The DSM-IV gives a list of diagnostic criteria for social anxiety disorder. The following are the criteria according to the DSM-IV that must be met for a diagnosis of social phobia. First, there must be a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possibility of scrutiny by others (American Psychiatric Association, 1994). The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing to them. In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults (American Psychiatric Association, 1994). Also, exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a panic attack (American Psychiatric Association, 1994). In children, the anxiety may be expressed by crying, tantrums, freezing, or running away from social situations with unfamiliar people (American Psychiatric Association, 1994). In many cases, the person with S.A.D. recognizes that the fear is excessive or unreasonable. In children, this feature may be absent. The feared social situations are avoided or else are endured with intense anxiety or distress (American Psychiatric Association, 1994). The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, social activities, or relationships. In order for individuals under 18 years of age to be diagnosed, the duration of the previous listed symptoms must exist at least six months (American Psychiatric Association, 1994). The fear or avoidance cannot be due to the direct physiologic effects of a substance (e.g., drug abuse or a medication) or a general medical condition and is not better accounted for by another mental disorder (American Psychiatric Association, 1994). In social phobia, fear and avoidance typically develop into a vicious cycle that can become severely distressing, debilitating, and demoralizing over time (Bruce & Saeed, 1999).
Friday, December 26, 2008
SAD diagnosed
In understanding how serious this disorder is, it is important to recognize the symptoms and seek out some sort of treatment as soon as possible to improve lifestyle. The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), describes social phobia as an intense, irrational, and persistent fear of being scrutinized or negatively evaluated by others (American Psychiatric Association, 1994). However, to meet the diagnosis for this disorder, the symptoms must be severe enough to cause significant distress or disability (Bruce & Saeed, 1999).
The DSM-IV gives a list of diagnostic criteria for social anxiety disorder. The following are the criteria according to the DSM-IV that must be met for a diagnosis of social phobia. First, there must be a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possibility of scrutiny by others (American Psychiatric Association, 1994). The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing to them. In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults (American Psychiatric Association, 1994). Also, exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a panic attack (American Psychiatric Association, 1994). In children, the anxiety may be expressed by crying, tantrums, freezing, or running away from social situations with unfamiliar people (American Psychiatric Association, 1994). In many cases, the person with S.A.D. recognizes that the fear is excessive or unreasonable. In children, this feature may be absent. The feared social situations are avoided or else are endured with intense anxiety or distress (American Psychiatric Association, 1994). The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, social activities, or relationships. In order for individuals under 18 years of age to be diagnosed, the duration of the previous listed symptoms must exist at least six months (American Psychiatric Association, 1994). The fear or avoidance cannot be due to the direct physiologic effects of a substance (e.g., drug abuse or a medication) or a general medical condition and is not better accounted for by another mental disorder (American Psychiatric Association, 1994). In social phobia, fear and avoidance typically develop into a vicious cycle that can become severely distressing, debilitating, and demoralizing over time (Bruce & Saeed, 1999).
The DSM-IV gives a list of diagnostic criteria for social anxiety disorder. The following are the criteria according to the DSM-IV that must be met for a diagnosis of social phobia. First, there must be a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possibility of scrutiny by others (American Psychiatric Association, 1994). The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing to them. In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults (American Psychiatric Association, 1994). Also, exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a panic attack (American Psychiatric Association, 1994). In children, the anxiety may be expressed by crying, tantrums, freezing, or running away from social situations with unfamiliar people (American Psychiatric Association, 1994). In many cases, the person with S.A.D. recognizes that the fear is excessive or unreasonable. In children, this feature may be absent. The feared social situations are avoided or else are endured with intense anxiety or distress (American Psychiatric Association, 1994). The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, social activities, or relationships. In order for individuals under 18 years of age to be diagnosed, the duration of the previous listed symptoms must exist at least six months (American Psychiatric Association, 1994). The fear or avoidance cannot be due to the direct physiologic effects of a substance (e.g., drug abuse or a medication) or a general medical condition and is not better accounted for by another mental disorder (American Psychiatric Association, 1994). In social phobia, fear and avoidance typically develop into a vicious cycle that can become severely distressing, debilitating, and demoralizing over time (Bruce & Saeed, 1999).
