Social Anxiety Disorder - Research Paper Example

Social Anxiety Disorder Section I Social Anxiety Disorder (SAD), a debilitating chronic illness is characterized by unrelenting fear of one or several performance or social situations (American Psychiatric Association, 2013). The condition has high lifetime prevalence between seven and 13 percent in the public. The last two decades have features intense study on biological and dispositional factors behind the disorder (Berman & Schneier, 2004). This research paper reveals various aspects of the matter that require further research if the society is to control the condition among its members. For instance, the current therapeutically approaches have several undesirable side effects. It will be shown that some of the effects are undesirable that one may even opt to live with the disorder rather than taking the medication. Background to the Disorder Social Anxiety Disorder (SAD) is a feeling of discomfort, worry, or fear that is often centered on personal interactions with other people. It largely emanates from the concern of being judged negatively, looked down upon, or evaluated by other people. SAD may happen during the social exchange or pop up from the anticipation of the social exchange or occasion. Moreover, the disorder may result after the social interaction when one reviews their performance. Previous studies on the subject have shown that SAD, a debilitating chronic illness has a relative lifetime prevalence ranging between 7 and 13 percent in the society (American Psychiatric Association, 2013). Social anxiety seems overwhelming or even unwieldy to comprehend as a single disorder. It, therefore, is recommendable to view it from three distinct components that are interrelated. The three complement each other leading to an anxiety cycle as shown below (American Psychiatric Association, 2013). Anxious Sensation in our bodies: This is experienced through feelings such as blushing, racing heart, sweating, tremor or shaking, dry mouth, feeling faint, and shortness of breath. Anxious Thoughts: about self, situations or even other people: In this case, one suffers SAD from worries that (Beidel, Turner, & Morris, 1999) All people are looking at me I do not belong here They will think I am a loser People will perceive of me as being too nervous I will not have anything to say or defend myself I will still look more foolish They will not want to associate with me any more Anxious Behaviors: that may be triggered by anxiety or even make the SAD situation worse on long-term perspective: These are observed when one seems to Avoid social interactions Has a tendency to quit situations Tends to use MP3 players, mobile phones, or other devices to avoid conversations Enters places they are conversant with Often seeks reassurance from other people Apologizing frequently even when not necessary Preparing excessively, for instance memorizing what to say Attempts to divert people’s attention from one’s performance Careful with sign that other people may be watching or judging us Social anxiety disorder, therefore, may emerge from a diverse range of situations. Notably, though, the disorder results from concern over how other people will perceive of us. People will develop the disorder depending on their interaction with other people especially when scared that they may become the focus of other people’s attention (Furmark, 2002). Although the possibilities of developing SAD may be infinite, below are common situations when people develop and experience SAD to a noticeable extent. Interpersonal Situations: Anxiety and hence SAD may be triggered depending on our interactions with other people in settings such as when Going on a date Asking for directions Engaging in a conversation with strangers Sustaining a conversation Attending an interview for a job Attending a party Holding eye contact with others Performance Situations: The disorder may also occur when we are the focus of attention. This is in case of incidences such as when Public speaking Eating at a restaurant Public singing Spilling a drink Dropping something in public Reading in front of other people loudly Voicing, expressing, or defending an opinion during a meeting or class Remarkably, it is evident that social anxiety disorder is a consequence of the worry or concern over how other people perceive of us (Beidel, Turner, & Morris, 1999; Ginsburg G, 2000). It may result from interpersonal performance situations as shown above. Is It a Bad thing? Although, social anxiety is a health concern, it is worth noting that it is desirable in some way. In fact, it is a normal and a healthy element of human living. This is from the perspective that it triggers and mobilizes our bodies to act whenever exposed to some form of danger or unhealthy situation. Anxiety is what sensitizes us to evade dangerous such getting out of the way for an oncoming vehicle (Rosnay, Cooper, & Tsigaras, 2006). While this may be the case for anxiety from a general perspective, social anxiety is noticeably not different at all. This is because social anxiety keeps us on toes and sensitive to the needs and expectations of other people. Such sensitivity is crucial for the sake of establishing and building relationships. It is also vital for building and sustaining a positive public reputation for self and for acquaintances (Berman & Schneier, 2004). Strong social anxiety may be desirable in some cases. For instance, one is likely to be careful with their words and