Treating Social Phobias and Social Anxiety

Shyness And Social Anxiety System

The Shyness and Social Anxiety System is just as its name says. It is an e-book wherein in-depth discussions about the symptoms, causes and treatment for shyness and social anxiety are made. It is then written for individuals whose extreme shyness or social anxiety prevent them from enjoying a full life filled with social interactions among their family, friends and acquaintances in gatherings during holidays, outings and parties. The author Sean Cooper also suffered from shyness and social anxiety disorder so much so that he tried every trick in the book yet to no avail. And then he set out to conquer his own fears by researching into the psychology, principles and practices behind these two debilitating mental health issues. Read more here...

Shyness And Social Anxiety System Summary


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My Shyness And Social Anxiety System Review

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This is one of the best ebooks I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

When compared to other e-books and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

Comorbidity in Social Phobia Nosological Implications

Based on clinical studies as well as on general population surveys, social phobia is strongly associated with other anxiety disorders (about 50 ), affective disorders (20 ) and substance abuse (15 ). On average, 80 of patients with social phobia meet diagnostic criteria for another lifetime condition, which is indicative that comorbidity tends to be the rule rather than the exception 2,3 . According to the US National Comorbidity Survey 4 , the vast majority of individuals with any phobia in general (83.4 ), and primary social phobia specifically (81 ), meet the criteria for at least one other lifetime DSM-III-R diagnosed psychiatric disorder. In most cases (76.8 ), social phobia precedes the comorbid disorder 3 . In the presence of the diagnosis of social phobia, the odds ratio for other disorders are found to be 7.75 for simple phobia, 7.06 for agoraphobia, 4.83 for panic disorder, 3.77 for generalized anxiety disorder, 3.69 for major depression, 3.15 for dysthymia, 2.69 for...

The Epidemiology Of Social Phobia

It has been convenient to discuss panic, agoraphobia and the specific phobias in the setting of their parent surveys, but there are issues in social phobia that warrant a special section. Kessler et al. 46 found that the social fears in the NCS could be disaggregated into a class characterized by speaking fears and a class characterized by a broader range of social fears. Social phobia characterized by speaking fears was less persistent, less impairing and less comorbid than the more generalized social phobia. Heimberg et al. 47 subsequently argued that the prevalence of generalized social phobia appeared to be increasing among the white, the educated and the married. Pelissolo et al. 48 noted an increase in prevalence in a French sample and attributed this to varying thresholds in the diagnostic criteria. Wittchen et al. 49 reported from the EDSP survey that used the DSM-IV classification. This provided some support to the Kessler position people with generalized social phobia feared...

Social Phobia and Bipolar Disorder The Significance of a Counterintuitive and Neglected Comorbidity

Epidemiological studies have been focused largely on comorbidity between phobias, in particular panic disorder with agoraphobia (PDA), social phobia (SP) and major depression less attention has been devoted to the comorbidity between phobic and bipolar disorders. The co-occurrence of bipolar disorder in patients with phobias is counterintuitive, but increasing evidence for such a relationship comes from both epidemiolo-gical and clinical studies. In the National Comorbidity Survey 1 , the reported risk of comorbid PDA and SP is higher in bipolar (odds ratios respectively of 11.0 versus 4.6) compared to major depressive disorder (odds ratios respectively of 7.0 versus 3.6). More recently, in subjects meeting DSM-IV hypomania, recurrent brief hypomania and sporadic brief hypomania, Angst 2 reported elevated rates of comorbidity with PDA and SP over population controls. marked neuro-vegetative symptoms and inability to talk fluently during oral examinations. During adolescence, she...

Medical References For Social Phobia

Cox B.J., Parker J.D.A., Swinson R.P. (1996) Confirmatory factor analysis of the Fear Questionnaire with social phobia patients. Br. J. Psychiatry, 168 497-499. 31. Cox B.J., Swinson R.P., Shaw B.F. (1991) Value of the Fear Questionnaire in differentiating agoraphobia and social phobia. Br. J. Psychiatry, 159 842-845. 34. Kessler R.C., Stein M.B., Berglund P. (1998) Social phobia subtypes in NCS. Am. J. Psychiatry, 155 613-619.

Social Phobia F401 30023

When the normal slight anxiety at social occasions becomes so great as to disrupt everyday life, then it is a social phobia. Social phobia may be very focal, or involve several situations (mostly separate from agoraphobic ones), or be diffuse. Social phobia largely concerns a fear of scrutiny, of what other people think. A glance from someone else precipitates panic about being thought stupid. Sufferers may give up work as a secretary or in a call centre. Some social phobics may not only fear social situations but be anxious and depressed at other times too. A woman of 20 had had social phobias for three years, which reduced her socializing. She had not been out alone for a year except to travel to work, and since stopping work two months previously she had been out nowhere alone. She came to hospital with her mother. She dreaded people looking at her, that she might shake while drinking or walking out in public, or any other social situation. Even at home she was on edge, shaky and...

Whether Non Phobic Uncued As Well as Phobic Cued Symptoms are Present

The absence of non-phobic (uncued, unexpected, unpredictable) anxiety or depression is per se insufficient to classify a phobia, but its presence strengthens the chance that one is seeing agoraphobia or social phobia. Whereas specific phobics rarely have other mental health problems, many agoraphobics also have non-phobic panics and anxiety without any particular trigger, often during depressive episodes 4,5,16,21 . The more diffuse forms of social phobia too are liable to low mood. Calling such associated non-phobic symptoms comorbidities seems premature, as that would imply their being separate from the phobia. Until this issue has been better explored, we prefer to call them associations rather than comorbidities. In Krueger's 1999 analysis the internalizing factor broke down into two subfactors ''anxious-misery'' (major depressive episode, dysthymia, generalized anxiety disorder) and ''fear'' (social phobia, simple phobia, agoraphobia, panic disorder) similar to factors found...

Current Classifications Of Phobic Disorders And Their Similarities And Differences

ICD-10 lists, under the heading ''Neurotic, stress-related and somatoform disorders'', F40 Phobic anxiety disorders, the diagnoses F40.0 Agoraphobia, 40.1 Social phobias and 40.2 Specific (isolated) phobias, which closely resemble those that DSM-IV-TR lists under the heading ''Anxiety disorders'' (300.21, 300.22, 300.23 and 300.29).

Summary Consistent Evidence

The main international and US disease classifications have consistently recognized phobias over the last half century, with subdivisions into agoraphobia, social phobia and specific phobias. Such phobias are common and, if they become chronic, more often stay true to type for many years rather than change into other kinds of problems. Some phobias have, apart from characteristic triggering situations, particular onset ages, gender prevalence, types of discomfort, thoughts and physiological reactions, and associated non-phobic symptoms. Phobias can occur alone or as part of a wide range of problems.

