social anxiety disorder?

[C3]

I really wasn't sure whether to post this here or in GQ, because it's mainly a question, but one I think has the potential to turn into a debate.

Lately, I've been seeing a commercial that advertises a drug to treat "social anxiety disorder". In addition, I was listening to a radio program today on NPR called "What's on Your Mind?", hosted by Dr. Linda Austin. This is a call-in show out of the Medical University of South Carolina that deals with all sorts of mental illnesses, disorders, etc. Today, Dr. Austin was joined by another doctor to discuss SAD.

My question: does SAD = shyness? Or is it something more involved?

It seems like, from the commercial and from some of the comments from the doctors, that medication is being advocated for people who are just shy. For instance, one caller said, "Sometimes when I talk to people, I get embarassed and I can feel that my face turns red." The guest doctor replied (I'm not kidding), "What is occurring is something that is called blushing." He went on to encourage her to see a doctor about getting medicated for her "condition". He suggested Zolof (sp?).

Now, is there something I'm not getting? Is SAD really a serious disease that needs to be medicated? Or is it something that in the past we called shyness, but that society is now keen on "curing" in our attempt to homogenize our citizens? Why does it seem that so many doctors are suggesting medication first (as the ones hosting the radio program did) when there are so many cognitive therapies that have been successfully used to help people who suffer from severe shyness?

[Eve]

A friend of mine has "social anxiety disorder" (yes, it really IS a friend of mine—as those of you who kow me can testify, this is the LAST thing I suffer from!). I think it really does just boil down to a fancy-ass name for "shyness."

He's been on Zoloft for about a month and says it really does lift his mood and make him less hung-up, and if there's any side effects, he hasn't mentioned them.

[tracer]

Hasn't Paxil also been approved by the FDA for treating S.A.D.?

[QuickSilver]

I hear booze is a time honoured remedy for shyness. A little pot will mellow out most people as well. Not that I indulge in the latter.

Point is, why turn to phamaceuticals when off the shelf remedies will almost certainly do?

Oh wait, that's encouraging people to imbide mind altering substances, isn't it?! But Zoloft and Paxil are not the slight bit questionable because they come highly recommended by doctors.

[Finagle]

I thought that's what Powdermilk biscuits were for, to give shy people the strength to do what needs to be done.

[DoctorJ]

Finagle--I made the same joke in my post, which died in the last board crash. "Paxil--Heavens, it's tasty, and expeditious!"

A quick recap of that post--yes, SAD is extreme shyness. We give conditions like SAD, ADHD, and major depressive disorder specific names because we create specific criteria for them. This facilitates research and treatment--if I say someone is shy, that could mean a lot of things. If I say he has SAD, it means that he meets this particular definition we have devised.

Treating such conditions is not about homogenizing society, but about improving quality of life. Some people are so shy they never leave the house, and are miserable. If we can make them feel better by giving them some Paxil or Zoloft, why shouldn't we?

Dr. J

------------------
"Seriously, baby, I can prescribe anything I want!" -Dr. Nick Riviera

[Boris B]

I have nothing useful to add to this thread. All I have to say is that I am really annoyed on behalf of all the people who will inevitably be confused by the fact that SAD is the acronym for both seasonal affective disorder and social anxiety disorder. Of course, I heard of seasonal affective disorder first, so I consider social anxiety disorder to be the stooge.
Fer cryin out loud I've only recently gotten used to the fact that IRA can mean both individual retirement account and Irish Republican Army, and now I've got to deal with an ambiguous three-letter acronym, both of whose long forms are from the same field! This has warped my fragile little mind.

Did you know Franklin Roosevelt was an avid rifleman? He founded the NRA, after all. Two reasons some conservatives hate the NEA: their opposition to school vouchers and their support for Robert Mapplethorpe. Why do airline pilots hate AAA?

SWM ISO SWD for sweeping up some ambiguous TLAs!

[Boris B]

I apologize. I think I have ATP (ambiguous TLA phobia).

------------------
Am I reading Hippocrates right?
He's not just a big box for storing large semi-aquatic mammals, is he?

[tracer]

There's just one problem with using Paxil: one of the side effects is reduced libido.

Kinda throws a wet blanket on curing the shyness, doesn't it?

