Social anxiety disorder ( SAD ), also known as social phobia , is an anxiety disorder characterized by a significant amount of fear in one or more social situations , causing considerable pressure and impaired ability to function at least in some parts of everyday life. This fear can be triggered by the real observation of others.
Physical symptoms often include excessive blushing, excessive sweating, tremor, palpitations, and nausea. Stuttering may be present, along with a quick speech. Panic attacks can also occur under fear and discomfort. Some patients may use alcohol or other drugs to reduce fear and obstacles in social events. It is common for people with social phobia to treat themselves in this way, especially if they are undiagnosed, untreated, or both; this may cause alcoholism, eating disorders or other substance abuse. SAD is sometimes referred to as a "loss of opportunity" disease in which "individuals make the ultimate life choice to accommodate their illness". According to ICD-10 guidelines, the main diagnostic criteria for social phobia are fear of being the focus of attention, or fear of behaving in a way that will embarrass or embarrass, avoid and anxiety symptoms. A standard scoring scale can be used to filter out social anxiety disorders and measure the severity of anxiety.
First-line treatment for social anxiety disorders is cognitive behavioral therapy (CBT) with drugs recommended only to those not interested in therapy. CBT is effective in treating social phobia, whether delivered individually or in a group setting. Cognitive and behavioral components attempt to change the mindset and physical reactions to anxiety-inducing situations. Attention to social anxiety disorder has increased significantly since 1999 with the approval and marketing of medicines for its treatment. Prescribed drugs include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Other commonly used drugs include beta blockers and benzodiazepines. This is the most common anxiety disorder with up to 10% of people affected at some point in their lives.
Video Social anxiety disorder
Signs and symptoms
Cognitive Aspects
In the cognitive model of social anxiety disorder, people with social phobia experience fear how they will be presented to others. They may feel too self-conscious, pay high self-attention after the activity, or have high performance standards for themselves. According to the theory of social psychology of self-presentation, a sufferer tries to create a good impression on others but believes that he can not do it. Many times, before a potentially anxious social situation, the patient can deliberately review what can go wrong and how to deal with any unexpected case. After the event, they may have the perception that they appear unsatisfactory. As a result, they will see everything that may be abnormal as embarrassing. These thoughts can extend for weeks or longer. Cognitive distortions are characteristic, and studied in CBT (cognitive behavioral therapy). The mind is often self-defeating and inaccurate. Those with social phobia tend to interpret neutral or ambiguous conversations with negative views, and many studies show that socially anxious individuals remember more negative memories than those less depressed.
An example of an example might be an employee presenting to a co-worker. During the presentation, the person may speak loudly, where he may be worried that others are significantly noticing and thinking that their perception of him as a presenter has been tarnished. This cognitive thinking encourages further anxiety that flowering with further stuttering, sweating, and, potentially, panic attacks.
Behavioral aspect
Social anxiety disorder is an ongoing fear of one or more situations in which the person is exposed to the odds of oversight by others and fears that he or she can do something or act in a way that will be embarrassing or embarrassing. This exceeds the normal "shame" because it leads to excessive social avoidance and considerable social or job disruption. The dreaded activity can include almost any type of social interaction, especially small groups, dating, parties, talking to strangers, restaurants, interviews, etc.
Those who suffer from social anxiety disorder fear being judged by others in society. In particular, individuals with social anxiety are nervous in the presence of people with authority and feel uncomfortable during physical examination. People who suffer from this disorder can behave in a certain way or say something and then feel ashamed or humiliated afterwards. As a result, they often choose to isolate themselves from society to avoid such situations. They may also feel uncomfortable meeting people they do not know, and acting away when they are with a large group of people. In some cases, they may show evidence of this disorder by avoiding eye contact, or reddening when someone speaks to them.
According to psychologist B. F. Skinner, phobias are controlled by escape and avoidance behaviors. For example, a student can leave the room when speaking in front of the class (escape) and refrain from making a verbal presentation due to anxiety attack faced earlier (avoid). The main avoidance behavior may include almost pathological/compulsive lying behavior to maintain self-image and avoid judgment in front of others. Minor avoidance behavior is exposed when one avoids eye contact and crosses arms to avoid recognizable shocks. The fight-or-flight response was then triggered in such an event.