Giving Credit to Neglected or Minor Disorders

In the past, the phobias were either ''neglected'' or considered as ''minor'' disorders. The results of recent research in the field have highlighted the prevalence of phobias and the severity of the distress that is frequently associated with these disorders, as well as the impact on quality of life, interference with the person's normal routine, occupational functioning, social activities and relationships. This has led to a new and more adequate appreciation of the phobias in general and of social phobia in particular. In a recent study 1 we compared patients with social phobia to normal controls on measures of avoidance, using the Liebowitz Social Anxiety Scale 2 , assertiveness, using the Schedule for Assessing Assertive Behavior developed by Rathus 3 , quality of life, using the Quality of Life Rating Scale or WHO-QoL 4 , and disability, using the Disability Assessment Schedule, version II or WHO-DAS-II 5 . As was to be expected Marks and Mataix-Cols emphasize the fact that...

Diagnosis and Classification of Phobias and Other Anxiety Disorders Quite Different Categories or Just One Dimension

Even considering the categorical classification adopted by both ICD-10 and DSM-IV-TR, Marks and Mataix-Cols offer a classification of phobias that roughly supports the idea of a unique dimension for anxiety disorders and also include some other disorders (such as panic, depression and anorexia nervosa) which are often associated with phobias. In a merge to normality states, Marks and Mataix-Cols propose a new category of phobialike syndromes not called phobias (jointly with obsessive-compulsive disorder, post-traumatic stress disorder, somatoform disorders and avoidant personality disorder) that they call touch and sound aversions.

Disability Attributed to Panic and Phobias

Comorbidity, especially concurrent comorbidity, makes it difficult to attribute current disability and service utilization. Mendlowicz and Stein 30 reviewed the use of quality of life instruments in people with anxiety disorders and noted that they markedly compromise quality of life and psychosocial functioning. Importantly, they noted that treatment can reduce this disability. Goering et al. 31 , reporting from the Ontario survey, noted that people with single affective disorders typically have more disability than people with single anxiety or substance use disorders and that people with multiple disorders have disability rates comparable with those with affective disorders. Stein and Kean 32 from the same survey reported that people with social phobia were impaired on a broad spectrum of measures, including low functioning on a ''quality of well-being scale''. Bijl and Ravelli 33 obtained a similar result from the The Australian survey used the Short Form-12 (SF-12) 34 and the...

Major Public Health Problem

Panic and the phobias make a significant contribution to the burden of disease. The original Burden of Disease study only included panic disorder, while the estimation of the burden of disease in Australia in 1999 56 included panic, agoraphobia and social phobia but not the specific phobias. These three disorders accounted for 28000 Disability Adjusted Life Years lost, 1.1 of the total burden of disease in Australia, and 8 of the burden of all mental disorders. Put in context, the burden of panic and phobias was half the burden of asthma and four times the burden of insulin-dependent diabetes and comparable to the burden of prostate cancer.

Phobias A Difficult Challenge for Epidemiology

Phobias are in fact some of the most difficult challenges for epidemiology. Epidemiology requires clearly defined diagnostic criteria (and this is the reason for the ''epidemiological renaissance'' after DSM-III), but it also needs precise and reliable definition of the boundary between cases and non-cases. When the existence of a psychiatric pathology is an ''all or nothing'' phenomenon, then the epidemiologists may give fairly accurate estimates, with low variation (and this is the case with panic disorder). Phobias are instead continuous phenomena, ranging from normality to extreme severity, and the choice of a cut-off point to differentiate normality from pathology is somehow arbitrary. The often discussed issue of social anxiety, ranging from slight shyness to the complete avoidance of social situations, is perhaps the best example. The main criterion suggested by present classifications (namely DSM-III and later nosologies) for differentiating pathological from non-pathological...

Phobias Handy or Handicapping Conditions

In social anxiety disorder (phobia) there is also a great overlap with avoidant personality disorder 11 and it is therefore not surprising that more of those with social phobia than other anxiety disorders have personality abnormalities or disorder 12,13 they may be the same condition. A majority of those with personality disorder are treatment resisting (type R) rather than treatment seeking (type S) 14 so do not seek help. In view of this, the alleged mismatch between personnel and resources may not be as great as the epidemiological data suggest, since the assumption that scientifically proven treatment recommendations are correct is unwarranted for a large group that we fail to identify in our fragmented classificatory system.

Phobic Disorders Can We Integrate Empirical Findings with Clinical Theories

From a purely clinical vantage point, a single patient with a phobic disorder (including panic disorder, agoraphobia, social phobia and simple phobias) may be seen as one among the least dramatic and disabling cases to be encountered in clinical practice. We know now how such an oversimplification can be misleading. When one considers the population at large, phobic disorders do constitute a serious problem in public health and can prove challenging to treat. However, when one considers the bulk of information on phobic disorders that comes from basic and applied empirical research and tries to draw connections with clinical wisdom, things become much more complicated. Several of the concepts, models and therapeutic guidelines employed routinely in clinical practice are based on theories, models, common sense, intuitions or assumptions that are sometimes challenged by empirical research. That is why evidence-based medicine is there, but sometimes the contrast is clashing. On the other...

Comorbidity between Phobias and Mood Disorders Diagnostic and Treatment Implications

The results of a comprehensive epidemiological programme to assess the prevalence of affective and anxiety phobic disorders showed that panic and phobias are also frequent in Hungary. Investigating the prevalence of anxiety and phobia disorders in a random, representative sample of the Hungarian adult population (aged between 18 and 64 years), it has been found that the past-year prevalences of panic disorder, agoraphobia, social phobia and specific phobia were 3.1 , 10.5 , 4.9 and 4.8 , respectively. The lifetime prevalence rates for the same disorders were 4.4 , 15.3 , 6.4 and 6.3 , respectively 1,2 . These figures are in the same range as reported by Andrews in his review, suggesting that economic and cultural differences have no significant influence on the frequency of panic phobic disorders. More than half (55 ) of the patients with past-year diagnosis of panic disorder also had agoraphobia 2 . Investigating the lifetime comorbidity between panic phobic disorders and major mood...

Epidemiology of Phobias Old Terminology New Relevance

Given that epidemiological surveys are bound by the prevailing diagnostic systems, any current review is thus forced to make arbitrary decisions with regard to which anxiety disorder would qualify as a ''phobic condition''. Gavin Andrews decided to include panic disorder with or without agoraphobia, social phobia (or social anxiety disorder, as it is now called) and specific phobias. He argues that this choice was dictated by the preponderance of surveys that do not differentiate among phobic conditions, lump panic disorder with and without agoraphobia as one anxiety disorder, and or follow the diagnostic system of the most current DSM or ICD. While I agree with some of the choices, I disagree with the rationale. For instance, the reason most surveys consider panic disorder with and without agoraphobia as one condition is that research has clearly established basic similarities between them, including no substantive differences in treatment response 1 and neurobiology 2 . One could...

Dysmorphophobia F452 Body Dysmorphic Disorder 3007

Dysmorphophobic worry about how one looks or smells can cause handicap like that from social phobia. The phobia may be of being too short or too tall, too thin or too fat, being bald or having a big nose or bat ears or a protruding bottom, or being too flat-chested or too bosomy as a woman. Sufferers are endlessly preoccupied with minor or totally imagined body defects that are not evident even to the keenest observer. Severe dysmorphophobia can lead to avoidance of public transport or going on holiday or looking in a mirror, to dropping one's friends, to becoming a recluse, and to a quest for plastic surgery. Anxiety about one's body odour may cause excessive washing, endless use of deodorants and social avoidance. Social phobia. If the social fear and avoidance are not linked to worries about one's appearance or smell, then the condition is social phobia rather than dysmorphophobia.

