Social Phobia

Definition of Phobia Phobia is a conscious fear of on object, situation or a condition in which fear develops as a result of avoiding situations.

Social Phobia Social Phobia is listed under Phobic Anxiety Disorders in DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) According to DSM – IV in order to make a diagnosis as a Social Phobia there are certain criteria which has to be fulfilled

DSM-IV Diagnosis Criteria for Social Phobia Table 10: Social Phobias A. The development of apparent and persistent fear from one or more social acts carried out when unknown people are confronted or in front others. The individual has fears to behave in any manner that might demean or humiliate his/herself (or shows signs of anxiety). Note:Children must have the appropriate social skills to build relations with familiar individuals within their age group and anxiety should not only emerge in interactions with adults.

DSM-IV Diagnosis Criteria for Social Phobia B. Confrontations of feared social situations activate anxiety immediately and every time, in accordance with such or familiar situations activate forms of panic attacks. Note:Anxiety, crying, and signs of irritability can be externalized by freezing-up or distancing themselves in social situations with unfamiliar individuals.

DSM-IV Diagnosis Criteria for Social Phobia C. The individual is aware that his/her fear is extreme or that he/she is being analyzed. Note: There might not have any attributes.

DSM-IV Diagnosis Criteria for Social Phobia D. When a social situation is confronted or a social act is carried out it is either avoided or the anxiety and discomfort is endured

DSM-IV Diagnosis Criteria for Social Phobia E. In situations of avoidance, anxiety expectancy, confrontation of feared social situations or social acts are carried out feelings of stress disrupts the individuals daily tasks, career (or educational) related functionality, social interaction, and relationships or show apparent signs of discomfort in a developing phobia

DSM-IV Diagnosis Criteria for Social Phobia F.The duration period is at least 6 months for individuals under the age of 18. G.Fear or avoidance is not directly related to physiological effects by a drug (which can be abused or used for the purpose of treatment) or a medical condition and can not be clarified any better with another mental disorder.

DSM-IV Diagnosis Criteria for Social Phobia H. Even in a case of a medical condition or mental disorder is not related with the “fear” mentioned in the criteria under the A diagnosis. For example, fear, stuttering, and the trembling of Parkinson’s disease or the eating behavior of Anorexic and Bulimic Neurosis are irrelevant.

DSM-IV Diagnosis Criteria for Social Phobia Table 10: Social Phobias (Broad): If fears include most social situations (i.e. initiating or continuation of discourse, joining and participating in small social groups, dating, speaking with peers, going to parties). Note:Consider including Antisocial Personality Disorder in the diagnosis

Characteristics of Social Phobias Having irrational fear involving the individuals’ reaction to situations where others’ observation and criticism along with the desire to avoid are typical attributes of social phobias. The individual is concerned that he/she will get angry and tremble within social situations

Characteristics of Social Phobias The fears such as dining in a restaurant, to speak and perform tasks within a crowd, using public bathrooms, and writing in front of others are signs of social phobias. The individual is also worried that his/her fear with be revealed. The average age of these fears start at the age of 19 and is more widespread in women.

Characteristics of Social Phobias It is not uncommon for individuals how have social phobias to use alcohol, various drugs, medication to dampen anxiety.

Etiology of Social Phobia Behavioral factors; some social phobias can be explained with the conditional/unconditional theory. Psychoanalytic factors Genetic factors Nuerochemical factors

Treatment of Social Phobia Pharmacotherapy and psychotherapy can be applied together Observations have shown that revelations and analysis of subconscious conflicts during the development process during the application of psychotherapy based on insight in treatment has shown rapid recovery from symptoms

The function of Hypnosis in Therapy Using hypnosis to aid patients overcome the fear of social situations by reinforcing the idea that it is actually safe by the application of hypnotic prompts by therapists have been put into practice before

The function of Hypnosis in Therapy In addition autohypnosis has been used to relax patients by changing their thoughts when feelings of hopelessness emerged due to phobic objects.

Behavioral Therapy in Treatment of Social Phobia Exposure is used in hypnotherapy in combination of hypnodrama by the therapist to desensitize the patient In other words rehearsal takes place before confrontation. This is used in stages in every session and helps patients confront their social phobic stimulants

Cognitive Therapy in Treatment of Social Phobia Shame develops into catastrophe and the approval of others turns into a life necessity It is mandatory to give tasks that involve exposure to social environment in the treatment of social phobias

Case Example A twenty year old male patient came with a complaint of severe nausea and regurgitation when near or inside an environment with young females. Sometimes this situation caused difficulty in going to school, traveling, going to any restaurant or café Approximately 3 years ago he wanted to pass his letters on to a female friend in the class room. When his other female friends made fun of him by saying “your in love with A.” he got so nauseated trying to explain the misunderstanding

Case Example cont. He came for aid because his functionality had been impaired, so he was very eager to recover. The treatment started with 150 mg of SSRI daily in combination of hypnotherapy In stages through hypnosis the patient first confronted and conversed with a female friend he trusted before.

Case Example cont. Patients that were able to converse successfully had an increase in courage. In following session the number of females unknown and known were confronted in groups After the first session his nausea and regurgitation eventually turned into a minor cramping feeling

Case Example cont. Through autohypnosis he was taught to relax himself and change the symptom He now has a girlfriend, is continuing his education, and able to travel

Important Points When patients use hypnosis to lesson stimulus and relax it helps them to control themselves, gives them ability to overcome and increase self esteem It effects prior thoughts of facts that they thought could not be changed. This changes their views about the focus control and increases their feelings of self- sufficiency.

Conclusion It might be necessary to apply fundamental hypnosis, behavioral, cognitive, and other psychotherapy methods by constructing a treatment plan based on each individual due to the variety of different patients.

References: 1. Handbook of Clinical Psychiatry, Kaplan – Sadock, Psychiatric Symptoms and Syndromes, Doç.Dr. Oğuz Arkanaç, Anxiety disorders and Its Treatment, Tahir Ozakkaş, 67 – Clinical Hypnosis, Graham D. Burrows, Robb O. Stanely, Peter B. Bloom, 173 –