Physiological aspects
The physiological effects, similar to other anxiety disorders, are present in social phobia. In adults, there may be tears and excessive sweating, nausea, difficulty breathing, tremor, and palpitations as a result of the fight-or-flight response. Running disorders (where someone is so worried about how they walk so they may lose balance) can show up, especially when passing a group of people. The red face is generally exhibited by individuals suffering from social phobia. These visible symptoms further strengthen anxiety in the presence of others. A 2006 study found that the area of ​​the brain called the amygdala, part of the limbic system, is hyperactive when the patient is shown with a threatening face or faced with a frightening situation. They found that patients with more severe social phobia showed a correlation with increased responses to the amygdala.
Comorbidity
SAD shows a high degree of co-occurrence with other psychiatric disorders. In fact, population-based studies found that 66% of those with SAD had one or more additional mental health disorders. SAD often coincides with low self-esteem and the most common clinical depression, possibly due to a lack of personal relationships and long isolation associated with social avoidance. Clinical depression was 1.49 to 3.5 times more likely to occur in those with SAD. Anxiety disorders are also very common in patients with SAD, particularly generalized anxiety disorders. Avoidant personality disorders are also highly correlated with SAD, with comorbidities ranging from 25% to 89%.
To try to reduce their anxiety and reduce depression, people with social phobia may use alcohol or other drugs, which can cause substance abuse. It is estimated that a fifth of patients with social anxiety disorder also suffer from alcohol dependence. However, some studies suggest that SAD is not associated with, or even protective against, alcohol-related problems. Those who suffer from alcoholism and social anxiety disorders are more likely to avoid group-based and relapse care than people who do not have this combination.
Differential diagnosis
The DSM-IV criterion states that one can not accept the diagnosis of social anxiety disorder if their symptoms are better noted by one of the autism spectrum disorders such as autism and Asperger's syndrome.
Because of its close relationship and overlapping symptoms, treating people with social phobia can help understand the underlying relationship with other mental disorders. Social anxiety disorders are often associated with bipolar disorder and attention deficit hyperactivity disorder (ADHD) and some believe they share an underlying cervical-anxiety-sensitive tendency. Co-occurrence of ADHD and social phobia is very high; especially when symptoms of SCT are present.
Maps Social anxiety disorder
Cause
Research into the causes of social anxiety and broad social phobia, encompassing various perspectives from neuroscience to sociology. Scientists have not found the exact cause. Studies show that genetics can play a role in combination with environmental factors. Social phobia is not caused by other mental disorders or by substance abuse. Generally, social anxiety begins at a certain point in the life of an individual. This will develop over time as the person struggles to recover. Finally, mild social awkwardness may develop into symptoms of social anxiety or phobias.
Genetics
It has been shown that there is a two to three times greater risk of having a social phobia if a first-degree relative also has an abnormality. This can be caused by genetics and/or because children gain social fear and avoidance through observational learning or parental psychosocial learning. Studies of identical twins raised (through adoption) in different families have shown that, if one twin develops social anxiety disorder, then another is between 30 percent and 50 percent more likely than average to also develop a disorder. To some extent this 'heritability' may not be specific - for example, studies have found that if parents have anxiety disorder or clinical depression, then a child is somewhat more likely to develop an anxiety disorder or a social phobia. Studies show that parents of those with social anxiety disorders tend to be more socially isolated themselves (Bruch and Heimberg, 1994; Caster et al., 1999), and the embarrassment of adoptive parents is significantly correlated with the embarrassment in adopted children ( Daniels and Plomin, 1985).
Growing with overprotective and hyperactive parents has also been linked to social anxiety disorders. Teenagers who were assessed as having an attachment (anxiety-ambivalent) with their mother as infants were twice as likely to develop anxiety disorders in late adolescence, including social phobia.
A line of related research has investigated 'inhibitory behavior' in infants - early signs of inhibited and introspective or frightening nature. Studies have shown that about 10-15 percent of individuals show this initial temperament, which seems partly caused by genetics. Some continue to exhibit this trait into adolescence and adulthood, and appear to be more likely to develop social anxiety disorders.