choice of outfit when attending an interview if they are socially anxious. This may lead to better performance in the interview. When social anxiety turns to a disorder Ordinary social disorder becomes a major problem if it causes in our functionality and hence quality of life. In that case, it is considered to be excessive and hence outside the norm. Sometimes, social anxiety makes people to consistently avoid social interactions, become distressed when exposed to social situations, to have excess fear of being judged, and/or to avoid things that we need or want to do. Mental health professionals often recommend diagnosis of social phobia or Social Anxiety Disorder whenever these happen (Ginsburg G, 2000). There are two categories of SAD identified as Generalized SAD and Non-generalized SAD. In the case of Generalized SAD the subjects avoids and is afraid of judgment hence keeps off all social situations that may subject them to negative judgment by others. People with Non-generalized SAD are usually not excessively anxious. They are only anxious when exposed to specific social situations. For instance, one may have the tendency to become anxious when public speaking or participating in a meeting. It is easy to know when we have SAD. Researchers have indicated that we can know whether we have social phobia from self-assessment. If one finds that their social anxiety exceeds what they would consider as “normal”, then the impression could be that they are suffering from the disorder (Beidel, Turner, & Morris, 1999). This could be confirmed with an evaluation to determine whether the anxiety interferes with ones quality of life. Once the self-diagnosis shows that one could be suffering from the disorder, it is recommendable to consult with a mental health practitioner in time. Causes of Social Anxiety Disorder Essentially, social anxiety and SAD are caused by the same factors behind any other strong emotional experience. These factors include the genetic make-up, culmination of learning experiences, and biological factors (Furmark, 2002). It is unrealistic to single out one factor as the cause of the disorder in a specific person. Rather, social anxiety disorder results from a combination of several factors that coincide in place, time and occasion. Below is an assessment of how the genetic make-up, life experiences, and brains or mentality contributes towards the development of the disorder in most people. Our Genes: Present research on genetic foundations of both physical and mental health has shown that the tendency towards anxiety and SAD has a considerable level of heritability. Children born top parents with the disorder are vulnerable to the same if not other forms of anxiety disorders. This is largely because of inherited genes. It is not a developed condition (Furmark, 2002). Our Life Experiences: Experiences in life are a major factor leading to the development of social anxiety disorder in most people. This happens especially if one is consistently exposed to situations where they are singled out negatively, exposed to negative judgment by others, or made to feel inferior before other people. In that case, most people understandably develop negative attitude and beliefs about themselves and the world. As these experiences persist, one may start paying attention solely to the parts of the environment that seems to reinforce their negative beliefs (American Psychiatric Association, 2013). For instance, a public speaker will start focusing on two people who seem bored and neglect 48 listeners who may be nodding their heads in appreciation of a good speech. The eventual result is social anxiety and hence the disorder. The tendency to act, think, and feel in a social anxious manner dominates as these beliefs are gradually enhanced. With time, these beliefs may lead to helpful assumptions in neutral situations. For instance, a person with undeveloped SAD may assume that anyone who glances at him or her on the sidewalk is surprised by his or her strange walking style, which may be a deceitful thought. This is because the other person may be astonished in how the subject is dressed. It could also be a way of appreciating for giving way yet the subject is impulsive in making irregular conclusions about the encounter. Naturally, the person with the anxiety will naturally feel that social situations will often yield undesirably for them. They will avoid the discomfort by avoiding social interactions (Ginsburg G, 2000). The impression here is that the subject temporarily escapes the repulsive feelings of anxiety and confirms their belief that they cannot handle social situations. Further, the subject misses the opportunity to realize that their negative assumption is not always correct. Avoiding social situations in fear of being evaluated strengthens our beliefs and negative bias. Warning signs of SAD become apparent as this pattern continues to interfere with our functioning (Berman & Schneier, 2004). Our Brains: Mediations used to treat social anxiety and hence SAD affects the brain levels of neurotransmitters. The verdict on whether the differences in levels of neurotransmitters causes social phobia is not yet established. Several studies, however, have suggested that some areas of the brain are often active in persons with social anxiety. Such areas of the brain include amyglanda, the small almond shaped part (Blair et al., 2008). Treatment Pharmacological Treatment Anxiolytic medications, among them benzodiazepines are