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. Continue reading...

Shyness And Social Anxiety System Summary


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My Shyness And Social Anxiety System Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

All the modules inside this e-book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Aetiology of social phobia

Both genetic and environmental factors contribute to the emergence of social phobia. Studies of first-degree relatives of probands with social phobia have clearly established that it runs in families. One of the first proband studies interviewed 83 first-degree relatives of individuals with social phobia and 231 first-degree relatives of individuals with no psychiatric history to assess their lifetime history of DSM-IIIR disorders. Of relatives of individuals with social phobia, 16 per cent met the criteria for social phobia compared with only 5 per cent of relatives of individuals with no psychiatric history. Rates for all other anxiety disorders were similar among relatives of the two proband groups. Similarly, first-degree relatives of probands with DSM-IIIR simple phobia, social phobia, and panic disorder with agoraphobia most frequently met the criteria for the proband's anxiety disorder, but were not more likely to meet the criteria for the other disorders. (33) Further, in a...

Course of social phobia

Scant information is available on the course of social phobia. In the only prospective study to date, social phobia persisted throughout adulthood. (38 Furthermore, course was unrelated to gender, age of onset, duration of illness, level of functioning at intake, lifetime history of anxiety disorders, or current comorbidity of anxiety or depressive disorders 3 39) To date, no studies have followed individuals across their entire lifespan. Most other information on course is derived from retrospective accounts of individuals with social phobia. In an epidemiological sample, individuals with social phobia had, on average, met the criteria for the disorder for 19.4 years.(2l) In ECA, 15.5 per cent of participants reported that they had experienced symptoms of social phobia throughout their whole lives. (9) In childhood, two related conditions emerge and are relatively stable into adulthood. Individuals who had been shy as children exhibited overall lower levels of functioning when...

Management of social phobia

Several statements can be made regarding the management of social phobia. First, several classes of medication (monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, clonazepam) and cognitive-behavioural therapies that include an exposure component may effectively provide symptom relief. These treatments generally work equally well for individuals with non-generalized and generalized social phobia, although individuals with generalized social phobia may require a longer course of treatment to reach an optimal end-state. Second, pharmacologically treated individuals tend to get relief from social anxiety symptoms quickly perhaps as quickly as a few weeks after initiation of treatment. Third, patients treated with cognitive-behavioural therapy may not respond as quickly as individuals treated with these medications, but they may be less likely to relapse than medication responders. Benzodiazepine treatment may be contraindicated among patients with a history of alcohol...

Prevention of social phobia

Few studies to date have specifically examined ways of preventing social phobia. However, the evidence for familial aggregation and for a large degree of environmental influence is strong. Furthermore, recent evidence suggests that parents may reinforce anxious children for making avoidant choices, (94 and these data suggest that anxious children may benefit from the inclusion of their parents in treatment, family-oriented treatment interventions, or successful treatment of their parents' anxiety. Since social phobia has an early age of onset, the treatment of children and adolescents should help to prevent social phobia from becoming a chronic condition. In a more purely prevention-oriented mould, the Queensland Early Intervention and Prevention of Anxiety Project, administered by Dadds, Barrett, and colleagues is a model for the future. These investigators implemented a 10-week school-based child- and parent-focused psychosocial intervention for child anxiety and compared it to a...

Social phobia in a group format

Weissman and Jacobson (unpublished work) have adapted IPT in a group format for shy patients. The patients had social phobia in unstructured interpersonal situations (at parties, in intimate discussions with significant others), but not in defined work situations. Most patients were successful in professional or business careers despite their phobias. The 10-session time-limited group defined and described the diagnosis, gave patients the sick role, and developed practical strategies for dealing with shyness in specific situations for example, developing scripts to initiate a more personal conversation with an estranged father, or a discussion with a spouse about having a baby. As Lipsitz noted, the chronicity of the disorder led to a focus on a iatrogenic role transition from an impaired to a less-impaired state. The group format seemed

Avoidant personality disorder JLC

Avoidant personality disorder was first introduced into psychiatric classification in DSM-III. ( 1) Before this, such patients were included among the schizoid or dependent patients. The emphasis on avoidant behaviour as a consequence of an intense sensitivity to rejection led to the differentiation of this new personality type. Before this, such people had been described as 'hyperaesthetic shut-in individuals', (1 ) phobic personalities,(95) or active-detached personalities. (96 The characteristic behaviour of the avoidant personality is active isolation from the social environment. Unlike schizoids, who are characterized by passive social isolation, avoidant subjects turn inward to protect themselves because they are extremely sensitive to rejection. (9Z) They desire interpersonal relationships but they avoid any chance of disapproval. Thus, only relationships that are likely to lead to complete non-critical acceptance are established. The extreme sensitivity to criticism is based...

Application to Antisocial Histrionic Narcissistic Dependent and Avoidant Personality Disorders

The Dependent Personality Disorder and Avoidant Personality Disorder can also be viewed as disorders of the ancestral status hierarchy. Dependent persons are known to make excessive attachments to another person in the status hierarchy. Through their exceptional submissiveness, they avoid all the dangers of competition in the hierarchy. A negative consequence of this strategy, however, is that they are subject to abuse and domination by their partner. A similar pattern is seen among avoidant persons. They actively avoid social situations and competition. They should not necessarily be seen as submissive, however, because they choose not to participate in the status hierarchy. Theoretically, this means that they must maintain and survive without the benefits of the group, and although it is a low frequency solution, it survives and persists, nonetheless, in modern societies.

Issues arising from shrinking social support networks and social isolation

Parents may reach a point where physical mobility and capabilities are declining, and in some cases dementia (in a caring parent, or the person being cared for) may complicate the situation. Input from services becomes essential, even if families have been managing with few or no services. Many will have relied on informal sources of support such as family members, friends, and neighbours, but in later life family and social networks tend to break down, and households such as these become increasingly isolated from sources of informal support. This isolation in the community tends to coincide with the increasing frailty of ageing carers. (38) Parents of children with severe disabilities, and or challenging behaviour, may well become isolated from family and friends at a much earlier stage as a result of their dedicated caring role, increasing the likelihood of social isolation in later years.

