Social anxiety disorder (SAD) is characterised by a persistent fear of interacting or performing in social situations due to concerns of embarrassment, humiliation or negative evaluation by others.¹ Social anxiety disorder is the third most common psychiatric disorder, following major depression and alcohol dependence.² According to epidemiologic studies, the lifetime prevalence of SAD is estimated to be between 2.8% and 13.0%.³ Although its exact aetiology remains unclear, multiple interrelated variables – such as genetic predisposition, temperament, family dynamics and environmental influences – contribute to its development.⁴ Most aetiological frameworks hypothesise that biological and psychological susceptibility traits interact and are subsequently exacerbated by a chronic cycle of negative thoughts, anxious feelings and behavioural avoidance.^2,3 Regarding family-related factors, parental attitudes involving overprotectiveness, rejection, lack of interest and early adverse experiences frequently come to the fore as significant risk factors.^5,6 According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characteristic symptoms of SAD include an intense fear of shame and negative evaluation when exposed to potential scrutiny by others.¹ Social anxiety disorder is usually chronic, with an average age of onset ranging from 13 years to 15 years, significantly impairing academic, occupational and social functioning. Ultimately, SAD reduces overall quality of life while elevating the risk of substance dependence and suicidal ideation.^2,7

Adverse experiences, such as childhood abuse and neglect, are considered critical components in the aetiology of SAD symptoms.⁸ Childhood traumatic experiences – defined as adverse life events occurring before the age of 18 years – function as profound risk factors that shape early behavioural patterns, rendering individuals more susceptible to psychological problems later in life.⁹ Extensive literature indicates that significant physical, emotional or sexual abuse during childhood routinely links to adult anxiety and depression.^10,11 From a biological perspective, repeated exposure to severe stressors during childhood can permanently disrupt the architecture of the hypothalamic-pituitary-adrenal (HPA) axis, keeping the body in a perpetual state of vigilance via increased cortisol levels and elevating vulnerability to anxiety spectrum disorders in young adulthood.^12,13 Indeed, contemporary studies report a substantial 15.5% – 32.8% increase in SAD symptoms among young adults who experienced early adversity.^14,15

Theoretically, the distinct impact of emotional trauma on SAD symptoms can be conceptualised through cognitive-behavioural and interpersonal theories of psychopathology. Chronic emotional abuse and neglect directly disrupt early core relational schemas regarding self-worth and interpersonal safety.^16,17 When primary caregivers repeatedly validate a child’s environment through emotional hostility or coldness, the child internalises cognitive models that depict the self as inherently unlovable and others as critical or rejecting.

This pervasive fear of negative evaluation forms the cognitive core of SAD.¹⁰ Consequently, emotional maltreatment is theoretically expected to be a more robust predictor of adult social anxiety than physical trauma, as it fundamentally attacks self-esteem and shapes chronic interpersonal vigilance.^16,18

Although the overarching link between childhood trauma and social anxiety is established, more nuanced data are required to delineate how specific dimensions of trauma independently contribute to these symptoms.^11,19

Understanding how distinct forms of childhood maltreatment manifest as adult social anxiety symptoms holds profound cross-cultural relevance, particularly for developing clinical screening frameworks in global contexts facing an alarmingly high prevalence of trauma, such as South Africa. Contemporary evidence from South African cohorts underscores that early-life trauma heavily impairs subsequent psychological functioning across both clinical and community populations.⁸ Investigating these pathways within a non-clinical sample can therefore provide critical baseline indicators for designing targeted, context-specific interventions in highly traumatised societies worldwide.¹¹ The current study aimed to explore the associations between types of childhood trauma and SAD symptoms in non-clinical young adults. Identifying the relationship between SAD and types of childhood trauma has the potential to shed light on developmental risk factors for SAD.

This cross-sectional design study was conducted between March and September 2024.

