Social Anxiety Disorder (S.A.D)

1. Social Anxiety Disorder (S.A.D) By Dr. Ibtihal Mohamed Aly Ass. Lecturer Psychiatry Department

2. Definition: The fundamental feature of social anxiety disorder is the marked and persistent fear of social or performance situationsin the presence of unfamiliar people or when scrutiny by others is possible, even in the context of small groups. Exposure to such social and performance situations almost invariably provokes an immediate anxietyresponse or avoidance behavior. Ibtihal M.A. Ibrahim

3. Ibtihal M.A. Ibrahim

4. The most frequent social trigger situations are Ibtihal M.A. Ibrahim

5. Ibtihal M.A. Ibrahim

6. Social Anxiety or Shyness • Shyness is a term used to describe the feeling of apprehension, lack of comfort, or awkwardness experienced when a person is in proximity to, especially in new situations or with unfamiliar people. • Shyness may come from genetic traits, the environment in which a person is raised and personal experiences. There are many degrees of shyness. Ibtihal M.A. Ibrahim

7. Social Anxiety or Shyness Social anxiety disorder has been portrayed as the extreme of shyness. Shyness is more likely to be a lifelong characteristic of an individual’s temperament, whereas social anxiety disorder is characterized by a group of coexisting symptoms that might be independent of shyness. Evidence to support the distinction between shyness and social anxiety disorder comes from developmental studies. Shy children who were followed over several years from the first school years through to early adolescence were not at an increased risk for developing social anxiety disorder. Shyness is usually present in all social situations while social anxiety may be triggered by very specific situations. Ibtihal M.A. Ibrahim

8. Epidemiology: Ibtihal M.A. Ibrahim

9. DSM-IV Diagnostic Criteria: Ibtihal M.A. Ibrahim

10. Ibtihal M.A. Ibrahim

11. Clinical Picture Ibtihal M.A. Ibrahim

12. Symptoms Cognitive Physiological Behavioral Ibtihal M.A. Ibrahim

13. Cognitive symptoms: Before Event After Ibtihal M.A. Ibrahim

14. Behavioral symptoms: Major avoidance behaviors Minor avoidance behaviors Ibtihal M.A. Ibrahim

15. Physiological symptoms: children with social anxiety may display tantrums, weeping, clinging to parents Ibtihal M.A. Ibrahim

16. Etiology Ibtihal M.A. Ibrahim

17. Ibtihal M.A. Ibrahim

18. Genetic and family factors: • It has been shown that there is a 2-3 folds greater risk of having social phobia if a first-degree relative also has the disorder. • This could be due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning. • Studies of identical twins brought up (via adoption) in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30 – 50%more likely than average to also develop the disorder. Ibtihal M.A. Ibrahim

19. Neural mechanisms: Oxytocin, Vasopressin, CRFand Cortisol Serotonin Norepinephrineand Glutamate. GABA Sociability is closely tied to dopamineneurotransmission Ibtihal M.A. Ibrahim

20. Neuroanatomical: • related to fear cognition and emotional learning. • hypersensitive amygdala. involved in the experience of physical pain, also appears to be involved in the experience of 'social pain' Ibtihal M.A. Ibrahim

21. Cognitive Context: • Research has indicated the role of 'core' or 'unconditional' negative beliefs (e.g. I am inept) and 'conditional' beliefs nearer to the surface (e.g. If I show myself, I will be rejected). They are thought to develop based on personality and adverse experiences and to be activated when the person feels under threat. Ibtihal M.A. Ibrahim

22. Ibtihal M.A. Ibrahim

23. Evolutionary context: Ibtihal M.A. Ibrahim

24. Social experiences: Specific humiliating social event Person with increased interpersonal sensitivity Specific social phobia longer-term effects of not fitting in observing or hearing or verbal warning Ibtihal M.A. Ibrahim

25. Social/cultural influences: • Society's attitude towards shyness and avoidance, affects the ability to form relationships or access employment or education. • In China, research has indicated that shy-inhibited children are more accepted than their peers and more likely to be considered for leadership and considered competent, in contrast to the findings in Western countries. • lower rates of social anxiety disorder in Mediterranean countries and higher rates in Scandinavian countries, and it has been hypothesized that hot weather and high density may reduce avoidance and increase interpersonal contact. Ibtihal M.A. Ibrahim

26. Co-morbidity Ibtihal M.A. Ibrahim

27. Ibtihal M.A. Ibrahim

28. A V R four or more O E Avoidant personality disorder is in many ways equivalent to pathologic shyness Avoidant Personality Disorder I D Ibtihal M.A. Ibrahim

29. Treatment Ibtihal M.A. Ibrahim

30. Ibtihal M.A. Ibrahim

31. Pharmacotherapy Ibtihal M.A. Ibrahim

32. Ibtihal M.A. Ibrahim

33. Ibtihal M.A. Ibrahim

34. Ibtihal M.A. Ibrahim

35. psychotherapy Ibtihal M.A. Ibrahim

36. Ibtihal M.A. Ibrahim

37. Exposure: Ibtihal M.A. Ibrahim

38. Applied relaxation: Progressive muscle relaxation (PMR) is a well-known technique for the management of the physiological arousal that often accompanies anxiety. PMR alone is generally accepted as insufficient as a treatment for social anxiety disorder, and we know of no evidence that counters this consensus. Ibtihal M.A. Ibrahim

39. Social skills training: NB: people with social anxiety disorder may possess adequate social skills Ibtihal M.A. Ibrahim

40. Cognitive restructuring: In cognitive restructuring, individuals are taught to: Ibtihal M.A. Ibrahim

41. Cognitive-Behavioral Group Therapy: 12 weeks 6 patients rationale 1&2 sessions 2.5 hours instructions Ibtihal M.A. Ibrahim

42. Predictors of treatment response to CBT: • Expectancy for improvement. • Homework compliance. • Subtype of social anxiety disorder and avoidant personality disorder. • Axis I comorbidity. • Anger. Ibtihal M.A. Ibrahim

43. Thank You Ibtihal M.A. Ibrahim