Application to Schizoid Schizotypal and Avoidant Personality Disorders

Individuals with Schizoid Personality Disorder are highly detached from nearly all social relationships and have a restricted range of emotions in interpersonal interactions. A schizoid person is the quintessential loner, who appears aloof, cold, and remote to others. Even when pressed into relationships, they do not appear to enjoy them, including sexual interactions. Individuals with Schizotypal Personality Disorder share two of the same criteria as the Schizoid Personality Disorder (1) constricted affect and (2) a lack of close confidants. Like schizoid persons, schizotypal persons have serious social and interpersonal difficulties. Unlike schizoid persons, schizotypal persons have in addition eccentricities in their thinking and reasoning, such that they find highly personal meanings in meaningless events (ideas of reference) and have odd beliefs and speech or magical thinking. Like the Schizoid and Schizotypal Personality Disorders, individuals with Avoidant Personality Disorder...

Avoidant Personality Disorder

This disorder manifests itself as a pervasive pattern of social inhibition or intense shyness, coupled with a longing for relationships. People with Avoidant Personality Disorder are extremely sensitive about how others perceive them, and they are especially preoccupied with and afraid of social criticism or rejection. As a consequence, they typically avoid entering into social situations in which they might be scrutinized or rejected. Cogni-tively, they tend to exaggerate the risks associated with new activities and people, and they are also prone to interpret comments from others as critical confirming and justifying their fears. In essence, the avoidant type rejects others first to avoid being rejected by them. As a consequence, they are often isolated and lonely. When they are in relationships with others (e.g., close relatives), people with Avoidant Personality Disorder have strong fears of being ridiculed and therefore are highly controlled, reserved, and restrained. They often...

Quality of social interactions in MDD

Not surprisingly, therefore, a significant body of literature has examined impairments in the quality of social interactions in depression. For example, early behavioral formulations of depression viewed depression as resulting from a lack of environmental reinforcement (e.g., Lewinsohn, 1974). According to this perspective, depressed persons lack the skills that are critical in eliciting reinforcement from others in social situations. Subsequent studies have demonstrated that, in both dyadic and group interactions with strangers, depressed individuals do indeed exhibit a number of behaviors that are indicative of social-skill deficits. For example, when engaging in conversation, depressed individuals have been found to smile less frequently than do nondepressed individuals (Gotlib, 1982 Gotlib & Robinson, 1982). Compared with nondepressed controls, depressed persons tend to make less eye contact with those with whom they are interacting (Gotlib, 1982) they speak more slowly and more...

Quantity of social interactions in MDD

Continued to report restricted social networks even when they were no longer symptomatic (Billings & Moos 1985a, 1985b Gotlib & Lee, 1989). Moreover, there is strong evidence that depression is associated with such stable characteristics as low assertiveness, social withdrawal, avoidance, and shyness all traits that have been found to be associated with reduced social activity (Alfano et al., 1994 Anderson & Harvey, 1988). In fact, both the lack of assertiveness (Ball et al., 1994) and the presence of social withdrawal (Boivin et al., 1995) have been found to predict future depression, a pattern of results that suggests that reduced social activity may serve as a risk factor for depression. Although promising, it is clear that more research using prospective designs needs to be conducted before we are able to understand fully the causal nature of the relation between reduced social activity and episodes of depression. In this context, there are several reasons why depression may be...

Social phobia

Social phobia only recently became an official diagnostic category. In the first and second editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM),(12) all phobias were grouped together. However, in 1966, Marks and Gelder(3) observed that various phobias had different ages of onset and surmised that they might be distinct disorders, providing the initial impetus for the inclusion of social phobia in DSM-III. (4) Nevertheless, research into the nature and treatment of social phobia lagged behind that for other anxiety disorders, leading to its description as the neglected anxiety disorder. (5) Over the past decade, however, attention to the conceptualization, definition, and classification of social phobia has increased dramatically.

Dual focus driving intentionality down and defining the biological contrasted with the physical

However, three further aspects of the operation of rules are implied in this account, and need to be spelled out. Firstly rules are conventionalized within biological systems. They have to be followed throughout the system for the information to be preserved, and for this to happen the elements in the system have to use the same convention. The term 'agreement' adequately captures the essential point that how a rule is specified is open to substantial variation, but that rule has to be adopted throughout the system, for it to work. This is linked to the point made earlier in respect of Wittgenstein's view of what is involved in a person's following a rule the rule is made in a shared practice. In respect of a person that means it is made in their shared social interactions, and for a biological system it means that elements of the system work in consort with other elements. In both cases the idea that the rule is made captures that there is a convention that things will be this way...

Box 15 Dimensions of stigma

Epilepsy carries a particularly severe stigma because of misconceptions, myths and stereotypes related to the illness. In some communities, children who do not receive treatment for this disorder are removed from school. Lacking basic education, they may not be able to support themselves as adults. In some African countries, people believe that saliva can spread epilepsy or that the epileptic spirit can be transferred to anyone who witnesses a seizure. These misconceptions cause people to retreat in fear from someone having a seizure, leaving that person unprotected from open fires and other dangers they might encounter in cramped living conditions. Recent research has shown that the stigma people with epilepsy feel contributes to increased rates of psychopathology, fewer social interactions, reduced social capital, and lower quality of life in both developed and developing countries (22).

Driving intentionality back up

The task of taking intentionality back 'up' is not complete without a consideration of the way two or more organisms that have evolved the capacity for multiple rules of interpretation may co-exist, co-operate, or compete. As long as our examples concern the interaction between a rule-bound organism and the physical world, then only one side of the equation is open to variation. When both participants behave in ways that are open to variations, depending on the rules, there is scope for substantial misinterpretation. This is not a problem for many organisms in which the rules of social interaction are invariant and genetically set. This does not mean that they lack complexity. Bees communicate the direction and distance of nectar-bearing flowers in relation to the hive in a dance in which the distance and the angle of the central run to the sun carries the key information. This has all the features of intentional processes that we described earlier, notably that it is conventionalized...

Social and emotional development

Alongside cognitive development, children are developing both socially and emotionally. It has been recognized for years that children brought up in institutions, away from their natural parents, often develop serious and subtle problems in social interactions and emotional development. Having good supportive social relationships has been shown to be a major protective factor in the aetiology and maintenance of many psychiatric disorders. The ability to make and maintain friends initially of the same age and later of any age is often related to the existence of disorders such as personality disorders, social anxiety disorders, depression, and even PTSD. The emphasis on social skills training for socially inadequate persons points to the early basis for such deficits even though they may have their greatest impact in adulthood. Some children are less sensitive to social cues than others, and some misinterpret the intentions of other people. Both lead to difficulties, albeit of...

