by Seshata on 19/12/2012 | Consumption

Cannabis, Social Anxiety, and Avoidant Personality Disorder

Social Anxiety As with so many psychological and neurological conditions, it can be difficult to ascertain the precise relationship at work; does the sufferer experience the symptoms due to their cannabis use, or do they use cannabis because of their condition?

Cannabis has long been known to be strongly linked to a range of related conditions including agoraphobia, social anxiety disorder and avoidant personality disorder. Sufferers of these conditions are demonstrated to be more likely than the general population to develop dependence on cannabis, as well as tobacco and alcohol. As with so many psychological and neurological conditions, it can be difficult to ascertain the precise relationship at work; does the sufferer experience the symptoms due to their cannabis use, or do they use cannabis because of their condition?

Similarities between SAD, AvPD and related disorders

Social anxiety disorder (SAD or SAnD; less commonly referred to as social phobia) is a spectrum disorder, characterized by fear of social situations that can cause impairment in everyday life. At its most severe, this disorder renders sufferers unable to work or perform everyday functions. More commonly, sufferers are able to perform to some degree in social situations, but are far more likely than the general population to heavily “self-medicate” with drugs or alcohol to reduce inhibitions and social stress.

Avoidant personality disorder (AvPD) is considered by some within the medical community to be simply another term for SAD at its most extreme, as the two disorders are so closely related. However, others consider AvPD to be characterized by a fear of close interpersonal relationships, while SAD is more closely related to a fear of performing in social situations. Few sufferers of SAD match the DSM-III-R criteria for AvPD, whereas many sufferers of AvPD display symptoms of SAD. Furthermore, the fact that a small but significant number of patients are diagnosed with AvPD but not SAD strengthens the argument that the two disorders are separate, but closely related.

Agoraphobia is another similar condition, in which sufferers feel little to no control in unfamiliar environments; common triggers include crowds, travelling, and wide-open spaces. For many, agoraphobia is not a social phobia; however, others find their symptoms are compounded by an extreme fear of social embarrassment. Individuals in this latter group are often known as social agoraphobics. Cannabis use has been linked with agoraphobia and anxiety disorder, with many patients reporting an increase in agoraphobic tendencies after commencing cannabis use.

Panic disorder (PD) may also be closely related to SAD and AvPD, and agoraphobics may or may not exhibit PD symptoms too. Although there is high comorbidity with anxiety disorders and agoraphobia, the relationship with cannabis use may be somewhat different. In one study, many sufferers of PD reported initial onset of symptoms within 48 hours of cannabis use, and up to 40% of regular cannabis users reported at least one panic attack after commencing use of the drug.

Cannabis, Social Anxiety, and Avoidant Personality Disorder

The relationship between cannabis dependence and anxiety disorders

A study from 2008 found that in a sample group of SAD sufferers, individuals were 6.5 times more likely to be dependent on cannabis than the general population, as well as being at 4.5 times greater risk of alcoholism. Another study, in France, determined that 29% of a sample group of 90 highly-dependent cannabis users suffered from SAD, 16% from panic disorder with or without agoraphobia, and 9% from agoraphobia without panic disorder.

Overall, it is clear that long-term cannabis users display a far higher rate of SAD than the general population. Social anxiety disorder is thought to be the third most common psychological disorder after depression and substance abuse, with a current prevalence rate of between 1-4% of the U.S. population. However, other sources put the current prevalence at as high as 7.1-7.9%, with a lifetime prevalence rate of 13%. The World Health Organization (WHO) estimates an overall world lifetime prevalence rate of 7%.

Regional variation in rates of anxiety disorders

While it is difficult to ascertain precise figures due to varying diagnostic procedures, it is clear that there is much regional variation in prevalence: up to 52.7% in Udmurtia (a federal subject of Russia), and as low as 0.4% in Taiwan. The remarkably low figure in many east Asian countries may be due to the difficulty of establishing cross-cultural criteria for the disorder: other tests have shown Latin American countries to have the lowest prevalence rates for SAD, and east Asian countries to have the highest.

Avoidant personality disorder is less common, with an estimated lifetime prevalence rate of 0.5-1.3% of the U.S. population; agoraphobia affects approximately 1.7%. There is less regional variation with these conditions than with SAD, although some still exists: Norway has particularly high rates of AvPD (around 5%), and agoraphobia varies from as low as 0% in metropolitan China to 4.8% in South Africa.

Sufferers seek to “self-medicate” to control their symptoms

The fact that this regional variation does not correspond well to the variation in cannabis consumption rates implies that these conditions do not arise as a result of cannabis use; rather that sufferers, wherever they are located, are more likely to seek out cannabis (or whatever psychoactive substance is available locally) to relieve their symptoms.

