to outbursts, and have a tendency to be easily startled.

Symptoms of Post-traumatic Stress Disorder (PTSD)

Several months after being involved in a serious car accident, an individual reports experiencing recurrent nightmares about the crash, actively avoids driving or even being a passenger in a car, and becomes intensely distressed and jumpy at the sound of screeching tires. Based on this pattern of symptoms, which of the following provides the most accurate psychological explanation for their condition?

Social phobia, more commonly known as social anxiety disorder (SAD), can potentially limit a person's ability to socialize and interact with others without extreme fear. However, the specific longterm effects that SAD has on a person's life, especially their academic success, are not well-known. A longitudinal study  followed students who did not have diagnosed social anxiety but did possess high trait social anxiety. The students' performance during their first two years of college was examined. Findings suggested that while social anxiety traits were common among the participating college students, coping with said anxiety seemed possible enough to not result in high transfer rates, and only studying the first two years is not long enough to begin observing very negative, clear effects on academic performance. 

The effects of social anxiety and social skills on academic performance

An association exists between individuals with social anxiety disorder (SAD) and risk for developing marijuana dependence, appearing especially vulnerable to marijuana use disorders (MUD). Research indicates that social anxiety disorder and marijuana dependence share an especially prevalent relationship, wherein the rate of marijuana dependence is greater than twice more likely to occur in individuals with SAD as opposed to any other anxiety disorder. Furthermore, adolescents with SAD have approximately five times greater the risk of developing marijuana dependence. Evidence strongly suggests social anxiety is a risk factor of MUD. 



Risk of marijuana dependence

 Common social triggers for Hyperhidrosis include: 
- Being in public, such as at work or school 
- Eating at a restaurant
- Spending time with friends 
- Thinking about hyperhidrosis 



Social Triggers for Hyperhidrosis

About 69% have said they faced conflict from others due to their condition, resulting in a constant sense of worry whether an individual is sweating or not.
This condition is thought to be a possible symptom of Social Anxiety disorder.

Conflicts Faced with Hyperhidrosis

Through MBSR research, it was found that MBSR attacks social anxiety disorder on a behavioral level and a neural level.  Patients found that they had less negative emotions when focusing on breath work.  In the neural networks it was found that focusing on breathing allowed attention regulation from an explicit to implicit process.  This means that breath works allows a patient with social anxiety disorder to rewire their brain to be more focused when breathing, thus limiting the symptoms of social anxiety.

MBSR and Social Anxiety

Functional neuroimaging has identified several brain regions and circuits involved in pathological anxiety, such as the amygdala, insula, and prefrontal cortex. Neural dysfunction associated with SAD varies from reduced regional volume to increased or decreased activation and functional connectivity.

The Neural Basis of Social Anxiety Disorder

Social anxiety disorder is the most common disorder when it comes to anxiety. Through the use of neuroimaging, it was confirmed that there is hyperactivation in the fear areas in relation to social anxiety disorder. The lobes that were activated, specifically are the amygdala, insula, anterior cingulate, and prefrontal cortex. It was found that insular activity is often involved with anxiety. The insula becomes a part of the default-mode-network in humans, especially healthy humans. The introduction of state anxiety might explain why there isn't a significant difference in studies observing social anxiety disorder. The disturbance of normal homeostatic network systems might be similar to an imbalance in heightened emotional arousal and enhanced perception of fear stimuli. The role of the parietal and occipital lobes has a heavy emphasis on anxiety disorders. The meta-analysis study shows that the medical parietal regions play an important role in most anxiety disorders.