Biological psychology

To a large extent, psychiatric symptoms can be interpreted in terms of radicalized temperaments and extreme emotions. l) For example, the shyness implicated in social phobia is connected to neuroticism or, as some researchers prefer to call it, negative affectivity. Likewise, the impulsive behaviour of a psychopathic criminal is the extreme manifestation of a trait known as sensation-seeking. Phobic reactions represent exaggerations of normal fear, while the blunted affect of a schizophrenic patient indicates the breakdown of normal emotion regulation. Thus it is obvious that the study of temperament and emotions is relevant to psychiatry.

Earlier Observations of Psychical Secretion

Note that in the last sentence Whytt also anticipated Garcia's (1990) bait-shyness learning. Further descriptions of salivary responses presumably elicited by learned stimuli were made by Erasmus Darwin (the grandfather of Charles Darwin) in 1796, French physiologist C.-L. Dumas (1803), Claude Bernard (1872), and others, as I have documented elsewhere (Rosenzweig, 1959, 1960).

Chapter References

Wells, A., White, J., and Carter, K. (1997). Attention training effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4, 226-32. 103. Clark, D.M. and Wells, A. (1995). A cognitive model of social phobia. In Social phobia diagnosis, assessment and treatment (ed. R. Heimberg, M. Liebowitz, D.A. Hope, and F.R. Schneier), pp. 69-93. Guilford Press, New York. 105. Stopa, L. and Clark, D.M. (1993). Cognitive processes in social phobia. Behaviour Research and Therapy, 31, 255-67.

Social Functioning In Depression

Depressed individuals are characterized by a wide range of social deficits (see Barnett & Gotlib, 1988 Segrin, 2000, for reviews). It is noteworthy that there is no single cohesive theory to account for the origins of these social difficulties. Instead, relatively isolated bodies of empirical research (for example, studies examining the associations between depression and stressful life events, social networks, marital functioning, etc.) have implicated different aspects of interpersonal functioning as being important in understanding the etiology and maintenance of depression, as well as relapse of this disorder. Given recent reviews of the social functioning of depressed persons (e.g., Hirschfield et al., 2000 Segrin, 2000), we will not attempt to present an exhaustive review of this research in this chapter. Rather, we will organize our discussion of the social functioning of depressed persons by describing two main types of social deficit in MDD those that involve problems with...

Helping motivation the social matrix

When incentives are powerful, many newly abstinent patients are able to abstain for short periods. Others lack the skills to cope with the triggers to drinking even when their motivation to abstain has been strong. Cognitive-behavioural therapies seem to improve the coping skills of these patients. If the triggers are in social situations, assertiveness or conversation skills training can help. If the trigger is related to life problems, cognitive therapy may be effective. Other patients are helped by learning to handle frustration and criticism without anger, and to express anger instead of harbouring it. Treatment can be in groups, where the opportunity to discuss these topics with others who have similar problems is appreciated. Groups also enable learning through role playing and by modelling on others.

Response stereotypy A reformulation of emotional deficits in MDD

The results of naturalistic studies also indicate that depressed individuals exhibit emotional stereotypy, showing little modulation of their facial affect (e.g., Andreasen, 1979 Kulhara & Chadda, 1987) or vocal characteristics (e.g., Hargreaves et al., 1965). These findings are especially important because they indicate that depressed individuals exhibit stereotyped emotional responses in social situations. Indeed, as we will discuss in the following section, we believe that the capacity to shift affect appropriately is crucial if one is to interact effectively with others. In this context, therefore, the lack of affective modulation among depressed individuals is likely to have important implications for their social functioning.

Who uses drugs and why

Why take drugs Some have argued that the search for 'altered consciousness' is a basic human appetite, fy,8) but most young experimenters would simply say that drugs are pleasurable, exciting, or useful for getting into the party spirit. Other reasons include the relief of unpleasant feelings such as shyness or anxiety, fitting in with friends, or revelling in a sense of sophistication, rebellion, or independence. (4) Males are less likely to be total abstainers and tend to consume larger quantities than females. Genetic make-up, psychological factors, family background, and socio-economic circumstances are all influential in shaping the response to an offer of a drug and in determining the cost-benefit equation that will result in cessation, persistance, or abuse. (9)

The preschizophrenic person

Individuals who develop schizophrenia as adults are more likely to manifest difficulties in social interaction during childhood and adolescence than individuals who do not develop schizophrenia. Among children at increased genetic risk (having a parent with schizophrenia), poor social competence at age 7 to12, and passivity and social isolation in adolescence, have been found to be common in those who go on to develop the disorder as adults. (93 The association between such 'schizoid' traits and the risk of adult schizophrenia is not restricted to such high-risk populations. Evidence of early developmental peculiarities in children who develop schizophrenia as adults has been provided by prospectively collected data on a national birth cohort in the United Kingdom. (94) Preschizophrenic children had an excess (odds ratios, 2.1-5.8) of speech and educational problems, social anxiety, and preference for solitary play.

Social and geographic risk factors

Social isolation in poor deprived parts of the city could precipitate schizophrenia. However, subsequently their results were interpreted as a consequence of social drift, i.e. the idea that individuals with this illness 'drift' down the social scale. (42) This effect is postulated to result from not only the illness itself but also its prodroma and consequences such as loss of employment and estrangement from family. A related finding is that of lack of upward social mobility in individuals with schizophrenia. For example, Hollingshead and Redlich(43) reported that individuals with schizophrenia to be less likely than expected to attain the socio-economic status of their fathers.

Eyegaze Perception Neurological Evidence

The system for eye-gaze detection is ideal for exploring neural mechanisms of relevance to social interactions even if, in itself, eye-gaze detection is an elementary part of social behavior. For one, eye-gaze perception can be explored with invasive methods in nonhuman primates, yielding highly specific and localized information. Second, since eye-gaze perception is relatively independent from language, it is less problematic to make generalizations across species. Finally, since eye-gaze detection is driven by external stimuli, it is possible to systematically manipulate the system.