Social experience
A previous negative social experience can be a trigger for social phobia, perhaps especially for individuals with high interpersonal sensitivity. For about half of those diagnosed with social anxiety disorder, certain social or traumatic events or insults seem to be related to the onset or worsening of the disorder; Such events seem to be primarily linked to specific social phobias (performance), such as public speaking (Stemberg et al. , 1995). As well as direct experience, observing or hearing about other people's negative social experiences (eg carelessness done by someone), or verbal warnings about social problems and dangers, can also make the development of social anxiety disorder more likely. Social anxiety disorders can be caused by long-term effects because they are unsuitable, or repressed, rejected or ignored (Beidel and Turner, 1998). Shy teens or avoiding adults have emphasized an unpleasant experience with peers or childhood abuse or abuse (Gilmartin, 1987). In one study, popularity was found to be negatively correlated with social anxiety, and children who were ignored by their colleagues reported higher social anxiety and feared negative evaluations of other children's categories. Children who are socially phobic seem to lack a positive reaction from peers and children who are anxious or inhibited can isolate themselves.
Cultural influence
Cultural factors that have been linked to social anxiety disorders include public attitudes toward shyness and avoidance, affecting the ability to form relationships or access work or education, and shame. One study found that the effect of parenting differed depending on culture: American children were more likely to develop social anxiety disorder if their parents stressed the importance of other people's opinions and used shame as a disciplinary strategy (Leung et al. , 1994), but this relationship is not found for Chinese/Chinese-American children. In China, research has shown that shy children are more welcome than their peers and are more likely to be considered for leadership and considered competent, in contrast to findings in Western countries. Pure demographic variables can also play a role.
Problems in developing social skills, or 'social fluency', may be the cause of some social anxiety disorder, either through the inability or lack of confidence to interact socially and get positive reactions and acceptance from others. However, studies have been mixed, with some studies not finding significant problems in social skills while others. What is clear is that social anxiety perceives their own social abilities to be low. Perhaps an increasing need for sophisticated social skills in shaping relationships or careers, and an emphasis on firmness and competitiveness, makes social anxiety problems more common, at least among 'the middle class'. Interpersonal or media emphasis on 'normal' or 'attractive' personal characteristics has also been debated to encourage perfectionism and low self-esteem or insecurity about negative evaluations of others. The need for social acceptance or social standing has been outlined in other lines of research related to social anxiety.
Substance-induced
While alcohol initially reduces social phobia, excessive alcohol abuse can worsen the symptoms of social phobia and may cause panic disorder to develop or worsen during alcohol poisoning and especially during alcohol withdrawal syndrome. This effect is not unique to alcohol but may also occur with long-term use of drugs that have an action mechanism similar to alcohol such as benzodiazepines that are sometimes prescribed as tranquilizers. Benzodiazepines have anti-anxiety properties and can be useful for short-term treatment of severe anxiety. Like anticonvulsants, they tend to be mild and well-tolerated, although there is a risk of habit formation. Benzodiazepines are usually given orally for the treatment of anxiety; However, sometimes lorazepam or diazepam may be given intravenously for the treatment of panic attacks.
The World Council of Anxiety does not recommend benzodiazepines for long-term treatment of anxiety due to various problems associated with long-term use including tolerance, psychomotor disorders, cognitive and memory disorders, physical dependence and benzodiazepine withdrawal syndrome after cessation of benzodiazepines. Despite increased focus on the use of antidepressants and other agents for the treatment of anxiety, benzodiazepines remain an anxiolytic pharmacotherapy mainstay because of their strong efficacy, rapid onset of therapeutic effects, and adverse event profiles are generally advantageous. Treatment patterns for psychotropic drugs seem to remain stable over the past decade, with benzodiazepines being the most commonly used drug for panic disorder.
About half of patients attending mental health services for conditions including anxiety disorders such as panic disorder or social phobia are the result of alcohol dependence or benzodiazepine. Sometimes an alcohol anxiety or a pre-existing benzodiazepine dependence but alcohol or benzodiazepine dependence act to keep the anxiety disorder away and often make them worse. Many people who are addicted to alcohol or prescribe benzodiazepines when described to them that they have a choice between sick mental health or stop and recover from the symptoms they decide to quit from alcohol or their benzodiazepines. It has been noted that every individual has an individual's sensitivity to alcohol or sedative hypnotic drugs and what one can tolerate without pain, others will suffer very bad health and that moderate drinking can cause anxiety syndrome and sleep disorders. A person suffering from the toxic effects of alcohol or benzodiazepines will not benefit from therapy or other drugs because they do not address the root causes of the symptoms. Symptoms may temporarily worsen however, during alcohol withdrawal or withdrawal of benzodiazepines.