The Main Phobic Syndromes

F40.1 Social phobias F40.2 Specific (isolated) phobias Subtypes animal type, nature forces, blood-injection-injury, enclosed spaces, sphincteric , other 300.23 Social phobia (social anxiety disorder) 300.29 Specific (formerly simple) phobia 301.82 Avoidant personality disorder -10 or DSM-IV-TR)

Phobias Reflections on Definitions

In the same spirit, if phobias are looked at merely as markers, then treatment would depend only on impairment, but if they herald future complications or other disorders then early treatment becomes of paramount importance. One needs to remember that phobias and anxiety disorders in general are among the earliest disorders that appear in one's life. A study by Dadds et al. reviewed by Andrews and Wilkinson 2 showed that early intervention with cognitive-behavioural therapy (CBT) among anxious children halves the risk of meeting anxiety disorder criteria (we still have, however, many questions on control groups in psychotherapy studies 3 ). But, which phobia, if prevented or treated, would decrease the chance of developing other disorders as adults While agoraphobia and social phobia are likely candidates, could the same be said about other phobias We think that early identification of phobias and more specifically the ones that carry more disability (social phobia and agoraphobia) is...

Phobias May be Cued Triggered Evoked by Almost Anything

A classification based entirely on the triggers of terror leads to an endless terminology telling us little beyond the label. Such a classification was prominent in the past. Numerous Greek and Latin prefixes were attached to -phobia according to the object or situation that was feared (for a long table of such phobias, see 13 ). Today's enquirers from the media often ask ''What do you call a phobia of spiders (or heights or blushing or whatever) '' and rest content with the label ''arachnophobia'' or ''acrophobia'' or ''erythrophobia''. Such dry scholasticism has little merit, though below we will see value in the terms ''agoraphobia'' (fear of public places) and ''social phobia'', because clinicians commonly see phobias of particular clusters of public or social situations, each cluster having its own correlates (e.g. a fear of crowds often associates with certain other agoraphobic and non-phobic features, and a fear of blushing with other social fears). Particular clusters of...

Purposes Of Diagnostic And Other Classifications

Classification is the arrangement of phenomena into classes with common features. Classes can be categories that are mutually exclusive, like most animal species, even though we cannot say exactly when the apes that preceded hominids became hominid on gradually evolving dimensions of change. Classes may overlap, like human physical types. Classes may shade into one another along continuous dimensions like age. We cannot say exactly when an infant becomes a toddler, a toddler a child, a child an adolescent, an adolescent an adult, but we can reliably tell an infant from an adult (except regarding behaviour sometimes ) and so carve out two mutually exclusive categories from the opposite ends of a continuous dimension. Even a continuous dimension like age has relative discontinuities, with more rapid change during pubertal than preceding years. Thus certain quantitative changes along dimensions can also mean qualitative categorical changes. Dimensional and categorical classes need not be...

Cognitive Approach to Phobias

Interpretation biases may also play an important role in social phobia. Social phobics show a tendency to underestimate their own performances and behaviours. Stopa and Clark 7 showed, for example, that social phobic patients underestimate their performance compared to observers' evaluations. This was not true of their ''mixed'' anxiety disorders control group. In a more recent study 8 these authors found that patients with social phobia also interpret ambiguous social situations in a more negative fashion than anxious control and normal subjects. The existence of preferential processing of social-threat-related words in social phobia has been confirmed in several studies. Hope et al. 9 and Mattia et al. 10 found that social phobic patients exhibit interference for social-threat but not physical-threat words in the Stroop task. Recently, Spector et al. 11 , using the Stroop test, confirmed the existence of an attentional bias in social phobia for specific social-phobia-related words...

Onset Age and Gender

Early onset age predicts certain other phenomenological features likely to be present, but is not enough to be a main basis for classifying phobias. In adults with specific phobias of animals or insects or of blood, the specific phobia usually began in childhood before age 8 and often even earlier 19,40 . The same is true for the diffuse shyness which is called avoidant personality disorder in DSM-IV-TR. In contrast, specific social phobias and agoraphobia tend to begin in young adult life (social phobias slightly earlier on average), and space phobia in middle age or later. Adults who have a coexisting animal phobia and agoraphobia almost always say their animal phobia began in childhood while their agoraphobia started after puberty. This points to separate origins for those two phobias and is another reason Gender predicts too little else to be a basis for classification. Most adults seeking help for phobias are female. Exceptions are that those who consult therapists for social...


Besides being known as an impassioned behaviour therapist, Isaac Marks is one of the most influential psychopathologists and psychiatric diagnosticians of the outgoing 20th century. His subdivision of the phobias into agoraphobia, social phobia and the specific phobias 1 was directly taken over by the DSM (from its 3rd edition in 1980 onwards) and the ICD (since its 10th revision in 1992). And Marks, a virtuoso of exposure therapy, has not by chance focused on exactly those conditions for which exposure therapy is efficacious, i.e. agoraphobia, social phobia and the specific phobias.


Disorder, agoraphobia, social phobia, generalized anxiety disorder, and alcohol and drug dependence were independently associated with disability on the mental health summary scale of the SF-12. Seventy-five per cent of people with an affective disorder scored as moderately or severely disabled (score

Difficult to Treat

There are effective treatments for panic disorder and the phobias 54 . The problem is that, apart from panic, few people with these disorders attend for treatment and, when they do, few are treated appropriately. In the Australian survey 55 , only 39 of people with panic disorder, agoraphobia or panic disorder with agoraphobia as a principal complaint sought a mental health consultation and 61 of them received medication or CBT, the treatments known to be beneficial. Thus only 24 of people with these panic and agoraphobic disorders were being helped. In social phobia the picture was more dismal 21 received a mental health consultation, and only 32 received medication or CBT, the treatments known to be beneficial. Thus, only 7 of people with social phobia could have been helped by treatment. In the Munich study 42 , the probability of consulting for a mental health problem ranged from a high of 50 for panic disorder through 36 for agoraphobia and 32 for social phobia to a low of 21 for...

Promising Approach

Sexual abuse, domestic violence) were constructed and used in log-linear analyses modelling the relationship between such risk factors and psychiatric disorder. The one-year prevalence of DSM-III-R anxiety disorders (panic disorder, agoraphobia, social phobia, simple phobias, generalized anxiety) was 23.8 . Close to half of the sample had experienced clinically significant depression at some point during the anxiety episode, while only 7.2 had depression without anxiety. Panic disorder was most likely (67 ), and simple phobias least likely (11 ), to be associated with depression. The time spent in anxiety (8.1 of the one-year period preceding the interview) was double the time spent in depression, and anxiety disorders were more often chronic than depression. Onsets of anxiety disorders within an ongoing depressive episode were rare however, onsets of depression among those with ongoing anxiety disorder were common. My last example illustrates the unsuspected insights into...