Clinical features

Schizotypal patients show pervasive deficits in social and interpersonal traits. They often demonstrate aloofness, poor eye contact, affective constriction, and suspiciousness. Consequently, close interpersonal relationships are either avoided or cause discomfort and anxiety. Thus, these individuals have few friends. Not surprisingly, schizotypal patients are often deficient in accurately sensing social cues or affective signals from others. Although they can interact with people when necessary, they often prefer not to, and do not become more comfortable in social situations with time.

Diagnosis and differential diagnosis

The differential diagnosis includes a variety of other disorders. A key difference between schizotypal personality disorder and schizophrenia, a psychotic mood disorder, or another psychotic condition involves the transient nature of psychotic symptoms in schizotypal personality disorder. It may be distinguished from developmental communication disorders by a lack of compensatory means (e.g. gestures) of communicating, and it may be distinguished from autistic or Asperger's disorders by the relatively greater deficits in social awareness and frequent presence of stereotyped behaviours in those disorders. Schizotypal personality disorder may be confused with several other personality disorders, but it can be distinguished. In particular, it differs from schizoid personality disorder by its pattern of cognitive-perceptual distortions, and by the odd appearance or behaviour shown frequently by schizotypal patients. The pattern of schizotypal symptoms also differs from that manifested in...

Possibilities for prevention

Primary prevention, which involves treatment before the disorder manifests itself clinically, is not yet available for schizoaffective disorder, schizotypal personality disorder, or other disorders in the schizophrenia spectrum. To develop such treatments, it will be necessary to predict who is most likely to develop a disorder. Here, there are some encouraging signs. These include several ongoing 'high-risk' studies, which follow the offspring of schizophrenic parents longitudinally. Such studies help to identify traits early in life that predict which individuals are most likely to experience clinical symptoms in adulthood. In the New York High Risk Project, for instance, problems with attention in childhood predicted social deficits in adolescence and social isolation in adulthood. (53) In another study, Walker and Lewine(54) found that social and neuropsychological impairments characterized children who subsequently developed schizophrenia. This type of study is important because...

Aspects Of Facial Information Processing Behavioral And Electrophysiological Evidence

The behavioral, functional, and anatomical results described above reveal a network of brain structures, including area MT, FFA, STS, amygdala, and OFC, which act in concert to compute many aspects of facial information that are important for social interactions. Much like the findings from other cognitive systems, these results reveal a division of labor, with each area performing a computation that is smaller than the task as a whole. At the same time, each subsystem is heavily modulated by general resources such as the allocation of attention, thus arguing against any type of strong modularity. For example, when the task requires that subjects pay attention to eye gaze, the activity of the STS is increased, while the activation of the FFA, the area that encodes the structural aspect of faces, remains invariant. As expected, paying attention to face identity leads to the opposite pattern (Hoffman & Haxby, 2000).

Course and prognosis

Case Study Delusional disorder grandiose subtype A 78-year-old unmarried woman who had always lived alone was admitted to a geriatric medical unit after being found in unbelievably squalid circumstances. Although unable to care for herself and showing some evidence of malnutrition, she was in reasonable physical health and appeared quite personable in social situations. Her mood was cheerful but not elevated and she was non-demented. It gradually emerged that she believed herself to be a multimillionairess who did not have to care for herself because her affairs were being attended to by multiple servants. Although she appreciated that her home was filthy, she did not see any conflict in this. Her delusions were absolutely fixed but were encapsulated, and she showed marked preservation of personality features. When discussing topics other than herself she was quite reasonable and non-grandiose, and she regularly kept up to date on current affairs via the media.

Preparation of the Subjects

Adapt the rats to the handling procedures (Ator, 1991) and to the food pellets that will be used to reinforce responding in the operant chambers. Typically, precision 45 mg pellets are used, or 25 mg pellets for mice or small rats, available commercially. This latter step can be accomplished by offering the rats 5 to 10 pellets each day in their home cages or in a holding cage for several days prior to beginning training. This adaptation will obviate possible bait-shyness that may accompany introduction of a novel food.

Impairment in social and familial relationships

The relationship between marital disturbance and affective disorder has received increased attention over the two past decades. First, descriptive studies have suggested that marital conflict correlates highly with concomitant depression,(65) and marital therapy has been found to be effective in reducing the symptoms of depression, alone(66) as well as in combination with pharmacotherapy 67) Further, previous research found dysfunctional patterns of communication in couples with a depressed spouse. Specifically, compared with their non-depressed counterparts, depressed couples have been found to exhibit more friction, lack of affection, lower levels of constructive problem solving, mutual self-disclosure, and reciprocal support. (Z6,69 The lack of a confiding and intimate relationships leaves individuals vulnerable to depression 7,7 Z1) Finally, marital distress may also exacerbate difficulties experienced in extramarital relationships, (72) thereby increasing introverted behaviour...

Positive affect PA and negative affect NA

There have been a few studies that have explored the regulators of PA and NA separately. Clark's (2000) review indicates thatNA is associated with threats and irritations, whereas PA seems particularly associated with social engagement and activity. Interestingly, MacDonald (1988) argued that PA systems have undergone extensive evolutionary modification in the last few millions years. The 'drive' for this has been the role of social relationships (especially affiliative ones) in our evolution, making us into the highly social and interactive species we are. PA capacity and control have evolved along with the complexity of, and multiple functions of, social relationships. Interestingly, there have been suggestions in the literature that some people may suffer from social anhedonia as a trait (that is, they have less interest in, and enjoyment of, social relationships). Such a trait may be related to vulnerabilities to schizophrenia (e.g., Blanchard et al., 2000). However, anhedonia in...

Is GAD a valid disorder

A subsequent study, using an anxiety clinic sample and an expanded array of measures, yielded similar results. (17 In this case, five primary factors (corresponding to panic, agoraphobia, social anxiety, obsessions compulsions, and general anxiety) and a higher-order factor (negative affect) were identified. Again, patients with GAD had a unique factor profile.