This argument is greatly strengthened by the recent findings that cannabidiol (CBD) causes a reduction in the social fear and anxiety felt by sufferers of SAD; however, this does not preclude the possibility that THC, known to be highly psychoactive, plays some role in the emergence of the symptoms themselves.

When an individual suffers from an acute episode of anxiety, the brain undergoes an increase in blood flow through the periaqueductal gray matter of the brain, responsible for defensive behavior such as the “fight or flight” response, while simultaneously experiencing a reduction in the prefrontal cortex, responsible for executive function such as rational decision-making.

How CBD may reduce symptoms of panic and anxiety

In another study, when individuals suffering from SAD were medicated with CBD they were found to undergo increased blood flow in the right posterior cingulate cortex, which may play an important role in interpreting the reactions of others. Simultaneously, sufferers experienced decreased blood flow to the hippocampus and parahippocampal gyrus, key to the formation and recall of memories, as well as to the inferior temporal gyrus, which is thought to be involved with perception of faces.

Separate research has also shown that CBD acts as an anxiolytic, or anxiety-reducing drug, which modulates defensive behaviors evoked by threatening stimuli when injected directly into the periaqueductal gray matter (PAG) in rats. The effect of CBD in the PAG can also be said to be anti-aversive, in that it reduces aversion to stressful situations, and panicolytic, or panic-reducing.

The periaqueductal gray matter contains CB1 receptors; however, as CBD is not thought to act on the CB1 receptor, its effect is believed to be indirect. CBD is thought to inhibit anandamide uptake in the PAG; anandamide is a CB1 receptor agonist, and substances which limit its uptake have been shown to be anxiolytic (prevent or reduce anxiety).

The areas of the brain affected by anxiety disorders, which include the prefrontal cortex, amygdala, hippocampus, hypothalamus, and PAG, are believed to work together to control the individual’s response to stressful stimuli. The fact that all these regions contain CB1 receptors implies a relationship. However, while anandamide and other direct agonists of the CB1 receptor may have anxiolytic effects in small doses, they are often anxiety-inducing in larger doses. Inhibitors of these agonists, on the other hand, do not increase anxiety even when administered in large doses.

Exactly what processes are at work is still unclear, and will remain so until further research is done. However, inhibition of memory recall may aid in the suppression of unpleasant memories of prior social embarrassment, while an increased ability to gauge reactions may boost confidence and aid in social performance.

The tendency to become dependent on cannabis is therefore problematic. While many varieties contain significant quantities of CBD, the effect of THC in large doses has repeatedly been shown to induce anxiety and panic. Sufferers of anxiety and panic disorders are unlikely to have a consistent source of cannabis that contains the correct ratio of cannabinoids, including high CBD and levels of THC low enough to be anxiolytic.

However, breeders are beginning to make such strains available, such as the Israeli-bred Avidekel, which contains 16% CBD and less than 1% THC. If sufferers of panic and anxiety disorders such as SAD, AvPD and PD can safely access cannabis varieties such as this, the potential for exacerbation of symptoms from use of high-THC varieties can be limited, and recourse to other therapies can be lessened.

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Delmar Ledsome

Underlying social anxiety disorder or social phobia is the fear of being scrutinized, judged, or embarrassed in public. You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. And even though you probably realize that your fears of being judged are at least somewhat irrational and overblown, you still can’t help feeling anxious...`..*



These social disorders could be create from the social taboo that was/is in place in many cultures. The illegality of cannabis would also be creating this pressure on to users to be closeted about their use.


(5) Do drink lots and lots of water before and during your flight in order
to stay well-hydrated. All of the negative and catastrophic thoughts we have which lead to our symptoms
can be reversed or greatly minimized by simple reinforcement techniques.
Medication can be taken but doctors will only want to prescribe medicine in extreme cases.



I feel like I have SAD. I been on medication for anxiety before, but I don't trust lab drugs. Over 100,000 Americans die from prescription drugs each year. I doubt it's from anxiety pills, but still, if there's a natural alternative I'm leaning towards that.

Hemp has CBD and no THC. If you have SAD I'd recommend trying hemp. I haven't eaten it consistently enough to post a decisive conclusion so I'll get on that and post back in a week with my findings.

Hopefully someone sees it lol.


Scarlet Palmer

Hi Nick, thanks for your comment and for sharing. I hope the hemp helps, and I look forward to hearing what difference it makes. We have a blog post here about juicing raw cannabis that you might find interesting, if you didn't see it already.

With best wishes,




That's really cool! I've heard a lot about cannabis being used as medicine, but I've never heard of juicing with it.