Service Utilization

Kessler et al. 39 reported the use of outpatient services from cases identified in the NCS. A quarter of people who met criteria for any 12 month disorder reported using services. The rates for any anxiety disorder were similar. The rates of service use varied considerably within the anxiety disorders, with panic disorder being associated with the highest utilization rates (46 ) and social phobia (23 ) with the lowest. Specific phobias and agoraphobia occupied intermediate positions. When the total number of visits to the health care sectors was calculated, there were no significant differences between diagnoses. Kessler et al. 40 reported on the delay between onset of first symptoms and treatment contact in the NCS. More than half of people with panic disorder made contact with health services within the year of onset. In contrast, half the people with phobias never made contact with treatment services, ever. The delay in getting treatment in the phobias was related to age of onset...


Between pairs of disorders occurring in the past year. In panic agoraphobia there were highly significant odds ratios for the co-occurrence of social phobia, generalized anxiety disorder and cluster A personality disorder, and significant odds ratios with post-traumatic stress disorder (PTSD) and alcohol abuse and dependence. In social phobia there were highly significant odds ratios with panic agoraphobia and generalized anxiety disorder, and significant associations between PTSD and cluster A personality disorder. In neither disorder did the association with the affective disorders remain significant once the probability of any comor-bidity was controlled.

Integration Of Adiposity Signals

The information about total body fat derived from insulin and leptin must be integrated with satiety signals as well as with other signals related to learning, social situations, stress, and other factors, for the control system to be maximally efficient. Although the nature of these interactions is not well understood, several generalizations or conclusions can be made. For one, the negative feedback circuits related to body fat and meal ingestion can easily be overridden by situational events. As an example, even though satiety signals might indicate that no more food should be eaten during an ongoing meal, the sight, smell, and perceived palatability of an offered dessert can stimulate further intake. Likewise, even though an individual is severely underweight and food is available, the influence of stressors can preclude significant ingestion. Because of these kinds of interactions, trying to relate food intake within an individual meal to recent energy expenditure or to fat...

Comorbidity and Associated Impairment

In clinical studies of individuals with GAD, rates of comorbid Axis I disorders have ranged from 45 to 98 (Barlow et al., 1986 Brawman-Mintzer et al., 1993 DiNardo & Barlow, 1990 Goisman, Goldenberg, Vasile & Keller, 1995 Sanderson, DiNardo, Rapee & Barlow, 1990 Yonkers et al., 1996). Similar to findings in the general population, major depressive disorder has frequently been the most commonly diagnosed comorbid disorder among individuals with GAD, followed by social phobia, specific phobia, and panic disorder (e.g., Brawman-Mintzer et al., 1993 Goisman et al., 1995 Massion et al., 1993). Recent research also found personality disorders to be fairly common among individuals with GAD. For example, 37.7 of individuals with GAD participating in the Harvard Brown Anxiety Research Program study met criteria for one or more Axis II disorders, with avoidant personality disorder being the most frequent (Dyck et al., 2001).

Functional Description of Free Will

Lacked (3), you would probably be excluded from many social situations that would otherwise benefit you. Of course, this is a little circular, for many human social structures depend upon the fact that we have properties (3) and (2) and would not be needed at all if it were not for (1 ). This is unsurprising, as this may well have occurred as a result of the coevolution of our social structures and abilities, as has been suggested for language (Deacon, 1992).

Posttraumatic Stress Disorder

Treatment MAO inhibitors and selective serotonin reuptake inhibitors (SSRls) may be helpful for generalized social phobia. Beta-blockers or benzodiazepines may alleviate anxiety on an as-needed basis in specific social phobias (e.g., test-taking or performance anxiety). Discussion Exposure to the feared situation almost invariably causes anxiety in patients with social phobia. The individual recognizes that the fear is an unreasonable one. Frequent comorbidity with substance abuse and depression.

Modifying appearance and behaviour to hide lesions

People with skin conditions may draw attention to themselves, not because of the skin disease itself, but rather because of the way they cope with and react to it. They may begin to avoid eye contact when in social situations, wear their hair so that it covers affected parts of their face, or choose to wear clothes that conceal the condition but may be inappropriate for the weather. Their reactions may give rise to what psychologists call a selffulfiling prophecy. This means that the person expects that others willreact unfavourably and so seeks to hide the problem. This attempted solution may give rise to a new problem that people notice the hiding behaviour. These expectations (of unfavourable reactions), although justified in some cases, are often the product of negative beliefs that patients hold about their condition.

Discussing the condition with other people portwine stain patient

It is clear from Adrian's description that his right to privacy is taken away. The insensitive reactions of others can make a person feel that they have less control in social situations and no choice about how to react. Your experience may be that your privacy is invaded and your control in social situations is undermined by insensitive reactions to your skin condition. Take back control by having a quick response ready to counter rude questions and by making eye contact and smiling at any one who stares at you.

Forming new relationships

The prospect of starting new relationships is stressful for most people. The importance that is placed on first impressions in social encounters means that this can be particularly stressful for a person who suffers from a skin disease. Involvement in a new relationship raises issues for this person about how they feel about their body and highlights their insecurities about it. Indeed, since identity is to some extent linked to body image, skin disease may leave the patient feeling that they are no longer the same person and may even lead to mood or personality changes. This may in turn affect how they react and relate to those around them. Patients bring their own beliefs and expectations to new social situations and may feel that they are expected to act in a certain way because of their appearance.

Specific Rehabilitation Techniques

Specific behavioural techniques are utilized by the rehabilitation workers in the group and sometimes individual context, such as role playing, feedback about communication style and perceptions, modelling, didactic instruction, problem solving and attention focusing. A complex piece of interpersonal behaviour, for example, asking someone for a date or a job, is broken down into discrete elements which are then trained by employing the various techniques. Liberman 14 states that these techniques are designed to ''promote the acquisition, generalization, and maintenance of skills required in interpersonal situations''. The problem-solving approach used by Liberman's group and others derives from the observation that disabled persons with schizophrenia appear to have problems in cognitive problem-solving abilities which produce failing performances in social situations 23 . In Liberman's basic social skills training model, the rehabilitation worker acts out and models the appropriate...

The Stigma of Mental Illness Some Empirical Findings

When mental disorder is understood in biological terms, the ill person is perceived as less blameworthy and amoral, but the illness is perceived as more serious, less likely to change, and more psychotic. Biological attributions also result in greater disruption of social interactions and the delivery of more intense shocks in ''learning'' experiments 7, 8 .

Disability Stigma and Discrimination A View from Outside the USA

Stigma involves loss of prestige, social contacts and self-esteem and has an unfavourable effect on the social course of schizophrenia. Those stigmatized lose resources and power in society. Stigma results in discrimination at various levels (a) individual (loss of partner, social isolation, etc.) (b) work (obstacles to finding work or returning to work, etc.) (c) family (loss of prestige, tense family atmosphere, etc.) (d) housing (landlords refuse rental, disabled schizophrenics cluster in city areas with high rates of unemployment, crime and homelessness) (e) legal (disadvantages in social security, health care and civil rights and liberties). According to a nationwide analysis based on the Danish case register 5 , the rate of psychiatric bed occupancy decreased from 2.36 1000 to 0.97 1000 (59 ) between 1977 and 1997. The readmission rate for schizophrenics in the first year after discharge increased from 30 to 45 , clearly above the results of good therapy studies (about 20 )....

