Social Anxiety Disorder
Social Anxiety Disorder Historical Perspective
Symptoms as Described by Hippocrates:
[A man who] “…through bashfulness, suspicion and timorousness, will not be seen abroad; … his hat still in his eyes, he will neither see nor be seen by his goodwill. He dare not come in company for fear he should be misused, disgraced, overshoot himself in gestures or speeches or be sick; he thinks every man observes him.”
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Clinical Feature of Social Anxiety Disorder
- Believes performance will be negatively evaluated with resulting embarrassment or humiliation
- Exposure to feared situation predictably elicits anxiety
- Avoids or endures feared social situation(s) with distress
- Fear is out of proportion to the actual threat posed
- Impairs occupational, social, or family roles
- Not better explained by drug of abuse, medication, or medical or mental disorder, e.g., major depression (social reticence), Parkinson’s Disease, obesity, burns, stuttering
* Performance only: if the fear is restricted to speaking or performing in public
Differential Diagnosis
- Avoidant Personality Disorder
- Panic Disorder / Agoraphobia
- Generalized Anxiety Disorder
- Depression-related social avoidance
- Separation anxiety disorder
- Body Dysmorphic Disorder
- Schizotypal / Schizoid Personality Disorder
- Medical conditions, e.g., tremor
Subtype Characteristics
| Generalized
(~70%) |
Performance only
(~30%) |
|
|
Typical Feared Social Situations
| Generalized | Performance Only |
|
|
Symptoms domain wise:
Physical
- Tachycardia
- Trembling*
- Blushing*
- Shortness of Breath
- Sweating*
- Abdominal Distress
- Socially-Cued Panic Attacks
Cognitive
- Perceived scrutiny and certainty of negative evaluation
- Misinterpretation or failure to note social cues
Behavioral
- Avoidance
- Freezing
The Course
- Median age at onset is 13 years
- 75% of individuals have onset between 8 and 15 years
Impairment
- Lower educational status
- Are less likely to graduate high school
- Work in less skilled occupations
- Lower income and socioeconomic status
- Lower likelihood of marrying
- Higher likelihood of divorce
- Impeded leisure activities
Best Treatment of Social Anxiety Disorder in Delhi & Noida
rTMS in
Social Anxiety Disorder
- The man should be the sexual leader
- Masturbation is wrong
- A woman should not initiate sex
- Men should not express their emotions
- A woman should always have sex when her partner makes sexual
- approaches
- All physical contact must lead to sex
- Good sex leads to a wild orgasm
- A man feels like having sex at any time
- Sex equals intercourse
Medications in Social Anxiety Disorder
- Sex happens automatically
- A `respectable’ woman should not enjoy sex too much and should
- certainly never masturbate
- All other couples have sex several times a week; have orgasm every time
- they have sex & orgasm simultaneously
- There must be something wrong with the relationship if sex is not good
- Cultural beliefs about formation of Semen and genital secretions
Psychotherapy in Social Anxiety Disorder
- Role of ‘Physical strength’ or ‘Muscle power’ in sexual performance
- Size of the penis
- Circumcision and sexual performance
- Bending of Penis
- Vasectomy/tubectomy decreases sexual potency
- Drugs enhance sexual potency in normal persons
- Porn increases sexual drive
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