ARTICLE

Do You Have Social Anxiety Disorer?

In my outpatient psychology practice, I see eight things every day--they show up again and again, presenting in one form or another. One of the bigger and more negative experiences clients have is anxiety. In addition, the first thing clients want to know is whether they have an anxiety disorder, in this case Social Anxiety Disorder. First, here is a rather clinical description of what anxiety is, according to an older but very accurate source, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition:

"...An apprehension, tension, or uneasiness that stems from the anticipation of danger, which may be internal or external. Some definitions of anxiety distinguish it from fear by limiting it to anticipation of a danger whose source is largely unknown whereas fear is the response to a consciously recognized and usually external threat or danger. The manifestations of anxiety and fear are the same and include motor tension, autonomic hyperactivity, apprehensive expectation, vigilance and scanning. Anxiety may be focused on an object, situation, or activity, which is avoided (phobia), or may be not focused (free-floating anxiety). It may be experienced in discrete periods of sudden onset and be accompanied by physical symptoms. When anxiety is focused on physical signs or symptoms and causes preoccupation with the fear or belief of having a disease, it is termed hypochondriasis."

Anxiety pervades almost all of our experiences in every venue. Most of the time, it is in the background. It turns out we need some very basic "tension" to exist and a little more to be motivated to do things. We psychologists call this ergic tension. You could not sit up or read this article if you had no ergic tension. It is normal. However, many people have more anxiety than this, which still could be good in some circumstances, like in sports or just before an important speech or even right before a major test in school. This keeps us focused and helps us appropriately utilize the extra adrenaline that accompanies such events. We are still in the normal range of anxiety if we understand and can manage it during and then after the specific event, presumably when our anxiety drops back to lower levels.

Some people have more anxiety than this, and it does not go back to "mark headings." These are the folks who probably have an anxiety disorder. Social Phobia is the sixth category in my ebook, which makes it pretty serious. There are seven major categories of anxiety disorders, depending upon the cluster of symptoms and their manifestations. I have written about these in my ebook, How To Diagnose and Treat Your Anxiety. Here's the categories as I listed them: Worrisome Personality, then the more progressive and I think more serious clinical categories follow: Generalized Anxiety Disorder, Adjustment Disorder with Anxiety, Post Traumatic Stress Disorder, Panic Attacks, Phobia Disorder and Obsessive Compulsive Disorder. I made up the first category because I see this a lot in my practice, but it is not in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (the latest version of this manuscript, which is the Bible of mental health professionals). The last six categories are clinical categories and are found in the DSM IV.

And, here is how anxiety typically manifests (symptoms):

...Trembling, twitching, or feeling shaky, muscle tension and aches or soreness (including chest pains), restlessness, easy fatiguing...or... shortness of breath or smothering sensations, palpitations or accelerated heart rate, sweating or cold clammy hands, dry mouth, dizziness or lightheadedness, nausea, diarrhea, or other abdominal distress, flushing, hot flashes, chills, frequent urinations, trouble swallowing, or... feeling keyed up and on edge, exaggerated startle response, difficulty concentrating or having your mind "going blank," trouble falling or staying asleep, or being excessively irritable.

According to the DSM IV, Social Anxiety Disorder, now called Social Phobia,

" ... is a marked and persistent fear of social or performance situations in which embarrassment may occur. Exposure to the social or performance situation almost invariably provokes an immediate anxiety response (see above symptoms). This response may take the form of a situationally bound or situationally predisposed Panic Attack. Although adolescents and adults with this disorder recognize that their fear is excessive or unreasonable, this may not be the case with children. Most often, the social or performance situation is avoided, although it is sometimes endured with dread..."

Social Phobia is one of many kinds or categories of anxiety. I have written specifically about this and other versions of anxiety in my ebook on How To Diagnose and Treat Your Anxiety. This is a publication that shows you how to think about any anxiety, disordered or not, how to assess your symptoms and more importantly, what to do about it. Here is what I wrote about phobias, which included the phobic version described above:

"A phobia is a persistent fear of a specific object(s) or situation(s) other than the fear of having a panic attack. In other words, the stimulus is external, not internal in most cases. (Once you are having a phobic experience, then there usually arise internal fears, for instance, that you will further lose control, and your symptoms will increase in intensity, etc. This is called secondary anxiety and it can occur in any of the symptom categories, but for our purposes it is not diagnostic with respect to the categories listed here.) The most common situations or objects reported are fears of animals, elevators, heights, enclosed or open places, air travel, blood, or public speaking or just being out "exposed" in a public place. (Some people are afraid to make contact with others, regardless of venue. This is Social Phobia, as opposed to simple shyness.) Exposure to the feared stimulus causes the above anxiety symptoms to be experienced, usually in direct proportion to the perceived inevitability of directly contacting the stimulus. Again, people typically experience four anxiety symptoms from the list above, and usually five or more when they are having intense anxiety reactions. Incidentally, not only can the symptoms be very intense during the initial phobic response, but also they can linger at less intense levels for very long periods of time in-between phobic reactions, proper. The mere thought of having another encounter with this group of symptoms can by itself evoke a renewed commitment to not being phobic. Obviously, these symptoms cause you to avoid the situation(s) or object(s), thereby altering your routine or customary way of dealing with things, sometimes in very dramatic ways. As in the case of panic attacks, people usually recognize that this fear or avoidance is irrational, but nonetheless cannot explain it nor make the symptoms go away by an act of will."

In sum, Social Phobia sufferers have a major version of anxiety disorder, one that can cause considerable discomfort. You have to think about your symptoms in a very specific and different way to diagnose whether or not you have ANY anxiety disorder, Social Phobia included. I show you how, step by step, in my ebook, and how to deal with it.

Dr. Griggs

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