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Conservative use of drug therapy
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A psychological approach that emphasizes the present and future of the patient, rather than the past.
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Emphasis on nutrition and physical exercise
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Family participation, if appropriate
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Psychoeducation for patients and relatives
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SOCIAL PHOBIA
What is Social Phobia?
The main feature of social phobia is a persistent and uncontrollable fear of social situations, including situations where one is expected to perform. People with this disorder have an irrational fear that they will be embarrassed, scrutinized, judged, or humiliated in public. Speaking in public, eating in public, using public lavatories, or virtually any other activity that might be carried out in the presence of others can elicit extreme anxiety. When exposed to these situations, these individuals are likely to experience extreme levels of anxiety or panic attacks. Social phobia is diagnosed only if the fear intrudes in the social or occupational functioning of the individual.
What are the Symptoms?
Individuals with this disorder tend to be hypersensitive to evaluation, criticism and rejection. They have difficulty in being assertive and experience low self esteem. They also may have poor social skills and engage in visible signs of anxiety such as cold clammy hands, tremors and shaky voice. Students with social phobia tend to be underachievers as they have test anxiety and also avoid participating in class activities. Adults with this disorder tend to be underachievers at work as they shy away from speaking in groups or to authority figures. These individuals tend not to have much social support and are likely to remain single. In severe cases, this individuals may drop out of school or be unemployed.
Among children, social phobia may be presented as crying tantrums, freezing, clinging to a familiar person and even refusing to talk altogether. Young children may be extremely timid and avoiding playing with other children.
Social-Cultural Impact
Social phobia may be manifested differently, depending on the social and cultural context of the individual. For example, in Japan, social phobia is manifested as extreme fear of bringing offense to others instead of fearing being embarrassed. One form of social phobia observed in east some asian cultures, taijin kyofusho, may present itself as a fear that eye contact, blushing or even one's body odor will be offensive to others.
Who Suffers from Social Phobia?
Epidemiological studies demonstrate that social phobia could be as prevalent as 13% of the population.
First signs of the disorder usually appears during the mid-teens, but could also begin during childhood. The onset of the disorder is usually in conjunction with a stressful and humiliating event. If untreated, individuals may suffer from social phobia through out his/her life.
The current psychiatric diagnostic manual (DSM-IV) indicates the following diagnostic criteria:
DSM-IV DIAGNOSTIC CRITERIA
- A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.
- Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack.
- The person recognizes that the fear is excessive or unreasonable.
- The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
- 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, or social activities or relationships, or there is marked distress about having the phobia.
- In individuals under age 18 years, the duration is at least 6 months.
- The fear or avoidance is not due to the direct physiological effects of a substance or a general medical condition and is not better accounted for by another mental disorder.
- If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it.
What Treatments are Available?
Cognitive and behavior therapy as well as certain medications are the current treatment of choice for Social Phobia.
Cognitive therapy involves teaching the individual to identify his faulty thinking patterns which lead to negative emotions and behavior and replace them with more rational and fact-based beliefs.
Behavior therapy techniques includes exposure and response prevention as well as social skills training. Exposure and response prevention involves gradually and repeatedly exposing the individual to feared and avoided situations. If the individual lacks social skills, teaching such skills may be necessary.
Research indicates that certain medications are effective for treating social phobia. Medications most commonly used include:
| MAO Inhibitors |
Prozac |
| Beta Blockers |
Luvox |
| Xanax |
Buspar |
| Klonopin |
Paxil |
| Anafranil |
Wellbutrin |
| Phenelzine |
Moclobemide |
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Consultations