Monday, December 15, 2008
What is social phobia? (continued)
| Another serious complication of social phobia is that of alcoholism. Alcohol is commonly utilized in an attempt to decrease anxiety and allow the individual to tolerate the feared social situation. In approximately 85% of the people with both social phobia and alcohol abuse, the social phobia preceded the alcohol problem (Jacobson, 2001). Social anxiety makes the treatment of alcoholism more difficult. People with S.A.D. are likely to resist group therapy or self-help meetings like Alcoholics Anonymous. I have to admit that I used alcohol in college when placed into social situations. It allowed me to be relaxed around my peers and to open up to them. I felt like I had no inhibitions and I could really act like myself around others. This is a dangerous situation because you then feel like you need to use alcohol whenever you are around others. Pretty soon you will find yourself being dependant on alcohol and having a major problem on your hands. Don’t fall into this situation because it is hard to get out of. Not only is alcoholism a common complication of social phobia but there are also many co morbid disorders that people may have along with S.A.D. Depression is one such disorder that is very common in persons with S.A.D. Many believe depression is a secondary effect from S.A.D. and that the social anxiety is the cause of it. There are studies that have found that children with social anxiety have more severe kinds of depression, more relapses, more suicidal ideation, and more suicide attempts than depressed people without the co morbid illness. We can’t conclude that social anxiety precedes other illnesses but we can say it is a predictor of future psychiatric illness. Tobacco abuse is yet another serious addiction found in concordance with S.A.D. Kids with social anxiety on average start smoking later than their peers but tend to smoke more and become nicotine dependent more rapidly and more often. As with alcohol, kids may use the nicotine to help relieve anxiety symptoms. |
Friday, November 28, 2008
What is Social Phobia (continued)
| When people with S.A.D. approach social situations or sometimes just imagine approaching them, they experience intense anxiety. These individuals often exhibit physical symptoms such as shortness of breath, excessive sweating, tremors, and rapid heart beat (Jefferson & Moore, 2004). In some cases, people with this disorder may be able to endure these symptoms and follow through with the situation. In other cases, however, the symptoms are so overwhelming that these individuals may refuse to continue the actions because of their acute fear. In extreme cases, they may even experience a full-blown panic attack. Individuals with social phobia are often so affected by the disorder that it can complicate many aspects of their life depending on the subtype of the phobia, the patient’s occupation, or the social demands placed upon them (Jacobson, 2001). For example, one with a phobia of public speaking may refuse a promotion for a new position that could involve giving public speeches. Some people with the fear of urinating in public rest rooms may choose not to be away from home for long periods. Anxiety and autonomic symptoms may, in fact, impair performance to the point where it is inept (Jacobson, 2001). For example, a patient phobic about writing in public may tremble so much that their handwriting becomes illegible. |
Saturday, November 22, 2008
What is Social Phobia? Continued
Social anxiety disorder typically begins during childhood with a mean age of onset between 14 and 16 years and is sometimes preceded by a history of social inhibition or shyness in younger years (JCP, 2001). This is of course just an average age. Social phobia can develop later in life or earlier.
There are two subtypes of social phobia, namely generalized and circumscribed (non-generalized). The generalized subtype describes a person that experiences anxiety in numerous situations such as meeting new people, answering questions in class, or interacting socially at all(Jefferson & Moore, 2004). In “Tina’s” case, she suffered from generalized subtype. The circumscribed subtype is characterized by a fear of acting foolishly in only very specific situations (Jefferson & Moore, 2004). The most common type of circumscribed social phobia is the fear of public speaking. Don’t you remember those people back in school that were terrified when the teacher said that everyone had to do a speech in front of the whole class. For these people, doing a speech in front of others is literally a nightmare. Other common feared social situations include: fear of trembling when writing in public, fear of choking when eating in public, or being unable to urinate when others are present (Jefferson & Moore, 2004). Regardless of the subtype, it is not so much the act itself that is feared, but rather, it is the doing of the act in public which arouses the fear (Jefferson & Moore, 2004). In terms of treatment, the generalized subtype is by far the harder subtype to treat.