The current study investigated the relationship between childhood traumas and SAD in a population of university students. According to the results of the study, childhood traumas were a predictor of LSAS total score and sub-dimension scores (fear and avoidance). This result is consistent with previous studies suggesting a link between childhood traumas and SAD.^3,11,17 Studies in non-clinical samples show that negative experiences such as childhood traumas are associated with depression, anxiety and emotional-behavioural disorders.^3,23,24 Specifically, recent research in non-clinical samples underlines that early adverse experiences, particularly emotional maltreatment, significantly elevate the risk of developing general anxiety and depressive symptoms in young adulthood. For instance, these studies have demonstrated that individuals with a history of childhood EN exhibit higher levels of emotional dysregulation and severe behavioural avoidance in social settings, further validating the long-term psychological burden of non-clinical trauma.^25,26 Although it has been shown that there is a strong link between child abuse and SAD, the results are limited in revealing the relationship between different types of abuse and SAD. According to the study results, EA was a stronger predictor of LSAS total and its subscales (fear and avoidance). This result suggests that parents’ emotional expressions towards their children may have long-term effects and contribute to SAD. Indeed, studies show that EA and neglect are at the forefront of anxiety disorders.¹¹ For example, Gibb et al.¹⁷ showed that childhood EA is more strongly associated with SAD than PA or SA. Similarly, in the meta-analysis study of Liu et al.²³ a stronger relationship between EA and neglect and SAD than other types of abuse is reported. Bandelow et al.²⁴ reported that patients with SAD have negative parental rearing styles, such as inadequate affection and care, compared to controls, and that these patients have high sensitivity to rejection and criticism. Simon et al.¹⁸ reported that 56% of individuals with SAD confirmed a history of childhood exposure to EA and 39% to EN. However, most of these studies included clinical samples. Our study differed from these in that it showed results from a healthy sample.

Understanding these associations in non-clinical populations holds significant global relevance, particularly for countries with an exceptionally high prevalence of trauma, such as South Africa. For instance, contemporary South African research highlights that early traumatic life events heavily impact psychological functioning and quality of life across both clinical and community cohorts.⁸ Therefore, demonstrating that EA and neglect predict SAD symptoms even in healthy, non-clinical young adults underscores the urgent cross-cultural need for early screening and trauma-focused interventions in high-adversity environments worldwide.⁹ Emotional abuse is considered to be the most destructive form of abuse; its negative consequences can accompany children’s lifelong development.^26,27 According to interpersonal theories, experiences during childhood form cognitive structures and relational schemas. Childhood trauma experiences negatively affect individuals’ self-perception. In particular, abuse of an emotional nature contributes to feelings of being unloved while also causing fear of interacting with others. The individual may develop a schema in which self-esteem and personal worth depend on the opinion of others.^28,29 They may have lower self-esteem and be more self-critical, and this may make others’ criticism or negative evaluation more threatening for them.³⁰

According to the study results, SA was a predictor of LSAS total and fear dimensions. A review of the literature indicates that the majority of studies investigating the effect of SA on anxiety disorders have predominantly focused on women with SAD. In these studies, it has been shown that the risk of SAD is higher in the population exposed to SA.³¹ Although many studies mention a stronger relationship between EA and neglect and SAD than physical and SA, according to our results, PA was a predictor of the avoidance subscale.³² Studies show different results regarding the relationship between sexual and PA and SAD. For example, Nanda et al.³³ showed SA and PA to be predictors of social anxiety symptoms, while Hamilton et al.²⁹ and Kircaburun et al.³⁰ mentioned a stronger relationship between social anxiety symptoms and EA and neglect than other types of abuse. From a structural perspective, these different trauma subtypes map differentially onto the fear versus avoidance dimensions of SAD. Emotional and SA directly fuel the cognitive ‘fear’ sub-dimension by creating highly sensitive threat-monitoring schemas focused on immediate social threat, embarrassment and scrutiny.¹⁶ In contrast, our findings that PA uniquely predicts the ‘avoidance’ sub-dimension can be explained by behavioural learning principles. Physical violence involves overt, inescapable aversive stimuli; in young adulthood, the individual translates the coping mechanism of physical safety into generalised ‘behavioural avoidance’ to proactively escape any potential social confrontation or perceived hostility.¹¹ The main reason for the different results may be the different characteristics of the sample group of the studies conducted on this subject. While the sample of most studies was a clinically diagnosed SAD group, the sample of very few studies was a non-clinical population. More study results with similar samples are needed to show the relationship between physical and SA and SAD.^34,35

