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Dr. Williams, we’re so worried about Sally!”

Sally’s Story
“I don’t sleep at night and I’m nauseous every morning.” Sally continues, “My ponytail must be perfect, so I do it over and over…I change clothes six times to make sure my outfit is just right! I’m a wreck on the way to school. If I don’t sit with Kandi the day is ruined!”

Sally’s parents see she is nervous, can’t concentrate or make easy decisions. Her grades have dropped and she calls herself stupid. They are convinced this behavior started after spending time with a popular girl at school.

According to Sally, every 6th grade student is regarded as “A Popular” like her best friend Kandi, or “A Normal” like her. “Kandi talks to me in class, let’s me be her partner and I get to sit with her at lunch. But if I decide to play soccer at recess, she says no, calls me names and tells other kids to ignore me. If this happens my social ranking falls down! Kandi decides if my day turns out good or bad.

Adolescent Social Anxiety
Sally needs her peers for validation. During adolescence, friends surpass parents as the primary source of social support and self-concept. In contrast, problematic peer relations cause maladaptive functioning. Negative interactions with peers, can ultimately lead to mood and anxiety disorders.

In adolescence, social anxiety is the fear of being judged. Kids become tentative in their actions and withdrawn. High levels of social anxiety lead to social phobia, discomfort in unfamiliar situations and locations. High levels of social anxiety may lead to serious disorders, such as major depression and substance abuse.

Social Anxiety and Peer Victimization
Sally’s social anxiety is unique. The catalyst of her anxiety is Peer Victimization, a form of bullying with a strong link to social anxiety. Sally is experiencing two forms of peer victimization: relational and reputational victimization.

  • Relational victimization – An established friendship used to harm (ex. deliberate exclusion in the cafeteria).
  • Reputational victimization – A peer attempts to damage a person’s reputation in the larger peer group (ex. spreading rumors or gossip).

Like Sally, adolescents who experience this type of bullying begin to feel awkward around other friends. They engage in fewer positive and more negative interactions. This greater exclusion heightens feelings of social anxiety.

There is a huge contradiction to Sally and Kandi’s relationship. Sally admits Kandi is a bully, but she will agree to join her on projects, accept her phone calls and invite her to sleepovers. Sally explains that she feels sorry for Kandi because her parents are divorced. When Kandi acknowledges Sally as her friend, she feels special within the group. Sally realizes these feelings are irrational, but Kandi’s constant intermingle of kindness and nastiness has created this toxic bond. Similar to a traumatized person with Stockholm Syndrome, Sally shows empathy and even defends Kandi’s negative actions.

Girls versus Boys
Peer victimization impacts both boys and girls. This type of bullying is more often discussed in the female population because girls tend to emphasize personal qualities of their friendships and are more likely to become distressed by negative interpersonal events. When boys are victims, they are more likely to respond with aggression than anxiety.

Risks of Peer Victimization
Sally is a quiet, sensitive girl. Perpetrators of peer victimization identify kids who are less likely to retaliate. Vulnerable qualities include:

  • Fewer friends
  • Low self-confidence
  • Awkward in groups
  • Family history of anxiety

Parents should be aware of the signs:

  • Reluctant to attend school
  • Complaints of illness
  • Highly focused on a peer or peer group
  • Excessively concerned with appearance
  • Nervous / tense
  • Easily tearful
  • Declining grades

Strategies to Decrease Social Anxiety

  • Sally and her parents have already taken the first steps in seeking psychological intervention.
  • The school was also notified with the specific details of bullying.
  • Sally was so empathetic toward Kandi and was worried about her social standing, thus it was unlikely she could ignore her at school. A collaborative decision was made to place Sally in a different 6th grade classroom.

The Next Steps Include:

  • Cognitive Behavioral Therapy– to decrease negative, irrational thoughts and restore a positive self- concept.
  • For some, Medication Intervention – to reduce anxiety symptoms and provide clarity of thinking.
  • Family Therapy– for support towards confidence and self-esteem.
  • Collaboration between the therapists, parents and school team – to facilitate ongoing positive social interactions.

Peer victimization is bullying that can lead to social anxiety. If untreated, social anxiety causes other serious psychological disorders. Do not assume it’s typical adolescent behavior. Talk to your child and seek professional help.

Siegel RS, La Greca AM, Harrison HM. (2009) Peer victimization and social anxiety in adolescents: prospective and reciprocal relationships. Journal of Youth Adolescent. Sep; 38(8):1096-109.

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Dr. Kimberly Williams is a clinical psychologist and neuropsychologist who specializes in the assessment and treatment of children and adults with psychological disorders including anxiety, depression, and disruptive behaviors, as well as learning disorders, developmental delays, executive functioning issues and social deficits. When Dr. Williams isn’t in her Great Neck and Brooklyn, NY offices helping kids get ahead in their academic and social development, she is consulting and providing workshops and training in issues related to Autism, Asperger’s Disorder, Nonverbal Learning Disability, Special Education and Parent Advocacy. Visit her site at Dr. Kimberly Williams.