Social Phobia Stereotypes
According to Dr. Richard, if people experience social anxiety one day... they will have it every day for the rest of their lives, unless they receive proper therapy from an experienced therapist. Without education and care, those suffering from this mental disorder will have a very difficult life. The hard part about treating this disorder is that everyone's symptoms can be different. Dr. Richard explains that many of the symptoms of "General" Social Anxiety Disorder include, but are not limited to, speaking very little and staying at home. Other symptoms are slightly more difficult to detect or define. For example, people with SAD know that their thinking does not make sense; However, they have no knowledge of how to act rationally. Also, they may not be polite just because they speak very little. Christina Brook explains, "SAD puts individuals, both children and adults, at risk for chronic stress and disorders and differs from the shame and anxiety of performance by greater severity and width." Understanding Social Anxiety Disorders is the first step in treating disorders.
Many people misunderstand what mental disorders are from media and television. In fact, mental illness images and ideas in the media are mostly negative and inaccurate (Hoffner et al). This example can be seen at the beginning of the 2000s television show, Monk. The television show is about a detective, Adrian Monk, who suffers from Obsessive-Compulsive Disorder and social anxiety. Both are mental disorders associated with Social Anxiety Disorder. While Adrian is negatively affected by this mental disorder, they seem to help him focus more on his work and solve crimes much faster than the average detective.
Many social phobia stereotypes may have resulted in series deaths. While much of the stereotype may be true, a study is completed to see how the event affects people with OCD. The study involved 142 men and women from the ages of 19-66. Overall, many people who are not directly affected by mental disorders have a positive attitude towards the show in that case because it positively influences their attitude toward people with Obsessive-Compulsive Disorder (Hoffner et al). On the other hand, people who are directly affected by mental disorders are less likely to believe that the monk has a problem aired by his television show. Television shows are also unrealistic because many people, not monks, do not want to reveal their mental illness to anyone or even seek medical advice or treatment (Hoffner et al). The monk is very open about his illness and makes little effort to hide it. The inaccurate representation of this mental illness may have resulted in low ratings that eventually led to the cancellation of the show.
The monk, however, had some positive influence during his journey (Hoffner el al). This drastically changed the public view of mental disorders and people began to recognize them more. According to research conducted by Cynthia A. Hoffner and Elizabeth L. Cohen, many are watching the show as a result of feeling sorry for the monk and his mental illness. This allows many people to recognize mental disorders more easily. Also, hopefully people suffering from mental illness feel compelled to come forward about their illness as a result of watching the show. Many seek medical care and professional help. In essence, the concept of the show has a positive effect overall, but the main character suffering from mental disorders is negatively and wrongly described.
Psychological factors
Research has shown the role of 'core' or 'unconditional' negative beliefs (eg, "I'm not worth it") and "conditional" beliefs closer to the surface (eg "If I show myself I will be rejected"). They are considered to develop based on personality and bad experiences and should be activated when the person feels threatened. One line of work has been more focused on the key role of the self-presentation problem. The resulting anxiety state is seen as disrupting social performance and the ability to concentrate on interaction, which in turn creates more social problems, which reinforces the negative scheme. Also highlighted has been a high focus and worry about the symptoms of anxiety itself and how they are seen by others. Similar models emphasize the development of self-distorted mental representation and over-estimation of the possibilities and consequences of negative evaluations, and the performance standards of others. Such cognitive-behavioral models take into consideration the role of negative memories of the past and the process of contemplation after an event, and previous fearsome anticipations. The study also highlights the role of smooth evasion and defensive factors, and shows how efforts to avoid a dreaded negative evaluation or use of 'safety behavior' (Clark & ​​Wells 1995) can make social interaction more difficult and anxiety become worse in the long run. run. This work has been influential in the development of Cognitive Behavior Therapy for social anxiety disorder, which has been shown to have efficacy.
Mechanism
There are many studies that investigate the neural base of social anxiety disorder. Although the exact neural mechanisms have not been found, there is evidence linking social anxiety disorder with imbalance in some neurochemicals and hyperactivity in some areas of the brain.
Neurotransmitter
Sociability is closely related to dopamine neurotransmission. Abuse of stimulants such as amphetamines to boost confidence and improve social performance are common. In a recent study the direct relationship between volunteer social and affinity binding of D2/3 dopamine receptors in the striatum was found. Other studies have shown that the affinity of binding of dopamine D2 receptors in striatum to social anxiety is lower than controls. Several other studies have demonstrated abnormalities in dopamine transporter density in striatum with social anxiety. However, some researchers can not replicate the previous findings of evidence of dopamine abnormalities in social anxiety disorders. Studies have shown high prevalence of social anxiety in Parkinson's disease and schizophrenia. In a recent study, social phobia was diagnosed in 50% of patients with Parkinson's disease. Other researchers have found symptoms of social phobia in patients treated with dopamine antagonists such as haloperidol, emphasizing the role of dopamine neurotransmission in social anxiety disorders. Also, concentration problems, mental and physical exhaustion, anhedonia and decreased confidence can be seen in those with social anxiety disorders.