According to the study results, the LSAS total score did not differ significantly by gender. However, both the fear and avoidance sub-dimension scores were significantly higher in females than in males. Studies on the relationship between gender and SAD show mixed results. For example, in the study of Olivares-Olivares et al.,³⁶ fear and avoidance scores were significantly higher in females than in males in the Spanish population. Caballo et al.³⁴ reported that social anxiety scores were higher in females than in males in their study, but the result was not significant when the magnitude of the differences was examined. Asher et al.³⁵ examined the existing literature in terms of many parameters, such as functionality, comorbidity, prognostic indicators, health service utilisation and oxytocin status, to determine the differences between genders and found that SAD affects both genders equally. In Dell’osso et al.’s³⁷ study, females show higher rates of SAD symptoms. Caballo et al.’s³⁴ study of large sample clinical participants from 18 countries shows that there are significant differences in SAD between males and females. However, most of these studies include clinical samples, highlighting the need for more data in non-clinical populations.

In our sample, EA yielded the highest score, followed by EN and PA. A similar result was shown in the study of Yang et al.²⁵ conducted with a similar sample group in China, where EN followed by PA was reported as the most common childhood trauma. Studies on this issue show that EA and EN are common forms of childhood trauma.^33,35

According to our findings, females reported higher exposure to EA than males, whereas males reported higher exposure to PA than females. Consistent with these results, Tang et al.³⁸ demonstrated that males are more frequently exposed to PA. Similarly, Meng and D’Arcy³⁹ reported that males experience more PA and violent behaviours, while females are more prone to SA. These variations underscore that cultural characteristics and societal differences in child-rearing attitudes play a crucial role in gender-based patterns of exposure to childhood trauma.⁴⁰ The findings of this study highlight the need for routine clinical screenings for childhood trauma – especially EA and neglect – in patients with social anxiety. Both clinicians and patients often underestimate emotional trauma, perceiving it as less severe than PA or SA.^41,42 Therefore, raising awareness about different trauma types and utilising trauma-informed screening tools is crucial to detect these subtle early adversities in psychiatric settings.

This study investigated the associations between childhood traumatic life experiences and SAD in a non-clinical sample. Findings indicated that childhood traumatic experiences were a significant predictor of SAD in young adulthood. The most common childhood traumatic experience was EA, followed by EN and PA. Regarding SAD subscores, fear and avoidance scores were significantly higher in females than in males. These noteworthy results suggest that childhood traumatic experiences should be carefully considered in the assessment of SAD. Furthermore, our findings serve as a reminder that it is crucial to assess the specific type of childhood trauma individuals have experienced when evaluating SAD. Despite the historical tendency in the anxiety literature to focus primarily on sexual and PA, our results add to the growing body of literature demonstrating that EA is heavily associated with SAD.

Childhood trauma can cause severe emotional pain and distress, often leading to lifelong damage to physical and mental health. Crucially, untreated early adversity and underdiagnosed SAD can potentially trigger a cascading chain of psychological challenges during young adulthood. When early social avoidance remains unrecognised during formative years, it may function as a developmental risk factor that elevates long-term vulnerability to secondary emotional or behavioural complications. To break this cycle of maltreatment, clinicians must remain aware of these associations, thoroughly investigate adverse childhood experiences and initiate trauma-focused therapeutic interventions when appropriate. Furthermore, educational institutions and health services should focus on the early recognition of childhood trauma, providing relevant education and supportive interventions to prevent the long-term development of severe SAD symptoms.