To update with my hemp use, I've been using 2 - 3 teaspoons of hemp seeds in my smoothie every morning and I feel quite a bit better. I'm not as anxious around new people and I'm opening up at my new job pretty well. I don't have the "I can't do it" thought process that can sometimes take over, but I still have some moments where I opt out of doing things when I should just get out and do whatever it is I have to do.

I may try doubling the amount, taking some midway through the day or in the evening after work. I'll post again in a week or two with another update, but so far I'm feeling pretty good with how things are going.


Scarlet Palmer

I'm really glad to hear that, Nick! I don't think I get anything as severe as SAD but I definitely get a touch of the winter blues, however I've been eating at least a tablespoon of hulled hempseed every day for about three weeks and I'm feeling better than I usually do at this time of year. Also I notice my fingernails are stronger and my skin is not as dry as it usually is in autumn/winter. I'm going to increase the amount I'm eating as the hours of daylight get shorter, just to be on the safe side :) I'm interested to hear if you notice a difference in upping your amount. I've found simply stirring it through things just before serving works really well so it doesn't get too hot- made a pumpkin soup a couple of days ago with about 250- 300 grams and it was lovely!

Best wishes,




It gives knowledge for readers.


J. St. Mauritz

Why does the article focus on THC's intoxicating effect while failing to acknowledge its medicinal qualities? (image search "cannabinoid chart)



have been self medicating since I was diagnosed dsm-5TR/S.A.D. in 1999. Heroin, alcohol and indica cannabis only to gradually over the past 15 years get much more isolated and distant fromsocially situations. I am recently alcohol/drug free and starting to useC.B.D./C.N.G. to treat my hyper anxiety.This'd along with non-pharmaceutical psychiatric treatment I am starting to see a slow change in my unannounced panic attacks when I leave my house.Pharmaceuticald rugsalmostt killedm e, paxil caused internal hemorrhage and permanent physical damage. This is as very informative article and I felt compelled to sharem y experience with those enduring the same issues. We don't have to be prisoners of our minds and fears, there is healthy wayst o treat these disorders.



I found this post while searching whether my marijuana usage is helping or hurting my anxiety. I self medicated with opiates/benzos for 10+ years starting at the young age of 15. Now I'm 26 and finally got clean but now I can't hardly have a conversation with anyone that I don't see every day without panicking and breaking into a sweat, getting nervous about sweating, resulting in a vicious cycle until I just want to run away. I've started on some antidepressants but they seem to do nothing. I'm ready to really start trying to live my life again. I want to be able to ask a girl out like I could when I was younger. Instead almost every day I am miserable and I am starting to hate myself for being this way. I still smoke marijuana daily and I am willing to stop if it might help but I can only fore-see a small change by doing so. I need help :( Where can I turn if SSRI depressants don't work and I am unable to take benzos due to my dependence issues.. I just want to be free of this. So if anyone has any ideas please let me know.


John t

It may sound simplistic, but if you eat healthy and exercise for 1 hour daily, that's 95 percent of the battle. It will change your brain chemistry and your life.


former user

hey friend,
im in the same situation
im technically proficient at many things, but i fail in interviews because of my apparent anxiety and so forth. meeting new people, expanding my social circle, being an attractive male; they are all nearly impossible.

i run everyday, i do nofap, and i pray to god that i will become happy again. surely, some things have changed for the better.

will through the bad times. dont be afraid to sleep it out on some days, but never miss your interviews, never miss your work, go to meetings, talk aloud- it all helps. godspeed.

ps.... the ssri's can help for a bit, but theyre nothing more than another drug with a few less side effects. the real answers come from working through the tough emotions


former user

hey friend,
im in the same situation
im technically proficient at many things, but i fail in interviews because of my apparent anxiety and so forth. meeting new people, expanding my social circle, being an attractive male; they are all nearly impossible.

i run everyday, i do nofap, and i pray to god that i will become happy again. surely, some things have changed for the better.

will through the bad times. dont be afraid to sleep it out on some days, but never miss your interviews, never miss your work, go to meetings, talk aloud- it all helps. godspeed.

ps, the ssris can help for a bit, but theyre still just a crutch. the real answers that you need is that life is a daily struggle, and working through them feels amazingly real and human



Anxiety of any type is a real pain. I made a video on social anxiety trying to describe the condition in as much detail as possible. I hope it helps all of you


Portnoys Complaint

45 yrs ago I quit smoking pot due to the unpleasant effect's and / or anxiety. Today I find that the symptom's immediately return upon consumption of legally acquired medication with equal parts cbd/thc in the sublinqual type meds.

All in all, it's just not worth it for me. The unpleasantness is so intense that I cannot find any good in it that is worth continuing it's use.


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