Some evidence suggests the possibility that social anxiety disorders involve the reduction of serotonin receptors. A recent study reported an increase in binding serotonin binding in patients who have not yet used psychotropic treatment with generalized social anxiety disorder. Although there is little evidence of abnormalities in serotonin neurotransmission, the limited efficacy of drugs affecting serotonin levels may indicate the role of this pathway. Paroxetine and sertraline are two SSRIs that have been approved by the FDA to treat social anxiety disorders. Some researchers believe that SSRIs reduce amygdala activity. There is also increased focus on other candidate transmitters, such as norepinephrine and glutamate, which may be overactive in social anxiety disorders, and GABA transmitter inhibitors, which may be less active in the thalamus.
Brain area
The amygdala is part of the limbic system associated with fear cognition and emotional learning. Individuals with social anxiety disorder have been found to have a hypersensitive amygdala; for example in relation to social threat cues (eg perceptions of negative evaluations by others), angry or hostile faces, and while waiting to give a speech. Recent studies have also shown that other areas of the brain, the anterior cingulate cortex, already known to be involved in physical pain experience, also appear to be involved in 'social illness' experience, such as looking at group exclusion. A 2007 meta-analysis also found that individuals with social anxiety experience hyperactivity in the amygdala and insula areas that are often associated with fear and negative emotional processing.
Diagnosis
ICD-10 defines social phobia as a fear of examination by others that leads to the avoidance of social situations. Anxiety symptoms may appear as reddening complaints, hand tremors, nausea or urgency of the microsis. Symptoms can develop into panic attacks.
Standard scoring scales such as Social Phobia Inventory, SPAI-B, Liebowitz's Social Anxiety Scale, and Social Interaction Anxiety Scale can be used to filter out social anxiety disorders and measure the severity of anxiety.
Prevention
Prevention of anxiety disorder is one focus of research. The use of CBT and related techniques may decrease the number of children with social anxiety disorder after the completion of the prevention program.
Treatment
Psychotherapy
First-line treatment for social anxiety disorders is cognitive behavioral therapy (CBT) with drugs such as selective serotonin reuptake inhibitors (SSRIs) that are only used in those not interested in therapy. Self-help based on CBT principles is second-line treatment.
There is some evidence to emerge for the use of acceptance and commitment therapy (ACT) in the treatment of social anxiety disorders. ACT is considered a branch of traditional CBT and emphasizes receiving unpleasant symptoms rather than fighting against them, as well as psychological flexibility - the ability to adapt to situational demands change, to change one's perspective, and to balance competing desires. ACT may be useful as a second-line treatment for this disorder in situations where CBT is ineffective or rejected.
Several studies have suggested social skills training (SST) may help with social anxiety. Examples of social skills focused on SST for social anxiety disorders include: starting a conversation, building friendships, interacting with preferred gender members, building speech and firmness skills. However, it is unclear whether special social skills training and techniques are needed, rather than being supported only with general social function and social situation exposure.
Given the evidence that social anxiety disorders can predict the subsequent development of other psychiatric disorders such as depression, early diagnosis and treatment is important. Social anxiety disorders are still poorly recognized in primary care practices, with patients often coming for treatment only after the onset of complications such as clinical depression or substance abuse disorders.
A systematic review of 2014 interventions for adults with social anxiety disorders identifies the following psychotherapeutic interventions from published and unpublished sources:
Drugs
SSRI
Selective Serotonin Reuptake Inhibitor (SSRI), a class of antidepressants, is the first choice drug for general social phobia but second-line treatment. Compared with older forms of treatment, there is a risk of less drug tolerability and dependence associated with SSRIs.
In 1995, double-blind, placebo-controlled trials, SSRI paroxetine proved to be clinically significant improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking a placebo. A study in October 2004 produced similar results. Patients were treated with fluoxetine, psychotherapy, or placebo. The first four sets increased in 50.8 to 54.2 percent of patients. Of those assigned to receive only placebo, 31.7% achieved rank 1 or 2 on a scale of Improved Global Clinical Impression. Those looking for therapy and treatment did not see an improvement in improvement.