What Do Children And Adolescents Worry About

Reported more by older children compared to younger ones in a study of clinically referred anxious children (Weems, Silverman & La Greca, 2000). Similarly, Last, Strauss and Francis (1987) reported that children with a diagnosis of Overanxious Disorder Generalised Anxiety Disorder, were more likely to have a comorbid diagnosis of Social Phobia than any other anxiety disorder, indicating that in excessive worriers, worries about one's social functioning are paramount.

Antisocial Personality Disorder

HPI He reports that his shyness lias frequently prevented him from participating in social activities. At times, his fear of criticism has affected his performance in school. Discussion People with avoidant personality disorder often have social phobia as well. They are sensitive to rejection, socially withdrawn, and shy. Avoidant personality disorder can be differentiated from schizoid personality disorder in that schizoid individuals are happy being alone, whereas avoidant individuals are distressed at the prospect of being alone.

What if people are particularly rude and aggressive about my condition

This is one of the most difficult things to deal with. Rudeness in general is difficult to deal with but when it is directed at you owing to someone else's ignorance and is completely out of your control, it's even harder. Once again, as in other types of social interactions, it is very important to be firm with people that are like that. Remember, you are not there to take care of anyone else. Many times people are rude because they clearly have no understanding of what the condition is or why it's there.

NonGAD Symptomatic Samples

Nevertheless, high PSWQ scores are often present in non-GAD analogue clinical samples, including those with symptoms of post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD both in Molina & Borkovec, 1994), as well as panic disorder and social phobia (both from Erickson, 2002). Similarly, individuals diagnosed by questionnaire with analogue irritable bowel syndrome exhibit high levels of worry (Hazlett-Stevens, Craske, Mayer, Chang & Naliboff, 2003). Despite substantial worry elevation in these analogue non-GAD groups, analogue GAD groups manifest slightly higher average scores, as indicated in Table 7.2. However, because analogue studies have infrequently screened out other comorbid analogue conditions, such groups may well be symptomatically heterogeneous. In samples with clinically diagnosed patients, a parallel picture has emerged GAD patients tend to show higher PSWQ scores than other patients, though not in every case. For...

Prohibitive Costs or Insufficient Advocacy

Adjustment to community living and employability. The psychoeducational approach proposed by Anderson et al 1 , which focuses on educating both the patient and his or her caregivers (be they family members or friends) about the nature of the patient's illness the manner in which they can assist the patient in assuming increasing responsibility when he or she recovers from the psychotic decompensation and other interventions aimed at improving compliance and increasing the adaptive social repertoire of patients, described in some detail by Knapp and his colleagues, together with increased use of atypical neuroleptics, have shown sufficient promise to be tried in a large-scale community-based controlled clinical trial. A coordinated approach, however, must also take into account the substantial burden schizophrenic illness places on the family. The deinstitutionalization that got underway in the 1970s in the United States and Western Europe further increased family burden. While...

Reflections on Retrogenesis

Reisberg et al's excellent review on the clinical diagnosis of dementia presents a very powerful and lucid account of the idea of retrogenesis that he and his colleagues have developed over the last few years. In essence, this highlights the similarities between progression in Alzheimer's disease (AD) and reversal of development, such that in cognitive function, functional impairment, behaviour and social interactions, the more severely demented a patient becomes, the more similar he appears to an earlier developmental phase. Apart from being purely observational, this has extended into a theory regarding neurodegenerative processes in AD (particularly reversal of the myelination process) which may have an important bearing on our understanding of dementia and its progression. In particular, Reisberg et al make a very strong case for the use of the particular rating scale there group has championed (the Functional Assessment Staging, FAST) and how this corresponds to severity of...

PSWQ Cut Points For Differentiating Various Groups

Recent studies have enhanced the utility of the PSWQ by testing for optimal cut-scores to screen for GAD caseness. Several studies have applied receiver operating characteristic analysis to determine PSWQ scores that optimize sensitivity (likelihood of identifying true positives from all persons with positive diagnosis according to the questionnaire) and specificity (likelihood of identifying true negatives from all persons without diagnosis on the measure) vis-a-vis clinician diagnosis or questionnaire-selected analogue GAD. Behar, Alcaine, Zuellig and Borkovec (2003) found that a PSWQ score of 45 optimized sensitivity and specificity in discriminating treatment-seeking GAD clients from non-anxious controls in contrast, in a large student sample, a score of 62 performed best. This latter, higher, score was required to differentiate analogue GAD individuals (categorized via GAD-Q-IV) from those with self-reported diagnoses of social anxiety disorder, moderate depression, and or PTSD....

The Single Diagnostic SPD Criteria in a Clinical Phenomenological Perspective

Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self Lack of close friends or confidants other than first-degree relatives. Although this criterion is mainly defined in the DSM in the third person perspective as a sign (apart from a casual remark on a diminished desire for interpersonal contact), it usually involves or stems from specific subjective experiences, such as extreme sensitivity or a paranoid, suspicious attitude, leading to excessive social anxiety (criterion 9) and avoidant behaviour. Interpersonal anxiety may also be founded on a more fundamental insecurity, where it is one's own self and existence that are felt to be at stake (''ontological anxiety'', see below). Quite often, social isolation is a consequence of a pervasive deficit in the normally automatic, un-reflected (un-mediated) understanding of the significance of the world, other people, social rules, and...

Clustering Of Symptoms

Of Negative Symptoms (SANS) 53,54 and the Scale for the Assessment of Positive Symptoms (SAPS) 55 . The SANS includes items that describe different aspects of affective flattening, avolition-apathy, anhedonia-asociality and attentional impairment. The SAPS includes items that describe hallucinations, delusions, bizarre behaviour and formal thought disorder. The first factor analysis on the two scales showed that the correlations between the negative symptoms were quite high, as was the internal consistency of the SANS. The correlations between the positive symptoms were weaker, as was the internal consistency of the SAPS. Subsequent analyses of 15 studies of the SANS and the SAPS led to the conclusion that the symptoms fall into three natural dimensions 43 . While negative symptoms remain more or less the same, positive symptoms subdivide into a first dimension that reflects psychoticism (hallucinations and delusions) and a second dimension that includes disorganized bizarre...

Characteristics Of Dreams

The best research with such dream reports often uses what is called content analysis developed by two psychologists, Calvin Hall and Robert Van de Castle. Essentially, this method first categorizes things like the characters, settings, objects, activities, social interactions, and so forth that are found in a dream and then counting the number of instances in each category. For example, characters might be grouped according to sex and age (such as male adult, female child, or indeterminate elderly). The categories are carefully developed so that different researchers working with the same dreams will produce nearly the same results. An excellent resource to learn more about the technique of content analysis and how to use it is Frequently, the recalled dreams of college students are used for content norms, probably because they are the most accessible population for dream researchers. Bill Domhoff, a psychologist and sociologist at the University of California Santa...

