KIRA STEIN, MD, APC

ADULT PSYCHIATRY - BOARD CERTIFIED ABPN


Social Disorders and Social Anxiety

Social Disorders and Social Anxiety

Posted by Kira Stein MD
30 August, 2011

SOCIAL DISORDERS AND SOCIAL ANXIETY: When Depression Gets In The Way

Many times you are not aware of what triggers it; other times, you know it is triggered by a sense of being inadequate in a social situation. You start to feel flushed and warm, then sweaty, and have difficulties paying attention to a http://www.dreamstime.com/stock-photo-illustration-depicting-sign-social-phobia-concept-image30079540conversation and feel you are missing social cues and responding five sentences too late.  Suddenly, you feel a panic rising, a need to do something, although you don’t know what.  As the tension mounts, you feel a sense of dread as if you’re going to die or go crazy. You fear you’re going to die if you don’t get away; you have an overwhelming urge to escape.  As these symptoms mount, you realize that others may be noticing you; you become fearful that people are aware of your fear and you feel judged, scrutinized, embarrassed, or on-the-spot.  This, in-turn, drives your anxiety up further.  The cycle of social disorders, such as generalized social anxiety or phobia, has begun.

After this phenomenon subsides, you are still alive, but left with the fear, anticipating that this may happen again. These are symptoms of social anxiety disorder, or social phobia. Some people refer to them simply as “social disorders.”  These conditions are characterized by irrational fears.  Sensing everyday situations can lead to devastation often results in your avoiding more and more social interactions, becoming more withdrawn, and alienating yourself from unfamiliar people and situations. In essence, this is what social disorders and social anxiety behaviors are.  Such social disorders involve a definite fear of interacting with others in certain circumstances.

Symptoms of Social Disorders

There are many symptoms associated with social disorders; Social anxiety symptoms usually exist for 6 months or more and significantly interfere with normal work, academic or personal activities.  Most sufferers of social disorders are crippled by the emotional symptoms associated with social anxiety such as:

• a fear of being humiliated in public
• feeling so overwhelmed it disrupts your daily life
• a fear of speaking to people and becoming embarrassed
• a fear you may be judged
• a fear others can sense you are nervous

Some of the physical signs of social anxiety are:

• clammy, sweaty hands, flushed face
• confusion, muscle tension
• trembling, shaking
• nausea, upset stomach, diarrhea
• fast heart beat

Social Anxiety is quite common in society.  What researchers have concluded so far is that the lifetime prevalence of social anxiety is about 15% in women and about 13% in men. Social disorders and social anxiety usually become a problem around the age of 13 through the mid-teens.

Researchers are still studying social disorders, hoping to find the causes.  There is a relationship between social disorders and other psychiatric and medical illnesses.  Sometimes, a thyroid disorder can trigger these symptoms in some socially anxious patients.  Further, anxiety disorder is frequently associated with other mental health difficulties, such as generalized anxiety and panic disorder, as well as major depressive disorder.

Social Disorders Increase The Risk of Depression

People with social anxiety disorder are up to six times more likely to suffer from mood disorders such as major depressive disorder, dysthymic disorder, or bipolar disorder.  In the vast majority of cases, social disorders precede the mood disorder by several years.  When clinical depression occurs simultaneously with social anxiety, the severity of both disorders and the risk of serious dysfunction interpersonally and occupationally significantly increase.

Clinical symptoms of depression can include lack of joy, disinterest in life, difficulty getting out of bed, difficulty thinking or making decisions, problems concentrating and motivating, feeling physically sluggish or restless, feeling apathetic or irritable, sleeping too much or having trouble with insomnia, and a preoccupation with death or suicide.   Sometimes depression causes people to feel so hopeless that they withdraw from friends and family, more due to lack of interest than due to social disorders; other times, depression simply worsens a pre-existing social disorder.  More often, social disorders precede a depressive episode. When social anxiety and clinical depression co-occur, it is important to get both conditions addressed by a professional healthcare provider as soon as possible in order to avoid further worsening of your health.

Addressing Social Disorders:

Social disorders initially can be addressed with cognitive behavioral therapy (CBT), which involves meeting with a therapist who specializes in social skills training, cognitive restructuring and exposure therapy for social anxiety disorder.  Usually, CBT in a group setting is the most effective approach of therapy.  Sometimes, however, medications, such as benzodiazepines (ie, Klonopin, Ativan, etc.) can be used temporarily until the positive effects of CBT take place.  If symptoms of social disorders are so severe that CBT and benzodiazepines are insufficient, then serotonin-reuptake-inhibitors – SSRIs — (ie, Paxil and Zoloft), or MAO-Inibitors (ie, phenelzine, trancylcypromine), or other medications can help with social anxiety symptoms as well as major depressive episode symptoms.

Addressing Depression:

When patients with social disorders also suffer from clinical depression, their depressive symptoms can be so severe that they cannot apply themselves sufficiently to cognitive behavioral therapy; they therefore require other interventions, such a medications, to reduce their symptoms in order to “take the edge off” enough to focus on talk therapy.

Treatment of Co-Occurring Clinical Depression Can Make It Easier To Address Anxiety

Social disorders, anxiety and phobia are potentially debilitating conditions that increase the risk for depression.  For many, both social disorders and depression can be effectively addressed with psychotherapy and/or medication.  Medications are not always effective at treating depression, however, and can sometimes present intolerable side effects.  When depression is unsuccessfully treated, then it is much more difficult to manage social disorders.

TMS, or Transcranial Magnetic Stimulation, is a new alternative breakthrough treatment for clinical depression.  While TMS is not a treatment for social disorders, treating co-occurring clinical depression maximizes the chances of effectively treating social disorders.

TMS is a safe and non-invasive treatment for depression and uses MRI-strength magnetic pulses to stimulate the part of the brain that regulates mood. It is accepted by the FDA as the only method of treatment for depression that does not require the use of medication, surgery, or direct electrical stimulation. The process is a simple one. It is usually done as an outpatient in a relaxed atmosphere while watching TV or participating in meditation or talk therapy.

While TMS is not a specific treatment for social anxiety, TMS has been shown to improve symptoms of depression, including anxious depressive episodes. Preliminary studies also suggest that TMS can reduce general symptoms of anxiety.   It’s important to realize that severe clinical depression and social anxiety are not like colds…they often do not simply ‘go away’.   Professional help is needed to help people overcome these conditions.

Talking with your therapist, psychiatrist, or primary care physician about these disorders will help you understand what your next step should be. Social disorders and depression can be controlled so individuals can finally enjoy their lives fully.

If you found our Social Disorders and Social Anxiety post informative, click on our post on symptoms of anxiety.

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