There are two subtypes of social phobia, namely generalized and circumscribed (non-generalized). The generalized subtype describes a person that experiences anxiety in numerous situations such as meeting new people, answering questions in class, or interacting socially at all(Jefferson & Moore, 2004). In “Tina’s” case, she suffered from generalized subtype. The circumscribed subtype is characterized by a fear of acting foolishly in only very specific situations (Jefferson & Moore, 2004). The most common type of circumscribed social phobia is the fear of public speaking. Don’t you remember those people back in school that were terrified when the teacher said that everyone had to do a speech in front of the whole class. For these people, doing a speech in front of others is literally a nightmare. Other common feared social situations include: fear of trembling when writing in public, fear of choking when eating in public, or being unable to urinate when others are present (Jefferson & Moore, 2004). Regardless of the subtype, it is not so much the act itself that is feared, but rather, it is the doing of the act in public which arouses the fear (Jefferson & Moore, 2004). In terms of treatment, the generalized subtype is by far the harder subtype to treat.
Monday, November 17, 2008
What is Social Phobia? continued part 3
There are many other theories around how S.A.D. evolves. Many believe that this is a disorder caused through environmental exposure and is a learned behavior. Some researchers believe that individuals develop S.A.D. after experiencing a particular negative social experience in their life. After the encounter of the negative event, these individuals relate that negative experience to any general social experience they encounter in the future. They become very anxious in social situations, fearing that the previous negative social experience will occur again. The result of this is a change in behavior through the avoidance of social situations altogether.
Sometimes, through therapy, people diagnosed with social phobia can recall a specific traumatic incident that sparked their anxiety and irrational thought process. Through my experience, I could specifically nail down one incident from my childhood that ignited my behavior. I was in kindergarten when this occurrence happened. I remembered that I would always get excellent comments on all my work. But one day, my teacher announced to the class that I actually got something wrong on some sort of project. Many of my classmates made fun of me the rest of the day. This sounds like a very benign event and shouldn’t have had such an effect on my life but it really did. The rest of my life I was known as the quiet or shy kid that never talked. I hated more than anything when someone would say that to me. I will get more into this discussion on how I would deal with this in the chapter with my self help tips.
Attachment specialists attribute that another possible cause of S.A.D. may be an effect of not developing an adequate bond with one’s primary caretaker as a child. Researchers state that these children grow up lacking self-regulatory skills to calm, focus, and soothe one’s self in situations perceived as stressful or chaotic.
Sometimes, through therapy, people diagnosed with social phobia can recall a specific traumatic incident that sparked their anxiety and irrational thought process. Through my experience, I could specifically nail down one incident from my childhood that ignited my behavior. I was in kindergarten when this occurrence happened. I remembered that I would always get excellent comments on all my work. But one day, my teacher announced to the class that I actually got something wrong on some sort of project. Many of my classmates made fun of me the rest of the day. This sounds like a very benign event and shouldn’t have had such an effect on my life but it really did. The rest of my life I was known as the quiet or shy kid that never talked. I hated more than anything when someone would say that to me. I will get more into this discussion on how I would deal with this in the chapter with my self help tips.
Attachment specialists attribute that another possible cause of S.A.D. may be an effect of not developing an adequate bond with one’s primary caretaker as a child. Researchers state that these children grow up lacking self-regulatory skills to calm, focus, and soothe one’s self in situations perceived as stressful or chaotic.
Monday, November 10, 2008
What is Social Anxiety Disorder (continued)?
Social anxiety disorder is the most prevalent of any of the anxiety disorders and is the third most common psychiatric disorder following depression and alcohol abuse (Journal of Clinical Psychiatry [JCP], 2001). Epidemiologic researchers have found that there is a 13.3% lifetime prevalence of social phobia, with a higher rate of occurrences existing in women (15.5%) than in men (11.1%) (Jacobson, 2001). However, it is estimated that only 2% of the people with social phobia actually seek treatment for it (Jacobson, 2001). Many biological, psychological, and social factors are believed to be contributors to the development of social anxiety disorder. There is still a significant amount of research being conducted and many theories to the different contributory factors causing this disorder.