Clinical presentation

Almost everyone experiences anxiety in situations involving potential evaluation by others (e.g. job interviews, public-speaking engagements, first dates). However, for individuals with social phobia, these situations are typically associated with incapacitating levels of anxiety and a desire for escape or avoidance. Many individuals with social phobia are self-critical and perfectionistic attempting to conduct themselves according to extreme and exacting standards to avoid the negative evaluation of others that they may perceive as epidemic. Commonly, persons with social phobia experience somatic symptoms such as blushing, trembling, dry mouth, or perspiring, which they believe will be noticed by others and provide further evidence of their incompetence. By leaving anxiety-provoking situations (escape) or by foregoing them entirely (avoidance), individuals with social phobia may reduce or prevent the immediate experience of anxiety, but this relief may also reinforce their belief in...

Selective serotonin reuptake inhibitors

In an industry-supported trial,(53) 183 patients with generalized social phobia received either paroxetine or placebo. In an intent-to-treat analysis, 55 per cent (50 91) of patients receiving paroxetine, compared with only 23.9 per cent (22 92) of patients given placebo, were much or very much improved after 11 weeks. Patients tolerated paroxetine well, as indicated by relatively modest levels of attrition (15 per cent 14 91). In an earlier study, (54) patients with generalized social phobia were treated for 11 weeks with paroxetine. Of these, 16 responders were then randomly assigned to 12 additional weeks of paroxetine or pill placebo following a step-down discontinuation five patients given placebo, but only one paroxetine patient, relapsed following discontinuation. Favourable results were reported for a small cross-over trial of sertraline and placebo ( n 12).(55) Patients receiving sertraline first endorsed reductions in both clinician- and self-rated measures of social anxiety...

Cognitivebehavioural group therapy

In this section, we describe cognitive-behavioural group therapy ( CBGT)(78) (our treatment protocol, which integrates cognitive techniques and exposure in the treatment of social phobia) and briefly review the literature supporting its efficacy. Most commonly, this form of therapy is conducted in weekly sessions of approximately 2.5 h for 12 weeks. The optimal number of patients is six. Effort is taken to balance the group in terms of age, gender, and social phobia subtype. Ideally, male and female co-therapists lead the groups to allow for maximum flexibility in constructing within-session exposure exercises. In the first two sessions, patients receive the rationale and instructions for exposure, cognitive restructuring, and homework assignments as well as opportunities to practise cognitive restructuring skills. Thereafter, therapists lead patients through individualized exposures that are preceded and followed by therapist-directed cognitive restructuring exercises. Patients are...

Social skills training

Social skills training is based on the assumption that individuals with social phobia lack the basic skills for social interaction. This deficit provokes negative reactions from others, and social interactions become unpleasant and anxiety-provoking for the patient. (81) Research examining whether socially anxious individuals exhibit deficits in social performance is mixed, with some studies suggesting that their performance is poorer than non-anxious controls (82,83) and other studies finding no differences 84,8 and 86) Even if an individual with social phobia does perform poorly, this may be the result of inhibition caused by anxiety or maladaptive beliefs rather than poor social skills (i.e. a lack of knowledge or ability to carry out the appropriate behaviours). Nevertheless, the effectiveness of social skills training in the treatment of social phobia has been examined both alone(87 and as part of multicomponent treatment packages 88 Social skills training commonly includes...

Relaxation strategies

Relaxation strategies are based on the notion that individuals with social phobia experience extreme physiological arousal that interferes with performance. Applied relaxation involves training in three skills. First, the patients learn to attend to the physiological sensations of anxiety. Second, the patients learn to relax quickly while engaging in everyday activities. Finally, the patients learn to apply relaxation skills in anxiety-provoking situations. (90 Applied relaxation thus combines relaxation and exposure to help individuals cope with anxiety-provoking situations. Treatment studies suggest that applied relaxation is superior to delayed treatment (91, and as effective as social skills training. (,92 However, applied relaxation was less effective than cognitive treatment in one study.(91) Research has demonstrated minimal improvement in social phobia symptoms when relaxation techniques are not combined with exposure 61,62)

Human Values The Issue of Origins

As will be made clear in the text ahead, we do not wish to minimize the role of social interactions and cultural history in the construction, refinement, codification and transmission of those values. We are not reducing human values to biological inherited instincts. We simply wish to suggest that the construction

Treatment of comorbid patients

Treatment of comorbid social phobia, obsessive-compulsive disorder, or GAD has recently been made somewhat simpler with the demonstration that the SSRIs are effective in these other conditions as well. Although not yet empirically demonstrated, it is reasonable to expect that an SSRI would effectively treat the panic disorder as well as the other comorbid anxiety disorders. This is an important area for future research. Behavioural treatments specific to obsessive-compulsive disorder and to social phobia may well be needed in addition to medication treatment.

Definitions and Epidemiology

Fecal incontinence is defined as the impaired ability to control gas or stool to allow evacuation at a socially acceptable time and place. It has been shown in a number of studies that incontinence affects self-confidence and personal image, and can lead to social isolation causing a significant impact on quality of life.1-5 The true prevalence of fecal incontinence is unknown because it is thought to be greatly underreported. In a community survey of 7000 patients in the United States, 2.2 of patients reported incontinence to liquid or solid stool or gas.2 In other pop

Inpatient treatment

Inevitably the patient will find it irksome to forego home visits for the whole period of weight gain. Therefore interesting and therapeutic activities should be provided through group meetings, occupational therapy, and social interactions. Visiting is generally encouraged unless the patient's restlessness is such that visiting parents are subjected to emotional appeals to be taken home. They may then be asked to postpone their visits or reduce their duration.

Locomotor Response to Psychostimulants

Several studies have shown that stress-induced sensitization to the locomotor effects of psychostimulants depends on the increase in corticosterone levels induced by the stressor. Thus, treatments that block stress-induced corticosterone secretion, but maintain basal levels of the hormone, have been shown to inhibit stress-induced sensitiza-tion. For example, adrenalectomy associated with replacement of basal levels of glucocorticoids (via subcutaneous corticosterone pellets) prevents the increase in locomotor response to amphetamine observed after food-restriction stress (53). A similar effect is seen on the locomotor response to amphetamine following social isolation (68), restraint stress (69), or different repeated stressors (70). These findings are confirmed by the observation that pharmacological blockade of stress levels of corticosterone (with acute or repeated metyrapone treatment) also decreases sensitization to the psychomotor effects of cocaine or amphetamine (15,71) (Fig....