frequently used on people diagnosed with SAD. Physicians prefer these because they seem favorable to the elderly. Researchers have revealed that the elderly tend to present themselves for diagnosis and medication more frequently than the youthful (Beidel, Turner, & Morris, 1999). ECA data shows that benzodiazepine usage among the elderly is about 14 percent higher than the usage rate among the young (Rosnay, Cooper, & Tsigaras, 2006). An earlier survey on the use of benzodiazepines among adults in southern California revealed several disadvantages of using the medication. For instance, adults using benzodiazepines were twice likely to use 10 or more other medications compared to nonusers. Further, these users are likely to experience accidents that require medical attention. This is because of increased risk of fall, automobile accidents, and hip fractures. Older patients under benzodiazepines are also likely to develop disabilities in both daily and mobility activities (Rosnay, Cooper, & Tsigaras, 2006). Remarkably, though, benzodiazepines may impair memory and the cognitive operations of the body. Selective Serotonin Reuptake Inhibitors abbreviated (SSRIs) is often used as an alternative to benzodiazepines. Some physicians and older patients, however, disregard it because it also has several undesirable side effects. SSRIs, therefore, have not replaced benzodiazepines but are only used as an alternative (Furmark, 2002). Researchers are still working on safe alternatives for pharmacological treatment of social anxiety disorder. Psychosocial Treatments The efficacy and hence reliability of evidence based psychosocial treatments has been tested with the use of randomized trials for SAD. The same has also been reviewed with rising evidence in support of their use. Physicians often recommend supportive control conditions such as supportive counseling, discussion groups, and minimal contact. Cognitive Behavior Therapy (CBT), however, has proved to be effective compared to earlier approaches such as waitlist conditions, support control conditions and medication management-only situations. CBT has the capacity to suppress comorbid depression. Recent studies that sought to compare CBT against the combination of the same (CBT) with medication management; researchers showed that the combined approach was not superior in suppressing anxiety, distress, and worry (Beidel, Turner, & Morris, 1999). Remarkably, most elderly patients respond well to CBT, progressive muscle relaxation, and support therapy in treating and controlling social anxiety disorder. A concise comparison of support control conditions and waitlist shows that the most effective psychological therapy is relaxation training and CBT for anxiety symptoms and disorders respectively (American Psychiatric Association, 2013). This section has revealed that Social Anxiety Disorder is a chronic illness characterized by unrelenting fear of one or several social interactions or performance. The disorder manifests itself when one is scared of being criticized or worried about how other view him or her. It is evident that social anxiety is important for the sake of establishing and sustaining relationships with people as well as for maintaining a good public image. Social anxiety, however, may turn undesirable if it affects one’s normal functionality. In that case, one may have to seek medical intervention to convene the situation. The various treatment options have been discussed in this section and their limitation highlighted as important areas of focus for further research. Section II Donny Osmond life experiences with Social Anxiety Disorder Introduction Donny Osmond was born in Utah back in 1957 where he grew as a Christian abiding person. He was later married to Debra Glenn with whom they have raised five sons. Donny has lived as an entertainer. He has a long history as a solo artist although he also collaborated with his artist siblings earlier. As an artist, Donny could not avoid social anxiety. This is in view that the nature of his work demands concern for people’s views and judgment about his performance (Osmond, 2012). However, as a popular artists Donny has had to participate in various talk shows, engagements that easily provoke social anxiety. This section reveals Donny’s life with social anxiety from a psychoanalysis perspective. Remarkably, Donny shared his experience after identifying approaches that helped him to have control of his situation. Real Life Experiences Early in 1971, before his marriage, Donny released 18 singles that were successful. He went underground for about 20 years before returning with several other hits among them “Soldier of Love”. He went ahead to set box-office records as he still performed in the "Joseph and the Amazing Technicolor Dream coat". He showed versatility in co-hosting talk shows with his sister called Marie. He later hosted another show called the “game show pyramid” before trying his hand in racecar driving (Osmond, 2012). A review of exposures that are highly attributed to social anxiety and the consequential disorder shows that Donny would have been very lucky to avoid it. All his engagements involved the public. Performance was core in all he engaged in. Since he must have been scared of criticism and negative judgment, Donny would never avoid social anxiety disorder as he expresses it in his autobiography (Osmond, 2012). Donny’s experiences compelled him to compose the personal autobiography that he gave the title "Life