[Myron Van Horowitzski]

Easy for y'all who don't have it, to joke about it. It's no joke. It's a
living hell. What a relief they finally have a name for it and a treatment.

Social Phobia is a chronic and sometimes acute unnatural fear of people;
this fear having physical manifestations, e.g. high blood pressure,
headaches, sick feeling in the stomach, etc., and potential of substance
abuse. When I was younger it showed in stammering, voice quavering, hands
shaking, eyes tearing and inability to make eye contact. I know, and my
parents confirm, that I was born with it.

I can still see myself as a kid: "Pick up that snake." Okay, sure. "Climb to
the top of that tree." No problem. "Swim across that lake." Here I go. "Go
into that store and ask the saleslady for...." NO NO NO! Please don't make
me, I'D RATHER DIE!

As an adult, going to work and being charming and clever to people all day,
and going home at the end of the EXHAUSTED from the strain of faking poise.
And I have to explain, this is a GOOD job and these are GOOD people. There
IS no stress other than the phobia.

All the people who know me IRL wouldn't believe in a million years that I
have this, because I've learned to control it pretty well.

What I am controlling is my outward demeanor only, to appear calm and
assured when in reality I can barely restrain myself from fleeing in irrational terror. Some
people never do learn control. My father and his mother both had it. They
were virtual hermits.

They--and I--had divisions for people: there was the A-List, those you were
not only comfortable with but almost relieved to be with. Immediate
family and closest friends.

The B-List: People you saw a lot, at work or socially, who you could be
fairly comfortable around, but be relieved to take leave of them and go
home.

The C-List: Casual acquaintances and total strangers. Interestingly enough,
casual acquaintances were much more terrifying than total strangers, because
the latter you could try to ignore, the former you might have to TALK to
<shudder>.

Y'all think I'm nuts? Can't imagine feeling that way? Lucky you.

That's what a phobia is, an unreasonable fear. To wit: I had a
happy childhood. I've never been mistreated by anyone or been through any
sort of ordeal. I've never had anything really bad happen to me. Yet...this
affliction. Just "shyness"? Not to me.

I might have lived the rest of my life that way, but now there's Paxil. It
does work. I have not changed into a new person; I'm now the person I
was supposed to be all along. I have poise, but now I'm not faking it.
Nobody knows the difference, except me.

God bless serotonin, and feel free (with C3's permission) to turn this
thread into Ask the Recovering Social Phobe.

Your brain-in-a-jar,
Myron

PS-Hope y'all won't think less of me now that you know my affliction, but I
felt the OP needed some first-hand material. (envision smiley here)


------------------
Imbibo, ergo sum.

[Flinx]

I suffer from social phobia as well, and it definitely is not just shyness. Whenever I am around other people, I start getting nervous, for no reason other than there are others around. I start to wonder if maybe the others are reading my mind (no kidding), and that makes me extremely nervous and jumpy, to the point where I usually withdraw at that point.

I would describe social phobia as having a feeling akin to holding my breath when I'm around others, and I can't "breathe" (figuratively) or relax until I get alone again. This disorder, coupled with my paranoid schizophrenia, has made a virtual hermit of me. I can't go to church, I can't go to school or work around others, and I can't even go to the movies without suffering a minor nervous breakdown.

You can say, "Oh, you're just very, very shy," but it goes beyond shyness. It's extreme nervousness, and it cripples me socially. I stay at home 95% of the time, maybe more. I do go out, but when I do, I'm always relieved greatly to get home again. I hate being this way. Whether it's an illness, a phobia, or whatever, it's very real to me.

------------------
"Facts? Facts are useless. You can use facts to prove anything that's even remotely true!"
Homer Simpson

[DoctorJ]

Myron, Flinx--I apologize for my misstatement (that SAD=extreme shyness). Thanks for lending your experience.

Dr. J

------------------
"Seriously, baby, I can prescribe anything I want!" -Dr. Nick Riviera

[Flinx]

DoctorJ, no need to apologize. For all I know there are people out there who do suffer only from extreme shyness who can say that they suffer from SAD. I can only speak from my own experience, which tells me that for me, it goes beyond shyness.

------------------
"Facts? Facts are useless. You can use facts to prove anything that's even remotely true!"
Homer Simpson

[Green Bean]

I find the whole subject really interesting.