Neuroimaging in social anxiety disorder -- A meta-Analytic review resulting in a neurofunctional model

Social Anxiety Disorder Library

When around others:
- Blushing, sweating, trembling
- Rapid heart rate
- "Mind blank"
- Feeling sick
- Rigid posture
- Overly soft voice when speaking
- Challenging to maintain eye contact 
- Difficult to communicate with people even if they want to
- Self-conciseness or fear of judgment
- Avoid crowded places or locations with people
- Worry over fear or embarrassment 
- Intense fear of interacting or talking 
- Fear others will notice the appearance of anxiety
- Shaky voice
- Anxiety in anticipation of event or place
- Analysis of performance and perceived flaws in interactions
- Expecting the worst outcome
- Nausea
- Trouble catching breathe
- Muscle tension
- Avoidance of common social interaction

Symptoms of Social Anxiety

The conditions that are commonly and significantly linked with social anxiety disorder are mood disorders, such as depression, substance abuse disorders, and other anxiety disorders.

Disorders Strongly Associated with Social Anxiety Disorder

- Genetic and temperamental factors
- Cognitive aspects
- Family environment
- Cultural & societal influences
- Adverse life events
- Gender roles

The Etiology of Social Anxiety Disorder

Social Anxiety Institute. Retrieved July 1st, 2023, from https://socialanxietyinstitute.org/

Social Anxiety Institute

- Fear of at least one social or performance situation
- Exposure to situation provokes anxiety
- Recognition of the fear being unreasonable
- Situation is avoided or endured with distress
- Interferes with routine, occupational functioning, social life, or distress in having said phobia
- Distress is present for 6 or more months
- Distress is not due to a substance or medical condition

DSM-5 Social Anxiety Criteria

Cognitive behavioral therapy is used as a treatment for social anxiety disorder, but a portion of patients may still have symptoms after the initial therapy. This variation between different patients is not well understood but it is important to comprehend because it may be the key to understanding the etiologies of disorders and improving therapies for them. Functional magnetic resonance imaging (fMRI) may offer essential indications of patient variation using neuromarkers. The use of neuromarkers is a technique that allows following brain activations viewed during an fMRI.

Predicting Treatment Response in Social Anxiety Disorder from Functional Magnetic Resonance Imaging: Using Neuromarkers to Understand Patient Variation.

References for Predicting Treatment Response in Social Anxiety Disorder from Functional Magnetic Resonance Imaging

Social Anxiety Disorder and Autism Comparison

Reference for Autism and Social Anxiety Disorder

Reference for Causes and Consequences of Social Anxiety Disorder

Several factors can increase the risk of developing social anxiety disorder. These include:
* **Behavioral inhibition**: An inherited trait characterized by fear and restraint in unfamiliar situations.
* **Childhood temperament**: Being shy or withdrawn in childhood.
* **Attention-drawing conditions**: Having a physical condition or appearance that attracts attention.
* **Adverse childhood experiences**: A history of being bullied or abused.
* **Family history**: Having relatives with social anxiety disorder.
* **New life demands**: Facing novel occupational or social challenges.

Risk Factors for Social Anxiety Disorder

Behaviors that reduce the risk of developing social anxiety disorder:

* Getting help early if anxiety occurs.
* Setting priorities in life and engaging in enjoyable activities.
* Avoiding the consumption of unhealthy substances such as nicotine, caffeine, drugs, or alcohol.
* Keeping track of personal life in a journal in order to make the process of recognizing the stressors later easier.


Social Anxiety Disorder Prevention

Social anxiety disorder is a widespread condition in the United States. It is estimated that just over 12% of the American population will experience it at some point during their lifetime.

Prevalence of Social Anxiety Disorder

When left unaddressed, social anxiety disorder can lead to significant impairments across various aspects of an individual's life. Adults with this condition often have lower levels of educational achievement and reduced earnings. They may also exhibit poorer performance in the workplace and face a higher likelihood of unemployment. Furthermore, the disorder is associated with greater reported dissatisfaction with personal relationships, including family and friends, as well as with leisure activities and overall income.

Life Impairments Associated with Social Anxiety Disorder

Virtual reality offers an immersive and controlled environment for the assessment and treatment of social anxiety disorder. Virtual reality exposure therapies have shown effective results for improving symptoms post treatment in comparison to control groups like in vivo exposure therapy.  However, use of virtual reality for assessment of social anxiety disorder is less reliable and valid. 

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