We can all feel nervous in certain social situations, but for some anxiety can be so intense and overwhelming that it can have a serious and devastating effect on the life of the sufferer and those closest to them. Previously known as social phobia, social anxiety disorder takes the normal behaviour of worrying about social situations to excessive levels, sometimes to the point where the individual is unable to function in society. Worries can focus on many situations from meeting new people, to eating and drinking in public, or speaking in front of people, such as at lectures and committee meetings.
Symptoms of social anxiety disorder can include feelings of extreme fear of being observed by others or being humiliated by them; physical reactions such as shortness of breath, blushing, trembling, sweating or fainting; and changing behaviours such as avoiding situations, always needing a friend with you or drinking before social situations to “calm the nerves”. These symptoms are psychosomatic in origin.
Many individuals do not seek help for their social anxiety disorder as they can often fear even the process of keeping the appointment itself. It is therefore important that the process of receiving that treatment is made very easy. Things that can be done to help include having clear directions to the place of the appointment, ensuring that the patient knows what will and, more importantly, what will not take place during the appointment. It may also be necessary to follow up with the patient after the initial assessment if they do not return to ensure that they complete the treatment advised for them.
Although the symptoms of social anxiety disorder can be treated with medication, the treatment of choice to cure the disorder is usually Cognitive Behavioural Therapy (CBT) which seeks to replace irrational concerns with more balanced views.
A male patient of 26 years was recently referred for assessment and treatment. He had a long standing anxious dependent personality and had marked separation anxiety when he left home, and when he left his mother, in particular. He had coped well until his teenage years when he found it increasingly difficult to attend senior school and particularly to do any presentations in front of the whole class, or to do the reading at the general assembly of the school. He obviously had a severe phobia of public speaking and would use the avoidance response frequently which made it more and more difficult for him to be in social situations or to be the centre of attention. He had intended going to university but because of his marked separation anxiety, was unable to leave home. He had never had a girlfriend and was extremely embarrassed when he was talking to the opposite sex. He was diagnosed as having a social anxiety disorder.
He was given a prescription for citalopram 20mg in the morning and it was arranged for him to have a combination of individual Cognitive Behavioural Therapy, anxiety management, breathing exercises and mindfulness. He required 12 sessions of outpatient treatment and by the end of the treatment programme, he found it much easier to mix with other people. He had also given a speech as the best man at his friend’s wedding and he had also met a girl at the same wedding and was starting to go out with her. The patient was delighted with his progress and his confidence and self-esteem rose considerably.
The consultant psychiatrists at Private Psychiatry have many years’ experience in treating patients with social anxiety disorder. To make an appointment with any of our consultants, please get in touch.
