Social Anxiety at School

What’s it like – and what to do about it: A leading Oxford-based child psychiatrist explains

The mental health charity Mind says there should be more help for students affected by social anxiety disorder – which is sometimes known as school phobia or school refusal – in which a child will not go to school on a regular basis, or has problems staying in class.

Mind has called for school refusal to be given more recognition to stop young sufferers being tagged as truants. Vicki Nash, its head of policy and campaigns, said: “We really need to have a fundamental rethink about how we can make sure pupils with mental health problems can stay in school.” “

Leading child and adolescent psychiatrist Dr Hayley van Zwanenberg, of Priory’s Wellbeing Centre in Oxford, says it’s a frequent cause of visits by parents and their children to her clinic.

“It is one of the most common issues treated in the Priory Wellbeing Centre in Oxford among under-18s. We have so many success stories; treatment involves specialist intervention with a Child and Adolescent Psychiatrist and an expert cognitive behavioural therapist.

“With the correct treatment, and experts educating and involving the parents and the school, prescribing the correct speed and plan to introduce the young person back to the school, alongside Cognitive Behavioural Therapy and at times medication, young people often feel well enough to return to school – and often a full time timetable – within three months.

“We teach them how to trust their body to control the physical symptoms of anxiety, and how to help their body do this. We also teach them how to challenge the thinking patterns they have got into that lead to their worries and anxiety, and, if needed, use specialist non-addictive medication to help them. The skills they learn are skills they can find helpful for life.”

So how does social anxiety disorder start?

Dr van Zwanenberg explains: “Most people have anxiety in a social situation at some point in their life, even if it is just in an interview situation.

“Imagine that magnified by many multiples and occurring constantly in a wide variety of social situations.

“If the nerves you felt were amplified, and intensified, you may feel everyone is staring at you and judging you, that you are going to really embarrass yourself, that you will not know what to say and that there will be long awkward silences, and the physical symptoms of anxiety then are likely to make you believe you might be sick there and then, or have a heart attack or even wet yourself, or collapse, not being able to breathe.

“This anxiety can then grow even further as it makes you avoid more and more social situations, and you could get to the point where even thinking about going out to see a close friend could bring on intense worry and physical changes to your body that are not tolerable. This is a description of how someone with social anxiety disorder can feel on a daily basis.”

About one in eight people will experience social anxiety disorder at some point in their life and it can feel totally disabling to the person suffering from it, she says.

“Young people experiencing this broad, heightened anxiety cannot then cope with walking into school. With so many aspects for them consider – from friends, to other students, teachers, lessons, breaks, the canteen, these can all prompt the panic. Young people gradually begin to avoid certain aspects of school, and then perhaps school altogether, as that is the only way for them to feel relatively safe from their own mental health complexities.

“This can be very hard for those around them to understand, and it is not uncommon for adults to end up feeling frustrated with them, especially if they are threatened with fines and the legal consequences of their child’s poor attendance.

“Young people cannot just ‘snap out of’ their anxiety though. And they will also feel frustrated that they cannot, and it can lead to their mood deteriorating as a result and even lead to depression.

“However, social anxiety disorder is very treatable.”