Common side effects are common during the first week when the body adjusts to the drug. Symptoms may include headache, nausea, insomnia and changes in sexual behavior. Safety of treatment during pregnancy has not been established. In late 2004 much media attention was given to the proposed relationship between SSRI use and suicide [a term that includes suicidal ideation and suicide attempts and suicide]. For this reason, [although the apparent causality of the use of SSRIs and actual suicides has not been demonstrated] the use of SSRIs in child depression cases is now recognized by the Food and Drug Administration as a warning of warning statements to parents of children prescribed by SSRIs by family doctors. Recent studies show no increase in suicide rates. These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorders.
In addition, studies have shown that more patients of social phobia treated with anti-depressant drugs develop hypomania than non-phobic control. Hypomania can be seen as a drug that creates new problems.
Other drugs
Other prescription drugs are also used, if other methods are not effective. Prior to SSRI introduction, monoamine oxidase inhibitors (MAOIs) such as phenelzine are often used in the treatment of social anxiety. The evidence continues to point out that MAOI is effective in the treatment and management of social anxiety disorder and is still used, but generally only as a last medication treatment, due to concerns about dietary restrictions, possible adverse drug interactions and recommendations of multiple doses per day. This newer type of drug, Reversible inhibitor monoamine oxidase subtype A (RIMAs) such as drug moclobemide, binds reversibly to the MAO-A enzyme, greatly reduces the risk of hypertensive crisis with dietary tyramine intake.
Benzodiazepines such as clonazepam are an alternative to SSRIs. These medications are often used to relieve severe and disabling anxiety. Although benzodiazepines are still occasionally prescribed for long-term daily use in some countries, there are concerns over the development of drug tolerance, dependence and abuse. It has been recommended that benzodiazepines be considered only for individuals who fail to respond to other drugs. Benzodiazepines increase the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually start appearing within minutes or hours. In most patients, rapid tolerance develops into a sedative effect of benzodiazepines, but not on anxiolytic effects. Long-term use of benzodiazepines may result in physical dependence, and sudden cessation of drugs should be avoided because of the high potential for withdrawal symptoms (including tremor, insomnia, and in rare cases, seizures). A gradual reduction of clonazepam dose (decreased 0.25 mg every 2 weeks), however, has been shown to be well tolerated by patients with social anxiety disorder. Benzodiazepines are not recommended as monotherapy for patients with severe depression other than social anxiety disorders and should be avoided in patients with a history of substance abuse.
Certain anticonvulsant drugs such as gabapentin are effective in social anxiety disorders and may be a viable treatment alternative for benzodiazepines.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine have demonstrated similar effectiveness to SSRIs. In Japan, Milnacipran is used in the treatment of Taijin kyofusho, a Japanese variant of social anxiety disorder. Atypical mirtazapine antidepressants and bupropion have been studied for the treatment of social anxiety disorders, and provide mixed results.
Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical manifestation of anxiety and can be taken before public performance.
A new treatment approach has recently been developed as a result of translational research. It has been shown that the combination of acute d-cycloserine dose (DCS) with exposure therapy facilitates the effects of exposure to social phobia. DCS is an old antibiotic drug used to treat tuberculosis and has no anxiolytic properties. However, it acts as an agonist at the glutamatergic N-methyl-D-aspartate (NMDA) receptor site, which is important for learning and remembering.
Kava-kava also attracts attention as a possible treatment, although safety issues exist.
Epidemiology
Social anxiety disorders are known to occur at an early age in most cases. Fifty percent of those who develop this disorder have developed it at age 11, and 80% have developed it at age 20. This early-onset age can cause people with social anxiety disorders to be particularly vulnerable to depressive illness, drug abuse and other psychological conflicts.
When the prevalence estimates are based on examination of psychiatric clinical samples, social anxiety disorder is considered a relatively rare disorder. The reverse is true; Social anxiety is common, but many are afraid to seek psychiatric help, leading to a lack of understanding of the problem.
The National Membership Survey of more than 8,000 American correspondents in 1994 revealed 12-month and lifetime prevalence rates of 7.9 percent and 13.3 percent, respectively; this makes it the third most common psychiatric disorder after depression and alcohol dependence, and the most common anxiety disorder. According to US epidemiological data from the National Institute of Mental Health, social phobia affects 15 million American adults in a given year. Estimates vary within 2 percent and 7 percent of the US adult population.