Dimensions Of Psychopathology

Also in this research domain, the Roscommon study presents detailed information 170 . In a multivariate analysis of six (factor analytically derived) dimensions of SPD, four dimensions remained significant when tested together ''negative'' (poor rapport, aloofness-coldness, guardedness, odd behaviour), social dysfunction (lack of motivation, occupational status below expected), social isolation (isolation, social anxiety, and hypersensi-tivity), and formal thought disorder (odd speech, cognitive slippage). These four dimensions accurately characterized relatives of schizophrenic probands compared with the relatives of matched controls. Of the 12 items composing these dimensions, nine were signs and three were (self-reported) symptoms. Kendler et al. concluded that signs observed by trained interviewers were more powerful at detecting personality traits related to schizophrenia than were self-report measures. In a separate analysis, Fanous et al. 171 , using the Roscommon data,...

The impact of skin disease on relationships

Effect Skin Disease

Previous chapters have described the emotional and psychological effects of skin disease on the individual. However, as is the case with most illnesses, skin disease has an impact on a person's relationships, which inevitably affects, and is affected by, the individual's condition. In this chapter we consider the impact that skin conditions have on different relationships and consider some of the social situations in which difficulties regarding the skin condition may arise. Furthermore, the readerwiH be introduced to some self-help techniques which can be learned and used in social situations.

Assessment Instruments For The Diagnosis Of Schizophrenia

The SANS is a 25-item scale for the assessment of negative symptoms. The items may also be scored (from 0 to 5) on a summary sheet on which they are presented under five headings affective flattening, alogia, avolition-apathy, anhedonia-asociality, and attentional impairment.

Major depressive disorder

MDD has been reported in more than 20 of women aged 40-60 years who attended an inner-city primary care practice.1 By definition, symptoms must last for at least two consecutive weeks, be a significant change in usual functioning, and directly impair ability to conduct normal activities. A classic MDD presentation in a middle-aged woman is of fatigue interfering with managing housework cooking family responsibilities, loss of interest in hobbies and activities, gradual neglect of friends, and increasing social isolation. Physical symptoms of fatigue, malaise, pain, and vague physical complaints are also common. Some women express dysphoria more as irritability than as overt sadness.

State Trait Anger Expression Inventory2

The psychosocial problems of decreased social contact, depression, and loneliness that occur for many persons suffering from traumatic brain injury create a major challenge for enhancing efforts at community reentry. These psychosocial problems remain a persistent long-term problem for the majority of individuals with severe traumatic brain injury. The problems of social isolation and decreased leisure activities create a renewed dependence of the survivor upon the family to meet these needs. This is particularly true since individuals who experience severe traumatic brain injury are at high risk for a significant decrease in their friendships and social support.51 The goal of human rehabilitation is independent living. The National Council on the Handicapped52 defines this as managing one's affairs, participating in day-to-day community of life in the manner of one's own choosing, fulfilling a range of social roles, including productive work, and making decisions that lead to...

Measuring Aggression Aggression Questionnaire

Individuals with high scores on the VER scale are commonly aroused to anger by situations they perceive to be unfair. Persons with a preexisting antisocial personality will tend to obtain high scores on the VER scale. Low VER scores are obtained by individuals who do not perceive themselves as argumentative. The ANG subscale describes aspects of anger. Persons who score high on the ANG scale may benefit from relaxation training, as well as cognitive-behavioral and other arousal-reducing strategies or psychotherapy. Thus, this scale may be useful to predict those who might respond to treatment techniques aimed at reducing anger. The HOS subscale is most closely associated with pervasive social maladjustment, as well as severe psychopathology. It is probably wise to review this scale with elements on the MMPI-2. Predictors of violence from the MMPI-2 subtests are more fully explained in the forensic sections of this text. Persons with elevated HOS scores are more likely to demonstrate...

How do I feel less selfconscious in general

Most studies done in this area have shown that various types of therapy can help us to feel self-confident. What works in these types of therapy is restructuring the way we think about things, for example, challenging the notion, 'Once my acne goes away, then all things will be OK'. Rather say, 'My acne is part of me. I'm not proud of my acne. There is more to me. But, I can go to that dance, I can get that job, and I'm not going to wait for that to happen.' It is important not to put our lives on hold and this is one way to feel less self-conscious. Secondly, engaging in more social interactions, making more eye contact, wearing the clothes we want to wear, going to the places we want to go, will make us less self-conscious. Thirdly, knowing how to deal with people's reactions, as we spoke about earlier, things like staring or asking questions, once we become confident about that, we have a tool box to take out with us every time. This gives us a sense of confidence that we can cope...

Comorbidity with other psychiatric disorders

Alcoholism is complicated by the fact that, particularly in women, it is often accompanied by other psychiatric disorders therefore, a holistic approach is required for treatment. Comorbid conditions include tobacco use, drug abuse, major depression, anxiety disorders, bulimia nervosa, and antisocial personality disorder (ASPD).4 Alcohol problems predict the subsequent use of tran-quilizing drugs in older women.5 Severe alcoholism, impulsivity, and suicidal tendencies also tend to coexist but are more likely to group in men.6 ASPD and antisocial symptoms are more prominent in male alcoholics, whereas in women alcoholism is often associated with anxiety (particularly social phobia) and affective disorders.4 Major depression is much more common in women than in men, and many studies have shown that antecedent depression is a risk factor for problem drinking. In women, there is a strong relationship between depression and smoking depressed individuals are more likely to smoke and are...

How is skin disease different from other conditions

As with any illness, a skin disease brings on a variety of life changes and challenges that we may not be prepared to deal with. However, unlike conditions which do not change the way people look, skin problems raise a whole new set of challenges because of their visibility. The visibility of certain conditions may attract attention in social situations, thus making the individual feel that they can't keep their condition private or personal. Furthermore, owing to a lack of health education and awareness in dermatology, some people associate skin disease with contagion or lack of hygiene. This ignorance regarding skin conditions means that a skin disease patient may find that some people react negatively towards them or treat them differently because of the way that they look. In many cases the physical changes that may result from skin disease can have a negative effect on body image. Body image is our perception of the way that others see us, and therefore any sudden changes to the...

Clinical Point of View about Depression in the Elderly

Cognitive symptoms, referring to the subjective perception induced by the disease, predominantly concern feelings of low self-esteem, of worthlessness, of helplessness and hopelessness, pessimistic thoughts with sometimes the conviction of being incurable, ideas of death and suicide, a sense of guilt. These feelings are frequently reinforced by the reality of life events and of life conditions marked by concrete losses bereavement, social isolation, institutionalisation, physical diseases, economic problems. Most important is also the problem of memory. Concentration difficulties are often reported in depression, even by young adults. Both recording and recall are consequently disturbed. In old age the subjective perception of these troubles can be influenced by the prejudice that memory disturbances are common at that age, and by the fear of dementia. Consequently, the problem of failing memory could predominate in old age depression, constituting the so-called depressive...

Depressive Disorders in the Elderly A Fresh Perspective

Social factors are important in the genesis of depression in old age and would appear to effect outcome too. Adverse life events, loneliness and social isolation speak for themselves. Equally good close support structures from family and friends appear to be a major factor in protection from old age depression. It must be remembered that published work on younger patients may not be generalisable to the elderly.

