Fearful Attachment, Trauma, Social Anxiety, and Depression

Emerging research provides clinically-relevant findings for those addressing and living with combined social anxiety and depression.

Grant H Brenner
7 min readJan 23, 2022


Photo by Alex Iby on Unsplash

Key points

  • Social anxiety is common, correlated with childhood trauma, and predicts future depression.
  • Depression with and without social anxiety is different in symptom presentation, severity, and treatment.
  • Addressing underlying factors is likely to improve treatment outcomes and quality of life for those with combined social anxiety and depression.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are often co-present, up to 20 percent of the time, higher in some groups. Social anxiety starts earlier in life, affecting nearly 5 percent of people, foreshadowing future depression with a five-fold risk of depression for those with prior social anxiety (Ohayon & Shatzberg, 2010). Combined, they are more difficult to treat as the symptoms of each synergize with the other.

For example, anxiety and avoidance of social interactions in SAD worsen social withdrawal seen with depression. Negative feelings about oneself and often others in depression reinforce negative perceptions in social anxiety. The vicious cycle of negative perceptions of oneself, others, and the world can make recovery challenging, undermining relationships, including therapeutic ones.

Is Depression With Social Anxiety Different From Depression Alone?

A recent study in the Journal of Psychiatric Research (2022) compared patients with SAD alongside those with combined (“ comorbid”) MDD and SAD. The goal of this research by Elling and colleagues was to understand areas of overlap and differentiation between the two groups, with a focus on childhood adversity and attachment style.

It’s relevant that people with SAD have higher rates of childhood trauma, including a greater likelihood of a history of bullying or “peer victimization” (Pontillo et al., 2019), also associated with depression (Mei, 2021).



Grant H Brenner

Psychiatrist, Psychoanalyst, Entrepreneur, Writer, Speaker, Disaster Responder, Advocate, Photographer