Health Impact of Obesity

Obesity can negatively impact a young person's health in many ways besides the neurological, cardiovascular, and metabolic effects. The patient is at risk for developing hepatic steatosis, polycystic ovary disease, and orthopedic problems like slipped capital femoral epiphysis, pseudotumor cerebri, and sleep apnea 45 . Finally, the psychosocial trauma of low self-esteem and social isolation can significantly impact the quality of the child's life. Having a chronic disease like obesity, with or without comorbidities, can be traumatic for a pre-adolescent or an adolescent. In one cross-sectional study by Schwimmer et al., 106 severely obese children and adolescents aged 5 to 18 years ranked their health-related quality of life the same as did children and adolescents with cancer 46 .

Associated psychopathology and comorbidity

Kleptomania often co-occurs with other psychiatric disorders. Of 20 patients with DSM-IIIR kleptomania evaluated with the Structured Clinical Interview for DSM-IIIR HJ all 20 patients met criteria for a lifetime mood disorder (with 12 (60 per cent) having a bipolar disorder), 16 (80 per cent) for at least one anxiety disorder (with nine (45 per cent) having obsessive-compulsive disorder, eight (40 per cent) having panic disorder, and eight (40) per cent having social phobia), 12 (60 per cent) for an eating disorder, 10 (50 per cent) for a substance use disorder, and eight (40 per cent) for at least one other impulse control disorder. Of 37 people recruited by newspaper advertisement with DSM-IV-defined kleptomania, 30 (81 per cent) reported current psychiatric problems. Specifically, 54 per cent had 'hereditary psychiatric illness', 43 per cent had 'more general problems related to food intake and body weight', and 22 per cent had alcohol misuse or abuse. Conversely, high rates of...

Contributions From Neurological Studies

On tasks requiring the interpretation of social situations, which mirrored her impairment in real-life functioning. The role of the orbitofrontal cortex in emotion regulation is further supported by a study involving five cases with similar orbitofrontal lesions (Beer, Heerey, Keltner, Scabini, & Knight, 2003). Following comparison with healthy individuals on a number of social emotional measures, this study suggests that deficient behavioral regulation is associated with inappropriate self-conscious emotions, or faulty appraisals, that reinforce maladaptive behavior. Moreover, the authors provided evidence that deficient behavioral regulation is associated with impairments in interpreting the self-conscious emotions of others. The study of degenerative neurological diseases has also supplied evidence for relatively distinct routes to social cognition and empathy deficits. For instance, Snowden and colleagues (2003) have shown that both patients with a frontotemporal dementia (FTD, a...

Cognitivebehavioural therapy

Preliminary data suggest that cognitive-behavioural therapy (CBT) may be effective for treating BDD. Promising approaches include cognitive restructuring, exposure (e.g. exposing the defect in social situations and preventing avoidance behaviours), and response prevention (avoiding compulsive behaviours, such as mirror-checking). In a report of five patients, four improved using such approaches in 90-minute sessions for 1 day or 5 days per week (with a total of 12 to 48 sessions) 24' Techniques included having patients cover or remove mirrors, limit grooming time, and stop using make-up. Exposure techniques included going to restaurants or stores and sitting in crowded waiting rooms.

Irritable bowel syndrome

Patients with irritable bowel syndrome who seek medical care exhibit high rates of psychiatric disorders. The most frequently occurring are panic disorder (26 per cent), generalized anxiety disorder (26 per cent), social phobia (26 per cent), and major depressive disorder (23 per cent). (43) Patients with irritable bowel syndrome who are depressed and complain of diarrhoea may benefit from tricyclic antidepressant treatment because of their anticholinergic effects. Anxious patients may benefit greatly from buspirone.(39) Even among patients with no diagnosable psychiatric disorder, antidepressant or antianxiety medication may be helpful. In one study, Clouse(44 reported that among a group patients with treatment-refractory irritable bowel syndrome nearly half had no psychiatric disorder more than 90 per cent benefited from low-dose antidepressant or antianxiety medications 92 per cent of patients improved, and 56 per cent experienced complete remission of irritable bowel symptoms.

HIVassociated acute stress reaction

Some patients suffer from intrusive thoughts or brooding related to their uncertainties regarding health, the future, the risk of contagion to others (especially loved ones), and the idea of death. The vegetative symptoms of panic attacks are also usually present (e.g. palpitations, dry mouth, hot flush, trembling, pressure in the chest, epigastric disturbance). In more severe cases, the patient may also present social isolation, verbal expressions of rage or feelings of desperation, and other forms of altered behaviour. These symptoms tend to appear within a few minutes to a few hours after the subject is informed, and remit in 2 or 3 days.

A small mammal of the genus Mus family Muridea order Rodentia rodents

The mouse has a lot to offer to biologists and psychologists alike. It is a small mammal (20-35 g), but not small enough to make the life of anatomists and physiologists miserable. The size of the brain is manageable. The generation time is 3-4 months, and the litter size six to eight in inbred lines. Handling is easy and the food inexpensive. Only the smell of the mouse colony is a potential obstacle. The mouse is an agile, social animal (Williams and Scott 1953). It has a rich behavioural repertoire, and is quick to learn, especially in natural situations that involve the chemical senses, spatial information, and social interactions. Perhaps the classic example of mouse behavioural analysis is that of the dancing (waltzing) mouse by Yerkes (1907). Even Pavlov, whose favourite experimental subject was the dog ( classical conditioning), switched to the mouse to study the inheritance of conditioned reflexes (Razran 1958). Since those early days, mice have been used extensively in the...

Frailty dependency death and dying

Social policy and formal services are dealt with elsewhere in this book. This chapter draws brief attention to the ways in which lifestyle and life experience impact on patterns of service use. Wenger's network type correlates at high levels of statistical significance with most demographic and social variables, outcome variables such as health, morale, loneliness, and social isolation. In terms of formal services, it predicts the following the types of presenting problems, the likely duration of need for long-term care, the type of services most likely to be needed, and even the response of the person to different types of intervention. The distribution of support networks is related to community(primarily on the basis of population turnover) and hence knowledge of the distribution of network types in a given catchment area can be used as a planning tool for service provision. For instance, in stable areas with high proportions of family-dependent and community-integrated networks,...