Social Skills Training For Schizophrenia

Feeling of ability, comfort and assertiveness in social situations, and in changing the topographical elements of social skills. However, this latter effect generally only occurred when the assessment situation was very similar to the training setting. Often the generalization of changes in social behaviour to natural settings was not assessed. Available evidence suggested that social skills training could improve symptoms and reduce rates of relapse in patients with serious mental illness, but the treatment effect appeared to be weak and based on few studies 105, 111, 112 . From the small number of studies of overall psychosocial functioning among these patients, it did not appear that social skills training had any effect on this variable 112 . Furthermore, the paucity of studies in an outpatient setting was noted 111 .

Correlations Between Neurofunctional Deficits and Schizotypal Symptoms

The study of patients with schizotypal personality disorder suggests that a dimension of deficit-like or ''negative'' symptoms of asociality and interpersonal impairment may be associated with neuropsychological and psychophysiological correlates of altered cortical, particularly frontal, function. On the other hand, the psychotic-like or ''positive'' symptoms seem to be more related to increases in dopaminergic activity that may be partially responsive to neuroleptic treatment. Data from the same High-Risk Project also show that the correlation between psychopathological and neurocognitive deviations may show up over time in longitudinal analyses. Attentional impairment, assessed in childhood, was more frequent in children of schizophrenic parents, and was found to be related to physical anhedonia in adolescence 191 . Attentional impairment and physical anhedonia both were related to worse social outcome in young adulthood 70 . Thus, attentional dysfunction may be an early indicator...

Phenomenology And Diagnosis Spectrum Personality Disorders

Assessment tools available for each of these approaches differ in the underlying phenomenological and clinical concept, comprehensiveness of content of symptoms and signs, and relative weight of various components of schizotypal traits. The possible schizotypal features cover social, emotional and cognitive functions. This most comprehensive set of schizotypal traits included in SIS comprises poor rapport, aloofness coldness, guardedness, odd behaviour, illusions, ideas of reference, magical thinking, deperson-alization, suspiciousness, recurrent suicidal threats, inappropriate anger, affective instability, jealousy, impulsivity, chronic boredom, general lack of motivation, occupation functioning below expected, social isolation, social anxiety, hypersensitivity, anxiety, cognitive slippage, odd speech, hyper-vigilance and irritability. Not included in the SIS are two crucial features proposed by the classical papers ambivalence 2 and anhedonia 6, 7, 27 . Multimethod-multitrait...

About the book

In Chapter 3 we turn our attention to the actual medical facts concerning skin disease, investigating the causes, prevalence and treatment of different conditions. Chapter 4 is dedicated to examining the concept of coping and the psychological adaptation to skin conditions. In particular we explore ways to cope with difficult social interactions. In Chapter 5 we look at how skin diseases affect relationships and ways that we can improve our interactions with others. Our hope is that this book will provide you with ideas about how to understand and cope with your condition and also make you better equipped to deal with social situations. We want to end this chapter on a positive note by saying that many people living with illnesses get on with their lives and live happy and fulfilled lives irrespective of their skin condition. It is important to acknowledge, however, that everyone reacts differently to challenges in life and this book may be useful for those who find certain aspects of...

Alzheimers Disease

The diagnosis of depression in a cancer presents a challenge. There is a considerable overlap of cancer and depressive symptoms (loss of appetite, weight loss, insomnia, loss of interest and loss of energy) 105 . Also, cancer chemotherapeutics have been associated with depressive symptoms. The cancer patient with a depressive disorder is likely to be preoccupied with the illness, to develop feelings of worthlessness and guilt, with reliable differentiating symptoms from the normal emotional reaction to the cancerous disease. Recurrent thoughts of suicide are common in cancer patients but not as intense as in severe depression. Risk factors for depressive disorder in cancer include young age, female gender, active symptoms of the disease, presence of uncontrolled pain, history of mood disorder and social isolation 95 .


Us to consider a fresh interpretation. When the text is read in the light of the new interpretation, it may change our understanding of it. This may call for a revised interpretation, and so on. Such circles may occur several times during the reading and re-reading of a text. This example can be extended to having a conversation. Conversations normally progress not as an orderly sequence of question and answer, but as a tangle of starts and re-starts, as both interlocutors negotiate respective hermeneutical circles to arrive at a coconstructed meaning. The concept can be extended to social interaction. The behavior of the intelligent system depends on the challenges that arise from being embodied and being expected to participate in social interactions. There is a circular effect as new capabilities bring about more social experience, which in turn, modifies the capabilities for further social experience.


The pre-operational diagnostic systems offered several unclearly defined possibilities for diagnosing conditions corresponding to SPD (e.g. ICD-8 included latent, pseudoneurotic schizophrenia, schizoid personality, borderline cases), which were used differently at different sites. The introduction of an explicit SPD category into the operational classification systems (such as DSM-III IV and ICD-10), in principle, should entail a modifying influence on the definitions of all other non-psychotic and non-organic disorders. It is an intrinsic feature of a closed conceptual system (a classificatory system is one typical example) that adding a new concept to it (such as SPD) entails widespread repercussions on the conceptual validity (diagnostic status) of all remaining (non-psychotic) categories. Since no systematic studies were conducted to examine the potential effect of the SPD category on the diagnostic validity of other entities (e.g. anxiety disorders, certain depressions, dysthymic...

Disorder in Youth

Harrington's review, the depressive disorder usually begins after the onset of another psychiatric disorder. Cantwell and I 5 pointed this out using the primary secondary distinction. Definitions change, however. DSM-IV rediagnosis of the 14 youths who had met criteria for primary major depression using criteria available in 1978 revealed that 3 had prior social phobia, 2 had attention deficit hyperactivity disorder, primarily inattentive type (one including severe learning disabilities), 2 probably had Asperger's disorder. Four young people (all over age 12) had bipolar disorder (1 with bipolar depression, 3 with bipolar II disorder). Only three were really primary.

Presleep Experiences

Attempts to manipulate dream content by exposing people to specific experiences prior to sleep have had only mild success. Among the things that have been tried are social isolation, vigorous exercise, difficult or stressful mental tasks, subliminal stimulation, and wearing tinted goggles. Likewise, films with graphic, emotion-arousing scenes, such as a difficult birth, amputation, ritual circumcision, hard core pornography, compared to films with comparatively neutral images, have only occasional influence on dream content. However, some studies suggest the influence of such experiences on dream content may not occur until several nights later.


Stanley, Beck and Zebb (1996) evaluated the State-Trait Anxiety Inventory (STAI), WS, Fear Questionnaire (FQ), and Padua Inventory (PI) in an older sample with GAD and a comparison group of normal older controls. In the GAD sample, internal consistency was adequate ( .7) for the STAI, WS, PI, and their subscales, and for the total and Blood-Injury subscales of the FQ, but not for the Agoraphobia or Social Phobia subscales of the FQ. Adequate convergent validity was found for the STAI-Trait, WS, and PI, but not for the STAI-State or FQ. In the normal controls, internal consistency was adequate for all scales and subscales except the Social Phobia subscale of the FQ and the Behavior Control subscale of the PI. Test-retest reliability was adequate for the STAI-Trait, the WS except for the WS-Health subscale, and the PI, except for the Mental Control and Checking subscales. Test-retest reliability was lower for the STAI-State, as would be expected, and was also low for the FQ. Convergent...