I was given Paxil to combat depression. I had been on it for several months when I saw the "social phobia" TV commercial.

While I don't have social phobia, I do have the normal run of insecurities that make me shy at times. After seeing that commercial, I realized that I actually had become less shy in the 5 months that I had been on the drug. Maybe the shyness had gone away because the depression was being properly treated, or maybe Paxil really does combat "shyness" directly. I am not sure how much research has been done on shyness in people who don't have social anxiety disorder.

Either way, it is a welcome side effect.

[Myron Van Horowitzski]

No offense taken, DoctorJ. We're fighting ignorance and all that.

A few other comments:

Green Bean, Paxil is good for Social Phobia AND some cases of depression, because both can be caused by the same lack of free serotonin in the brain.

Flinx, I know exactly what you mean about the relief of finally being alone in your own little nest. (Or with your A-List, see above)

Yes, these drugs do decrease libido, dammit.

I also agree that they are being prescribed way too much on a whim. Embarrassed and your face turns red? That's nothing, eh, Flinx? This doctor told her to rush out and get medicated? Ugly trend.

Too, if medical organization you patronize is following correct procedures, the first thing they make you do, before giving you medication, is see a therapist, to see if your condition is accompanied by external factors, such as grief, traumas, abuse or whatnot. If so, medication will be combined with cognitive therapy to help the patient deal with the "baggage".

However, I want to emphasize that while the above factors can exacerbate a neurochemical imbalance, they are by no means required to begin an imbalance in the first place. This is how it is in my case, as I explained above. Few people know I'm on medication, mainly because I don't want them trying to guess what horrible thing happened to me to make me this way.

Your serotonin-soaked-brain-in-jar,
Myron



------------------
Imbibo, ergo sum.

[Flinx]

Myron wrote:

Flinx, I know exactly what you mean about the relief of finally being alone in your own little nest. (Or with your A-List, see above)

Yeah, it really is a big relief. It's like coming home from a war halfway around the world, almost.

I also agree that they are being prescribed way too much on a whim. Embarrassed and your face turns red? That's nothing, eh, Flinx? This doctor told her to rush out and get medicated? Ugly trend.

Good grief, that's a walk in the park on a spring day! If my biggest problem was red cheeks, I wouldn't have anything to worry about whatsoever.



------------------
"Facts? Facts are useless. You can use facts to prove anything that's even remotely true!"
Homer Simpson

[tracer]

Myron Van Horowitzski wrote:

God bless serotonin,

I believe the phrase you're looking for is "God bless serotonin reuptake inhibitors".

Speaking of which, I don't see reduced libido listed among Prozac's side effects. I wonder if it would work on S.A.D. as well as Paxil does....

[C3]

Thanks, Myron & Flinx, for the insight. A couple questions -
Does Social Phobia = Social Anxiety Disorder? Is what you have maybe a severe form of what the dr.'s on the radio show were describing? Do you know what the cut point is between being called "just shy" and being diagnosed with this disorder is?

What do you all think about medicating someone who is "just shy". Obviously, medication has helped both of you tremendously. I'm shy, but not phobic, meaning, it makes me extremely nervous to talk to most people (even people I know). I get panicky before social events (just a feeling in my stomach, not sweating or trembling). I stammer and get tonguetied. Sometimes, inexplicably, none of this happens and I feel comfortable in a situation (but this is pretty rare). I would label myself as just shy. Should something like this be medicated? It never would have occurred to me to take medication for this (or even get therapy) - it's just how I am. I think if I had called the radio show, though, they would have written me a scrip by that afternoon.

[Flinx]

C3 wrote:

Does Social Phobia = Social Anxiety Disorder?

I think so. Fairly sure. Yes, that's my final answer.

Is what you have maybe a severe form of what the dr.'s on the radio show were describing? Do you know what the cut point is between being called "just shy" and being diagnosed with this disorder is?

I don't. Maybe Myron does. I don't know much about the medical aspects of this disorder, just the effects.

What do you all think about medicating someone who is "just shy".

I say if it helps and you can afford it, go for it. You don't have to be a basket case to take advantage of medical advances that might help you.