Implications for mental health care

In addition to maintaining mobility, older people seek to maintain relationships with significant others and these two goals are not unrelated. Adequate informal social support reduces the risk of social isolation, loneliness, and depression. Risk is greatest at times of transition, crisis, or emergency. (14) Variation in patterns of social support or different types of support networks provide different forms of protection. Some types of networks are more robust than others. Mental health practitioners need to keep in mind (a) the importance of protecting independence, (b) the importance of relationships, and (c) the precise social context for each older person. These factors can be applied to all older people whether they are living alone, with a spouse, in a three-generation household, in sheltered housing, or in residential care. Protecting at least some autonomy, recognizing the importance of being seen as a participating member of society, and allowing choice during the third...

Schizophrenia and paranoid disorders

Although prevalence is lower than in younger adults, within the elderly group the prevalence of schizophrenia and paranoid disorders appears to increase with age. Moreover, psychotic states can be viewed as a continuum in the population, ranging from mild symptoms such as paranoid ideas to a diagnosable disorder. Psychotic symptoms are much more common in the elderly than psychotic disorders. Factors associated with psychotic symptoms include female gender, impaired hearing and vision, social isolation, and cognitive impairment. (34) In the case of social isolation, it is unclear whether this is a cause or an effect. Psychotic symptoms are common in dementia, but differ from those found in schizophrenia or paranoid disorders in that they can arise due to misunderstandings associated with memory or intellectual impairment.

Limitations of stimulant medication

Medication also has a limited duration of action. Typically, children take immediate-release stimulant medication twice daily or a sustained-release preparation once daily. Under these circumstances, medication is no longer effective after school. As a result, dysfunctional social interactions may persist, resulting in adverse effects on both immediate and long-term social function l1 ,161)

Child characteristics

Infants with temperaments classified as 'difficult' at 3 years of age are more likely to be referred for aggressive problems later on. (3Z38) The dimensions involved are behavioural impulsivity (lack of restraint), short attention span, and motor restlessness. Although not occurring at a clinical level, these are precisely the constituents of the hyperkinetic syndrome together with the trait of negative emotionality (irritability, anger, and bad moods) they have a clear modest effect in predicting later antisocial behaviour of the early-onset type. Social anxiety on the other hand is protective.

Anxiety disorders Classification

Anxiety disorders consist of a set of syndromes, ranging from very circumscribed conditions such as specific monophobias (e.g. a fear of spiders) to broad disorders characterized by free floating anxiety and general worry exemplified by the diagnosis of generalized anxiety disorder. According to DSM-IV there are eight major separate diagnostic categories with two specific to the childhood period separation anxiety disorder and reactive attachment disorder. In contrast, ICD-10 denotes five anxiety syndromes specific to this period of life separation anxiety phobic anxiety social anxiety sibling rivalry disorder and generalized anxiety disorder. ICD-10 prefaces the classification of anxiety disorders with a general introduction, indicating that these conditions are mainly exaggerations of normal developmental trends rather than phenomena that are qualitatively different and abnormal in themselves. Developmental appropriateness is a key diagnostic feature in defining the difference...

Other anxiety disorders

ICD-10 has retained phobic anxiety disorder, social anxiety disorder (avoidant disorder in DSM-IV and DSM-III), sibling rivalry disorder, and generalized anxiety disorders as specific diagnoses of emotional disorders in children. In contrast to ICD-10, DSM-IV has chosen not to emphasize the differences in the developmental timing of these disorders, even though the global clinical features of these conditions (including gender, race, and a range of comorbid characteristics) are broadly similar. A brief summary of the features of these disorders as they pertain to children is provided here. Detailed coverage of anxiety disorders can be found in Chapter 4.7.1,, Chapter. .4.7.2, and Chapter 4.7.3.

Leaf Van Boven George Loewenstein

Such emotional perspective taking is ubiquitous in everyday life, and doing it well is important for social interactions. This chapter describes a simple, dual-judgment model of how and how well people engage in emotional perspective taking. The chapter also describes recent studies that test a key implication of the model that errors and biases in predicting one's own reactions to emotional situations produce

The Central Theoretical Problem on the Functional Level of Description

Of course, one might think that the elementary body percept is consolidated in social interactions only after birth, or during earlier motor behavior in the womb.19 On the other hand, a persistent functional link between regions of primary somatosensory cortex and certain regions in the bodily self-model is proved by direct electrical stimulation during neurosurgical operations under local anesthesia (see Melzack et al. 1997 ). Of course, sensory body and motor maps are highly plastic and subject to the influence of experience even in the adult organism. And, of course, one has to see that there is probably no such thing as absolute invariance or functional rigidity. But there is good evidence for some kind of innate body prototype, as can, for instance, be seen from the phantom sensations reported by some phocomelic children, who are born without one or more limbs. It seems that these data show that even people born without limbs develop complex bodily self-models which sometimes...

Neurodevelopment and psychological development

We should be clear that there are other possibilities. For instance it could be argued that the neurodevelopmental deficit, whilst present from early childhood, is not expressed until the time when schizophrenia is commonly first seen, in adolescence, perhaps as a result of neuronal maturation at that age. Then our analysis might not apply. It seems, however, that at least a significant number of children who are at risk for schizophrenia do show differences from other children. Studies of the children of parents with schizophrenia have shown that they have more attentional deficits, and that these are associated with subsequent social insensitivity, social indifference, and social isolation (Cornblatt et al. 1992). Clearly studies such as this are complicated by the presence of parents with schizophrenia who might have the same or similar hypothesized deficits as their children, however they provide some preliminary evidence that deficits may be present in childhood which could...

Questions And Consequences Predicting Feelings versus Choices

Furthermore, when people are in different emotional situations from their interaction partner, they may have difficulty in taking others' behavior at face value, as it were. When other people are in an emotional situation, it may be difficult not to predict how oneself would react (Hodges & Wegner, 1997). This self-prediction, once made, is likely to serve as an (erroneous) expectation against which others' behaviors are judged (Reeder, Fletcher, & Furman, 1989). In our study of dancing for money, for example, a student facing a hypothetical choice may use her erroneous prediction that she would dance for 5 as a basis for inferring that another's decision not to dance reflects the nondancer's dispositional shyness rather than a normal reaction to an embarrassing situation. Self-predictions may thus lead people in cold states to misinterpret the actions of people who are in emotional situations.