Normal Sadness

The intimate relationship between depression and anxiety is best reflected in the overlap of depressive and anxiety items in the most widely used scales for measuring severity of the two disorders 134 . The extent to which depression overlaps or co-occurs with anxiety has been amply demonstrated in three major epidemiological studies the ECA study 37, 38 , the US National Comorbidity Survey 39 , and the WHO Study on Psychological Disorders in Primary Health Care 41,42 . According to the US National Comorbidity Study results, the majority (61.8 ) of the respondents with a lifetime history of MD had at least one other DSM-III-R disorder before the onset of depression and in only 26 depression was not preceded or overlapped by any other disorder. The 12-month comorbidity has also shown 51.8 of depressed patients to have anxiety disorders. The calculated odds ratios (qualifying the relative risk of an outcome between two exposure groups) in the study have shown considerable variability...

The child

Function are contained within the technical manual, and a well-trained psychologist experienced with this test instrument should have no difficulty with interpretation. The clinical disorder scales deal with 20 DSM-IV diagnoses ADHD, conduct disorder, oppositional defiant disorder, adjustment disorder, substance abuse disorder, anorexia nervosa, bulimia nervosa, sleep disorders, somatization disorder, panic disorder, OCD, generalized anxiety disorder, social phobia, separation anxiety disorder, PTSD, major depression, dysthymic disorder, mania, depersonalization disorder, and schizophrenia. The personality disorder scales evaluate pervasive aspects of inner sense, feelings, affect, and thoughts, as well as behaviors that deviate significantly from normal characteristics of adolescence. The five personality disorder scales include avoidant personality disorder, obsessive-compulsive personality disorder, borderline personality disorder, schizotypal personality disorder, and paranoid...

D Schizophrenia

This is a personality characterized by shyness, oversensitivity, seclusiveness, and eccentricity in communication and behavior. An example of schizoid personality is an adult who has a life pattern of social isolation (little or no interaction with other people). He is distant and somewhat distrustful of other people, rather fearful, and sensitive. Instead of dealing with people, he concentrates on nonpeople details of his life such as the meaning of Wash before wearing on a new pair of jeans. Does this mean wash the jeans before wearing the first time or, for some reason, do the jeans need to be washed each time before they are worn He considers this question for several days. This type of dilemma is comfortable for the individual with a schizoid personality because the problem requires no interaction with any other person.


The answer is d. (Wallace, 14 e, pp 1043, 1250-1251.) The proportion of firearms-related suicides has been increasing in recent years among youth and the elderly. Contrary to other methods, it is highly effective. The more difficult the access to a lethal method, the less likely someone will commit suicide. Limiting access to alcohol and drugs and compliance with therapy and medication will all be helpful to prevent a bad outcome. Social isolation contributes to a depressive state. Between 1955 and 1980, the rate of suicide among 15- to 24-year-olds tripled.


Personally, UI may lead to social isolation, loss of independence, and poor sexual health and self-esteem.22,23 Medically, UI can lead to urinary-tract and vaginal infections, pressure ulcers, and even renal failure and sepsis. The evidence for effective preventive strategies is very limited, but evidence for valuable and effective therapy is available. Treatment is achievable, and significant improvement and cure are possible if the physician and patient work together.24


Phobias are characterized by unreasonable or excessive fear of social situations (social anxiety disorder) or of specific objects or situations (specific phobia). Phobic patients strenuously attempt to avoid the trigger object or situation, and experience extreme anxiety if exposure cannot be avoided. Although sufferers relatively rarely seekmedical advice, social anxiety is the most common anxiety disorder and the third most common psychiatric disorder in the USA (exceeded only by depression and alcohol dependence).50 The overall lifetime prevalence is estimated to be 13 ,38 but the prevalence is 1.5 times greater in women than The patient with social phobia has much more than excessive shyness. She experiences severe anxiety symptoms (Table 7.7), humiliation, and embarrassment in social situations and, therefore, avoids or is symptomatic in certain circumstances. Common circumstances that produce symptoms in social anxiety disorder are public speaking and performing, being the...


Of it, so as to neutralise it or make it less threatening. An example of this is where you might challenge your view of a social situation where you feel that the way you look is being scrutinised. The latter involves doing something about it, such as using practical tools for how to deal with staring and rude comments and how to confront other difficult social situations. This may include making eye contact with the other person, having a quick, rehearsed response to rude comments, or changing the subject and diverting the other person's attention. In cases where you can exert control over the threat, problem-focused coping is effective whereas in cases where the threat is not directly controllable, emotion-focused coping is more useful. In most cases, both strategies are used both during and after a stressful event and the extent to which they prove to be useful will depend on the context in which they are used. (3) Controlling the effects of the stressful situation after it has...


The anxiety disorders are characterized by maladaptive, abnormal response to perceived threats or stressors, with resulting mood, cognitive, or physical symptoms (Table 7.6).37 They are the most common psychiatric disorders, with a lifetime prevalence of nearly 25 in the USA.38 Women are twice as likely as men to develop panic disorder, simple phobia, post-traumatic stress disorder, and generalized anxiety disorder, and are at increased risk for obsessive-compulsive disorder and social phobia.39

Neuroendocrine Tests

The hypothalamic-pituitary-growth hormone system. The release of growth hormone (GH) from the anterior pituitary is regulated by hypothalamic peptides, especially GH-releasing hormone (GHRH) and somatostatin, which in turn are controlled by the classic neurotransmitters and insulin-like growth factor-1. Blunted GH response has been reported following administration of insulin, L-dopa, d-amphetamine, clonidine and GHRH, but the findings are equivocal 149 . The blunted GH secretion to clonidine is not only observed in depression and panic attacks, but also in GAD and social phobia. However, the abnormality is not observed in schizophrenia or obsessive-compulsive disorder (OCD). On the other hand, some investigators have observed no difference between depressed patients and controls in the clonidine GH or GHRH GH challenges 149,150 . In a recent study, an enhanced GH release in response to pyridostigmine (PYD) in subjects with major depression (sensitivity 63 ), but not inpatients with...

Prefrontal cortex

Lesions in the prefrontal area produce what is called the frontal lobe syndrome. The patient cannot concentrate and is easily distracted there is a general lack of initiative, foresight, and perspective. Another common aspect is apathy (i.e., severe emotional indifference). Apathy is usually associated with abulia, a slowing of intellectual faculties, slow speech, and decreased participation in social interactions. Prefrontal lesions also result in the emergence of infantile suckling or grasp reflexes that are suppressed in adults. In the suckling reflex, touching the cheek causes the head to turn toward the side of the stimulus as the mouth searches for a nipple to suckle. In the grasp reflex, touching the palm of the hand results in a reflex dosing of the fingers, which allows an infant to grasp anything that touches the hand.

Overcome Shyness 101

Overcome Shyness 101

You can find out step by step what you need to do to overcome the feeling of being shy. There are a vast number of ways that you can stop feeling shy all of the time and start enjoying your life. You can take these options one step at a time so that you gradually stop feeling shy and start feeling more confident in yourself, enjoying every aspect of your life. You can learn how to not be shy and start to become much more confident and outgoing with this book.

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