------------------
"Facts? Facts are useless. You can use facts to prove anything that's even remotely true!"
Homer Simpson

[Myron Van Horowitzski]

I'm not a doctor, nor do I play one on the board. C3, you might ask yourself the question, "How much does my shyness affect/interfer with my leading a normal life?" (It's up to you to define normal, of course)

For me, the answer involved, over the years, mucked-up job interviews, missed opportunities for once-in-a-lifetime social events, making bad first impressions on people I wanted to make good impressions on, minor ripoffs, cheats and insults that were let go because I couldn't get up the courage to confront anyone...

Another question relates to what Flinx and I were talking about above: "How important is it to me to be safe in my own 'nest', how protective am I of it, and how difficult is it to leave it to go out into the world?"
This, I think, may be one of the things that can distinguish mere shyness from the real thing.

You seem concerned enough about this that I would recommend making an appointment with your local Behavioral Health clinic. They'll fix you up to meet a therapist, who won't start right in giving you therapy, but will ask the pertinent questions to discover the depth of problem and how it can be treated.

Good luck and take care.

Your brain-in-jar,
Myron

------------------
Imbibo, ergo sum.

[tracer]

Myron Van Horowitzski wrote:

"How important is it to me to be safe in my own 'nest', how protective am I of it, and how difficult is it to leave it to go out into the world?"

Are we still talking about S.A.D. here, or have we veered off into Agoraphobia?

[C3]

That's the thing, Tracer. I'm having some trouble, too, making the distinction. It sounds like what Myron and Flinx are describing is closer to agorophobia. What I think my problem is, and what the doctors I wrote about in the OP were describing, is mere shyness.
I understand medication (and hopefully, therapy will be the first option before drugs) when someone has a phobia. When someone is incapable of functioning or having a somewhat normal work & social life, which sounds like what M & F describe as Social Phobia, I get it.

Since when, though, is it a problem to "sometimes" get embarassed when you talk to someone and, therefore, blush? That is what one caller described and the doctors enthusiastically encouraged her to seek a doctor who would prescribe medication. To me, this smacks of trying to eliminate all levels of shyness.

Anyone else out there know what the line is and what the clinically-accepted indications are for Zoloft being used to treat SAD? Do you all think that drugs are sometimes used to homogenize people who have minor differences to most other people?

[Boris B]

I, for one, just thought that agoraphobia was just the old-fashioned word for Soc. Anx. Dis. Sort of like manic-depression is the old word for bipolarity. Or bipolarism. Or whatever the one-word noun form for bipolar disorder is. I think the reason is, in the olden days when people had Soc. Anx. Dis., it was interpreted that they were afraid of everywhere other than their own house. Now we know that in most cases, it's fear/anxiety associated with people, which should probably be called demophobia.

Myron, I hope you don't think I was making light of the condition. Really I was just making light of my own burdensome language expectations. Both SADs are pretty interesting to me, as a certified neurology/psychology dilletante.

------------------
Am I reading Hippocrates right?
He's not just a big box for storing large semi-aquatic mammals, is he?

[DoctorJ]

Here is a summary that I found on the Web of the official DSM-IV diagnostic criteria for Social Phobia, which is the same thing as Social Anxiety Disorder (bolding mine, and I have removed some of the standard DSM boilerplate):

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. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.

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 paragraph in bold, in my opinion, sums it up--if it's not interfering with your life, we don't diagnose it as a disorder. This is a pretty common misconception about psychiatry--that it aims to "homogenize" or "fix" traits that contribute to the normal personality. In reality, it only aims to eliminate those that are problems.

But isn't that subjective? Hell yes, it is! For instance, my short attention span would probably not be a problem at all for most people, and was never much of a problem for me before med school. Now that I'm here, though, it really does interfere with my life (such as it is). As such, I can now be said to have ADHD, and I can be treated. It's pretty simple, really.

Agoraphobia, strictly speaking, is the fear of being in a place or situation that you can't easily get out of, or where you won't be able to get help if you have a panic attack. This does manifest itself by avoiding social situations, crowds, lines, etc., but the fear is not of the people but of the situation. Someone with agoraphobia might not have any trouble being in a small social situation that is easily escapable, but freak out when alone in the car and stuck in traffic on a bridge.

Dr. J

------------------
"Seriously, baby, I can prescribe anything I want!" -Dr. Nick Riviera