Many research studies have shown that S.A.D. has a genetic link and does tend to run in first degree relatives. These individuals most likely have abnormalities in the functioning of specific parts of the brain that deal with the anxiety response system. This can be attributed to an improper chemical balance. There are several key neurotransmitters (brain chemicals); namely serotonin, norepinephrine and gamma-aminobutyric acid (GABA), which are produced in the brain that directly affect the way we feel about a given thought or situation. Researchers believe that at least four areas of the brain are critical in playing a role to our anxiety-response system: the brain stem which regulates cardiovascular and respiratory functions, the limbic system regulating mood, the prefrontal cortex that recognizes risky, dangerous situations, and the motor cortex which controls our muscular movements.
People with S.A.D. are noted to have low levels of the neurotransmitters in the brain, especially serotonin. So, with psychotropic medications, we can manipulate the amount of neurotransmitter levels. By increasing certain neurotransmitters in the brain, this in turn functions as providing us with a sense of emotional well being.
Many research studies have shown that S.A.D. has a genetic link and does tend to run in first degree relatives. These individuals most likely have abnormalities in the functioning of specific parts of the brain that deal with the anxiety response system. This can be attributed to an improper chemical balance. There are several key neurotransmitters (brain chemicals); namely serotonin, norepinephrine and gamma-aminobutyric acid (GABA), which are produced in the brain that directly affect the way we feel about a given thought or situation. Researchers believe that at least four areas of the brain are critical in playing a role to our anxiety-response system: the brain stem which regulates cardiovascular and respiratory functions, the limbic system regulating mood, the prefrontal cortex that recognizes risky, dangerous situations, and the motor cortex which controls our muscular movements.
People with S.A.D. are noted to have low levels of the neurotransmitters in the brain, especially serotonin. So, with psychotropic medications, we can manipulate the amount of neurotransmitter levels. By increasing certain neurotransmitters in the brain, this in turn functions as providing us with a sense of emotional well being.
Thursday, November 6, 2008
An example with someone with SAD
To get a sense of what this disorder is all about and how it presents itself, the following is a description of a real clinical case of a patient diagnosed with social anxiety disorder. This patient will be referred to as “Tina” and she is a 27-year old supervisor. The following paragraphs are a brief summary of some of her symptoms and the fears she faces on a daily basis. Tina, a supervisor, has been dreading going to work because of the fear that in meetings she will blush, her heart will race, and her thoughts will become so jumbled that she cannot express herself clearly. She is very worried about being seen as anxious or uncomfortable. Tina believes that her colleagues will think she is unable to perform at her job because of her anxiety. She has also begun to avoid eating lunch at work based on the fact that she gets very nervous around her co-workers and believes that she will say something embarrassing. Two months ago, Tina received a promotion at work and was anxious about the extra demands being placed upon her. She started using alcohol regularly to relax at the end of the day. Tina had always placed a lot of importance on other people's opinions of her at work, and probably had tended to be over-aware of others observing her. Now she was feeling even more self-conscious, particularly in situations involving being challenged by a staff member in front of others. She found meetings quite stressful and had avoided attending on a number of occasions. She did not understand what was happening to her and was considering requesting an extended leave from her employer.
Tina states that she has always been nervous around authority figures such as teachers in school or higher ups when working at past jobs. She has always found it hard to date and never had a big group of friends growing up. She has a few very close friends who she confides in and shares everything with. She states that people around her see her as a serious, quiet, and shy person. Tina has been working with her current company for 3 years; her second job since graduating from college. She says she does not like changing jobs and being in new, unfamiliar situations.
Tina describes her mother as a hard-working, "stressed" person, and her father as fairly strict and a perfectionist. Both parents encouraged her and her younger brother to focus on work and to strive in their respective jobs. This gives you an example of how social anxiety disorder is displayed in a single patient and why it is considered such a disabling disorder.
Tina states that she has always been nervous around authority figures such as teachers in school or higher ups when working at past jobs. She has always found it hard to date and never had a big group of friends growing up. She has a few very close friends who she confides in and shares everything with. She states that people around her see her as a serious, quiet, and shy person. Tina has been working with her current company for 3 years; her second job since graduating from college. She says she does not like changing jobs and being in new, unfamiliar situations.
Tina describes her mother as a hard-working, "stressed" person, and her father as fairly strict and a perfectionist. Both parents encouraged her and her younger brother to focus on work and to strive in their respective jobs. This gives you an example of how social anxiety disorder is displayed in a single patient and why it is considered such a disabling disorder.
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