Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Social Anxiety Disorder

Social phobia, also known as social anxiety disorder, is a mental illness that is distinguished by a persistent fear of social situations in which embarrassment may result to the individual. Exposure to such situations provokes an impulsive anxiety attack in response, which is almost always characterized as excessive or unreasonable.1 Individuals affected by this mental disorder report significant interference with their normal routine, occupation, academic functioning, or relationships with their peers. Affected individuals are hypersensitive to criticism, negative evaluation, or rejection; which leads to low levels of self-esteem or feelings of inferiority.1 These symptoms usually manifest in acts of avoidance of certain situations, which ultimately have an impact on the individual’s professional, academic, or social life.

Diagnosed with SADPercentage
U.S. Population12.5
Current smokers35.9
Lifetime smokers54.0

Social Anxiety Disorder and Smoking

Consistently having to find ways to avoid confrontation can take its toll on an individual as the resulting anxiety continues to increase. The overwhelming amount of stress and anxiety is a major factor contributing to why so many individuals diagnosed with social anxiety disorder use tobacco. Some research has cited that smoking is a socially acceptable behavior that relieves anxiety in social situations.4 As with other anxiety disorders, the relationship between smoking or tobacco use behavior seems to be correlated with the expectation of reduction of anxiety symptoms, high levels of anxiety sensitivity that increase sensitivity to withdrawal symptoms, use of tobacco as a coping strategy in response to life stress, and conditioning of anxiety and trauma-related cues to trigger craving.2,3 However, at about 12.5% of the U.S. population, social anxiety is affecting almost 40 million Americans and at a current smoking rate of 35.9%, over 14 million Americans each year are dealing with co-morbidity problems arising from both social anxieties as well as smoking.5

References: 
  1. American Psychological Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.
  2. Feldner, M. T., Babson, K. A., & Zvolensky, M. J. (2007). Smoking, traumatic event exposure, and posttraumatic stress: A critical review of the empirical literature. Clinical Psychology Review, 27, 14-45.
  3. Morissette, S.B., Tull, M.T., Gulliver, S.B., Kamholz, B.W., & Zimering, R.T. (2007). Anxiety, anxiety disorders, tobacco use, and nicotine: A critical review of interrelationships. Psychological Bulletin, 133, 245-272.
  4. Sonntag, H., Wittchen, H.U., Hofler, M., Kessler, R.C., & Stein, M.B. (2000).  Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults? European Psychiatry, 15(1), 67-74.
  5. Ziedonis DM, Guydish J,Williams J, Steinberg M, Foulds J. 2006. Barriers and solutions to addressing tobacco dependence in addiction treatment programs. Alcohol Res. Health 29(3):228–35.