The average onset of social phobia is 10 to 13 years. The onset after age 25 is rare and is usually preceded by panic disorder or severe depression. Social anxiety disorder is more common in women than men. The prevalence of social phobia seems to increase among whites, married, and educated. As a group, those with general social phobia are less likely to graduate from secondary school and are more likely to rely on government financial aid or have a salary for poverty. A 2002 survey showed youths in England, Scotland and Wales had prevalence rates of 0.4 percent, 1.8 percent and 0.6 percent, respectively. In Canada, the prevalence of self-reported social anxiety for Nova Scotia residents older than 14 years was 4.2 percent in June 2004 with women (4.6 percent) reporting more than men (3.8 percent). In Australia, social phobia is the 8th and 5th sickness and disease for men and women between the ages of 15-24 years in 2003. Due to the difficulty of separating social phobia from social skills or shyness, some studies have large ranges. prevalence. This table also shows a higher prevalence in Sweden.
History
The description of literary morality can be traced back to the time of Hippocrates around 400 BC. Hippocrates describes a man who "through the nature of shame, suspicion, and punctuality, will not be seen abroad, loves darkness as life and can not hold light or to sit in bright places, his hat is still in his eyes, he is not will see, or be seen of his good will, dare not come to the company for fear he must be abused, humiliated, transcending himself in motion or speech, or illness, he thinks everyone is watching him. "
The first mention of the term social phobia psychiatry ( phobie des situation sociales ), was made in the early 1900s. Psychologists use the term "social neurosis" to describe a very shy patient in the 1930s. After extensive work by Joseph Wolpe on systematic desensitization, research on their phobias and care grew. The idea that social phobia is a separate entity from another phobia came from the British psychiatrist, Isaac Marks, in the 1960s. It was accepted by the American Psychiatric Association and was first formally included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The definition of phobia was revised in 1989 to allow comorbidity with avoidant personality disorder, and introduced a general social phobia. Social phobia has been ignored before 1985.
After a call to action by psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg, there is increased attention and research on the disorder. The DSM-IV gives the social phobia an alternative name of social anxiety disorder. Research on the psychology and sociology of daily social anxiety continues. Cognitive behavioral and therapeutic models were developed for social anxiety disorders. In the 1990s, paroxetine became the first prescription drug in the US approved to treat social anxiety disorders, with others following.
References
Further reading
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Belzer K. D.; McKee M. B.; Liebowitz M. R. (2005). "Social Anxiety Disorder: Current Perspective on Diagnosis and Treatment". Principal Psychiatry . 12 (11): 40-53. - Beidel, D. C., & amp; Turner, S. M. (2007). Shy children, adults phobia: Natural and social anxiety disorder treatment (2nd ed.) (Pp. 11-46). Washington, DC US: American Psychological Association. doi: 10.1037/11533-001
- Berent, Jonathan, with Amy Lemley (1993). Beyond Shyness: How to Conquer Social Anxieties . New York: Simon & amp; Schuster. ISBNÃ, 0-671-74137-3.
- Bruch M. A. (1989). "Familial and preliminary development of social phobia: Problems and findings". Clinical Psychology Reviews . 9 : 37-47. doi: 10.1016/0272-7358 (89) 90045-7.
- Burns, D. D. (1999). Feeling Good: new mood therapy (Rev. ed.). New York: Avon. ISBNÃ, 0-380-81033-6.
- Crozier, W. R., & amp; Alden, L. E. (2001). International Handbook of Social Anxiety: Concepts, Research, and Self-Reliance and Shame Interventions . New York: John Wiley & amp; Sons, Ltd. ISBNÃ, 0-471-49129-2.
- Hal, R. E., & amp; Yudofsky, S. C. (Eds.). (2003). Social phobia. In the Clinical Psychiatric Teaching Book (4th edition, pp. 572-580). Washington, D.C.: The Issue of American Psychiatry.
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Marteinsdottir I.; Svensson A.; Svedberg M.; Anderberg U.; von Knorring L. (2007). "The role of life events in social phobia". Nordic Psychiatric Journal . 61 (3): 207-212. doi: 10.1080/08039480701352546.
External links
- Social Anxiety (including self-help links) in Curlie (based on DMOZ)
- Group Provider Support for social anxiety disorder in Curlie (based on DMOZ)
Source of the article : Wikipedia
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