is just what you make it". He has also contributed to the control of the disorder in the public domain through his service as an honorary member constituting the board of directors in the America’s Anxiety Disorders Association of America abbreviated (ADAA). In his autobiography, Donny asserts that he could not relieve himself from the anxiety and fear that he could embarrass himself whenever performing his usual roles (Osmond, 2012). As is the case with SAD, a bizarre and terrifying feeling of fearfulness had substituted all that had been familiar and safe (Jacobs & Antony, 2008). It was difficult for him to think and plot the way out of the dread and panic situation he found himself in. Donny’s Experiences with SAD Performing in front of a mass while young is often a nightmare for most young children. With regard to Donny Osmond, this was the start of the nightmare that persistent through much of his youngster age. Donny started public performance as an artist while still young, an exposure that meant he had to face and perform before large crowds. This was after Andy Williams discovered his (Donny) and his siblings’ talents in music. The family troupe started a merry-go-round where they would perform publicly (Osmond, 2012). Like any other human being, Donny would not cease worrying about how perfect or impressionably he would perform (Lansford, Malone, & Castellino, 2006). Gradually, his social anxiousness led to social anxiety disorder because he did not act appropriately in time. In his autobiography, Donny tells about one of the Andy Williams shows when he had to run from the stage after performance. This was one of his earliest shows and he was scared of the applause from the audience as well as the flashlights. He further cites a later incidence when he was put on the spotlight when asked to perform any of Ella Fitzgerald songs (Osmond, 2012). He could not do it, which made him to feel defeated. In this case, Donny had already developed negative beliefs on what he could do which is obvious with a developing SAD. The audience applause was most likely a sign of appreciation for exemplary performance. Surprisingly, it scared him a lot no wonder he still remembers it despite being an occurrence at age six (Safren & Gershuny, 2002). Social anxiety began at a tender age when Donny started performing in public shows. It, however, was not until later in 1994 when he became paralyzed and collapsed in fear while still performing. He was playing the lead character called Joseph the Amazing Technicolor Dreamcoat in “Andrew Lloyd Webber musical”. The incidence was shocking and unanticipated as Donny defines it. He seldom recalls the details of the show other except the curtains that he remembers seeing being closed and opened. Over time, Donny developed intense fear of performance that he would not perform any show (Osmond, 2012). This fear perforated to other areas of his life that he would not visit stores. He was scared of how people would think about him (Magee, 1999). Developments of anxiety in Donny’s life concur with all that happens in the life of any other person with SAD. While it would have been better for him to constrain his fear within public performance incidences, the same perforated to other areas ruining his ordinary life. Donny was scared that people would still judge him negatively whenever they encountered in the streets. As is the case with people with the disorder, he had no choice other than to avoid public places. He would no longer perform his shows, a thing that he was talented and must have had the urge and passion to do. SAD is an undesirable condition that denies individuals the opportunity to do things they like or desire in their lives (Muller, Koen, & Stein, 19-24). With the disorder, Donny’s life would never resume normalcy. In defining one of the incidences when he could not perform as he had planned, Donny has written that he struggled and kept trying to recall his lines in vain. This is a confirmation that he already suffered from the disorder unknowingly. People with the disorder tend to memorize whatever they schedule to deliver because of the fear that they may fail once on stage. Because of the doubt from within, it becomes difficult to recollect in case one of the lines is forgotten just as it happened with Donny. He emphasizes the situation became more elusive as he tried harder to recall his lines (Osmond, 2012). Seemingly, Donny had started to focus on the slight mistakes in fear that people or his critics would spot and judge him negatively. That deprived him the opportunity to perform to his expectations that is an undesirable consequence of anxiety. An important lesson from Donny is that people who find themselves suffering from the disorder ought to take heart and seek help. He says that he was embarrassed to come out of the entertainment industry with the disorder. Then, he did not know that his was a disorder that required a therapeutically approach. He did not even know its name leave alone knowing where he could get some help. An important note from his autobiography is that it is necessary to understand that other people have suffered the same before and gotten through. In fact, many other people suffer from the same disorder at any incidence. Here, Donny implies that the disorder is a common condition that is easy to overcome. He emphasizes on consultations from mental health experts before the consequences cause irreversible damage (Osmond, 2012). This is from his view that