Social Anxiety; Part 1 of 2

Social Anxiety

Suffering in Silence

Social anxiety disorder, which is often referred to as “SAD” (not to be mistaken for Seasonal Adjustment Disorder which is completely different) is currently the 3rd largest mental health disorder in the world. According to the NIMH 40 million adults in the United States age 18 and older, or 18% of the population are affected.Anxiety disorders are highly treatable, yet only about one third of those suffering receive treatment. Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry, 60(7), July 1999). More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

I think its an area worth talking about, so here goes;

Symptoms

Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on the individual’s personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interferes with your daily routine, work, school or other activities.

Emotional and behavioral symptoms

Signs and symptoms of social anxiety disorder can include persistent:

  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Concern that you’ll offend someone
  • Intense fear of interacting or talking with strangers
  • Fear that others will notice that you look anxious
  • Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the center of attention
  • Having anxiety in anticipation of a feared activity or event
  • Spending time after a social situation analyzing your performance and identifying flaws in your interactions
  • Expecting the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety only during speaking or performing in public, but not in other types of social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

  • Fast heartbeat
  • Upset stomach or nausea
  • Trouble catching your breath
  • Dizziness or lightheadedness
  • Confusion or feeling “out of body”
  • Diarrhea
  • Muscle tension

Avoiding normal social situations

Common, everyday experiences that may be hard to endure when you have social anxiety disorder include, for example:

  • Using a public restroom
  • Interacting with strangers
  • Eating in front of others
  • Making eye contact
  • Initiating conversations
  • Dating
  • Attending parties or social gatherings
  • Going to work or school
  • Entering a room in which people are already seated
  • Returning items to a store

Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of stress or demands. Although avoiding anxiety-producing situations may make you feel better in the short term, your anxiety is likely to persist over the long term if you don’t get treatment.

Treatment

The two most common types of treatment for social anxiety disorder are medications and psychotherapy. These two approaches may be used in combination.

Psychotherapy

Psychological counseling (psychotherapy) improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.

Cognitive behavioral therapy is the most common type of counseling for anxiety. In exposure-based cognitive behavioral therapy, you gradually work up to facing the situations you fear most. This therapy can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others.

First choices in medications

Several types of medications are used to treat social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication tried for persistent symptoms of social anxiety. Your doctor may prescribe Paroxetine (Paxil) or Sertraline (Zoloft).

The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.

To reduce the risk of side effects, your doctor may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.

Other medications

Your doctor or mental health provider may also prescribe other medications for symptoms of social anxiety, such as:

  • Other antidepressants. You may have to try several different antidepressants to find one that’s the most effective for you with the fewest side effects.
  • Anti-anxiety medications. Benzodiazepines may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they’re typically prescribed for only short-term use. If your doctor prescribes anti-anxiety medications, try taking them before you’re in a social situation so you know how they’ll affect you.
  • Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They’re not recommended for general treatment of social anxiety disorder. As with anti-anxiety medications, try taking them before you need them to see how they affect you.

Stick with it & don’t expect a quick fix

Don’t give up if treatment doesn’t work quickly. You can continue to make strides in psychotherapy over several weeks or months. And finding the right medication for your situation can take some trial and error.

For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.

To make the most of treatment, keep your medical or therapy appointments, take medications as directed, and talk to your doctor about any changes in your condition.

In part 2 I will talk about the use of fMRIs & how they are being used to help people with the disorder.

 

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Author: Dr. Pete D

Psychologist & businessman from London in the UK now living in Japan. Continuing to practice & to conduct research into GID.

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