his show business was adversely ruined by the disorder largely because he did not call for medical intervention in time. In compliance with propositions by researchers interested in the therapy for the disorder, Donny would have benefited from self-diagnosis for the sake of avoiding adverse effects. A recommendable approach is to assess whether personal performance is being hindered by anxiety. One may notice this from personal evaluation to determine whether their daily functionality is or has deviated from the “normal”. This is in view that all people know their usual levels of operations. A slight deviation is easily noticed especially if one is engaging in public speaking or music shows. The major challenge with Donny was that he did know have any hint about what affected his performance. He did not know anything about social anxiety or the SAD. He, however, should have been sensitized on these since his engagements exposed him to the public. Treatment Like a few other people who have suffered from the disorder, Donny has openly discussed his SAD treatment program in his autobiography. He has elaborated his program revealing that he benefited largely from the combination of paxil medication and the cognitive-behavioral therapy (CBT). Remarkably, Donny admits that he may never live entirely free from anxiety. Through hard work, though, he has learned to recognize, control, and manage negative thought patterns. This enables him to ensure normal operations of the body. He has appreciably resumed his normalcy although he has to be keen with negative thought patterns. He confirms that he is competently managing his situation because he could live without medication by the time he composed the autobiography. The impression is that anyone can get out of the situation and live normal life. It though requires precise control of thought process. In one of the interviews when Donny was responding to a question on how he manages his social anxiety disorder, he emphasized that it is commendable for celebrities to talk about their illnesses and disorders. He further emphasizes that all people must appreciate their limitations and the fact that no one is ever perfect. Slight pitfalls or unexpected outcomes should not cause mental depression or anxiety. In fact, the audience is not even aware of what you anticipated to do hence should not worry about being judged negatively. Sometimes whatever a performer or public show host considers a mistake is perceived as innovation. Donny regrets that he it took him long to realize this. He would not wish other people to learn it when the beans are already spilled. By writing and hence speaking about his disorder, Donny feels that he moved from his storage shed that had subjected him to undesirable social anxiety. In one of the interviews after compiling his autobiography, Donny recommends that people should talk and write about how they were able to overcome social anxiety at various capacities. This is because other people benefits from the same. Chances are that other people with the same or similar disorders will be motivated to manage their situations. This is from the view that social anxiety is better controlled from within rather than from without. In any case, researchers have shown that exposure to real life stories of people who managed the disorder play a significant role in cognitive behavior therapy. CBT is recommendable more effective than other common treatment options. For instance, it does not have side effects common in medical treatment of the disorder. In summary, all people who engage in activities that involve performance in public places are likely to develop social anxiety. If not controlled and managed from an early stage, the same may develop to SAD. Knowledge of the early signs, therefore, is vital particularly for people engaging in such activities. Donny Osmond, for instance, had to quit his public show performance among other activities because he developed fear of being judged by the public. Surprisingly, the disorder manifested itself while Donny was still a little boy. This is clear from the incidence he had to run away from the performance stage when the audience cheered his goo performance. He deceitfully thought that he had messed and the crowd was yelling at him. SAD seem to have done him injustices to the extent that he had to avoid public places despite being multi talented. It is recommendable to learn to manage one anxiety as he recommends in his autobiography. References Beidel, D., Turner, S., & Morris, T. 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Retrieved March 11, 2014, from Social Anxiety Support: http://www.socialanxietysupport.com/disorder/ Lansford, J., Malone, P., & Castellino, D. (2006). Trajectories of internalizing, externalizing, and grades for children who have and have not experienced their parents’ divorce or separation. Journal of Family Psychology , 292–301. Magee, W. (1999). Effects of negative life experiences on phobia onset. Social Psychiatry and Psychiatric Epidemiology , 343–351. Muller, J., Koen, L., & Stein, D. (19-24). The spectrum of social anxiety disorders. In Social anxiety disorder (p. 2004). New York: Marcel Dekker Publishers . Osmond, D. (2012). Life Is Just What You Make It: The Autobiography. Chicago: Orion Publishers . Safren, S., & Gershuny, B. (2002). History of childhood abuse in panic disorder, social Phobia, and generalized anxiety disorder. The Journal of Nervous and Mental Disease , 453-456. Read More