Developing countries17

Rigorous studies are more difficult and good record systems less common in developing countries, so there are few reliable sources for estimating prevalence, but data available suggest differences related to the varying spectrum of organic causes, mortality, and social situations. fy,1.6.) Developing countries are not all the same for example the high infant mortality of most African countries is not shared by China. In some, cretinism due to iodine deficiency disease is an overwhelming cause and can affect over 10 per cent of village populations before salt iodization or similar programmes have much impact. Children with Down syndrome do not generally survive in communities with high infant mortality.

Environmental influences

Apart from the range of potential adverse psychosocial experiences that children in the general community might experience, children with mental retardation are more likely to experience further potentially adverse experiences such as respite and institutional care, social rejection, teasing and school adjustment problems, abuse, and neglect. Limited cognitive ability to understand and discuss socially stressful experiences may compromise adaptation and contribute to behavioural disturbance. Parental grief, guilt, hostility, ambivalence, and rejection, increased financial burden of care, and family stresses are further factors likely to impair attachment, relationships, and the quality of the care environment. (52 Behavioural problems, impaired responsiveness and capacity for reciprocal social interactions, communication difficulties, and low resilience, particularly in some vulnerable groups of children with mental retardation such as those with autism, further impairs attachment and...

Longterm social and interpersonal factors

Those with chronic mental illness, in particular schizophrenia, tend to have impoverished social networks. They often alienate or outlive their immediate family, are less often able to establish and maintain a partnership, are more often childless, and are often reduced to looking to casual acquaintances and professionals for their interpersonal contacts. A narrow range of social contacts providing inadequate support combined with conflict within those relationships which do exist may well predispose to violence.(8 ) Social isolation or the intense dependent, but conflictual, relationships with a single individual which so often accompany an impoverished social network should be considered risk factors for violent behaviour.

Schizotypal Personality Disorder

Emotionally, people with Schizotypal Personality Disorder are likely to show a restricted range of expression and in some cases, inappropriate affect. They have high levels of social anxiety with the themes of suspiciousness and paranoia contributing largely to the social deficits. Striking examples of unusual thought processes and emotions were shown in one of our patients, an 80-year-old woman, who during a relatively non-threatening part of the initial intake suddenly burst into tears and sobbed uncontrollably for several minutes. When asked what prompted her intense feelings, she replied that she was not sad, but rather that her sister (who was her only close relationship and who was living in another state) was crying at that very moment and the patient could always feel her sister's feelings. Later in the same interview, the patient began laughing hysterically and reported that her sister was having a good time at that moment. Table 2.5 provides the DSM-IV-TR diagnostic criteria...

Phobic and anankastic disorders

Phobias initially triggered by a very specific stimulus can eventually generalize. Thus an elevator phobia may become extended to all kinds of closed rooms. Some phobias are linked with broader circumstances from the beginning. In social phobia, for instance, patients avoid meeting people because they fear that they will be noticed because of certain body features or personality traits. Identical types of fears can be triggered by different stimuli in different subjects. Thus illness phobia is activated in some patients by observed body changes, but in others by situations involving the risk of infection.

Sadistic Personality Disorder Dsmiiir Appendix A

In contrast, spineless sadistics have predominately avoidant personality disorder features. These individuals are essentially highly insecure, and they have a strike first attitude to counter their insecurities and feelings of powerlessness. Millon and Davis (2000) propose that people who join hate groups often have the spineless type of Sadistic Personality Disorder. They also hypothesize that spineless types take out their aggression and hostility on especially defenseless or helpless targets.

The Evolutionary Neurodevelopmental Perspective

Perspectives such as biological, cognitive, interpersonal, and psychodynamic are useful for illuminating a given personality from a particular angle but do not permit holistic conceptions. Whereas most other personality disorders have ample historical precedent, the avoidant personality was originally formulated from Millon's biopsychosocial theory of personality in 1969 as the actively detached pattern, as distinctive from the passively detached schizoid personality. This conception shares many features with its modern evolutionary counterpart (Millon, 1990 Millon & Davis, 1996) that describes the avoidant as active and pain oriented in its evolutionary structure, while the schizoid is markedly passive, largely insensitive to either pleasure or pain, and only very moderately attuned to self over others in orientation. For schizoids, interpersonal detachment is ego-syntonic Social isolation is simply solitude and does not trouble the individual. In contrast, the avoidant is actively...

Sleeprelated Breathing Disorders Clinical Features

The daytime behavior is an important difference between adults and children with SDB. The abnormal daytime sleepiness may be recognized more often by schoolteachers than by parents of young children. An increase in total sleep time or an extra-long nap may be considered as normal by parents. Nonspecific behavioral difficulties are mentioned to the pediatrician such as abnormal shyness, hyperactivity, developmental delays, rebellious or aggressive behavior (45). Chervin et al. found conduct problems and hyperactivity are frequent among children referred for SDB during sleep. They surveyed parents of children aged 2 to 14 years at two general clinics between 1998 and 2000. Parents of 872 children completed the surveys. Bullying and other specific aggressive behaviors were generally two to three times more frequent among children at high risk for SDB (46). Other daytime symptoms may include speech defects, poor appetite, or swallowing difficulties (4,47). Nocturnal enuresis or bedwetting...

Cluster A personality disorders Paranoid personality disorder JLC

Personailty Disorder Table

Paranoid features may be present in childhood and early adolescence in the form of hypersensitivity, social anxiety, poor peer relationships, and eccentricity. These features sometimes elicit teasing from other children, which in turn may aggravate the paranoid attitudes. Individuals with this personality disorder may be at increased risk for agoraphobia, obsessive-compulsive disorder, and substance abuse or dependence. This personality disorder is often codiagnosed with schizoid, schizotypal, narcissistic, and avoidant personality disorders. People with schizotypal personality disorder are suspicious, have paranoid ideas, and keep their distance from others. However, they also experience perceptual distortions and magical thinking, and are usually odd and eccentric. Schizoid personality disorder is characterized by aloofness, coldness, and eccentricity, but these individuals usually lack prominent suspiciousness or paranoid ideation. Individuals with avoidant personality disorder are...

Variations of the Avoidant Personality

Avoidant Personality Subtypes

A defining feature of avoidant personality disorder is the conflict of longing for intimacy versus the fear of vulnerability that naturally ensues in a close relationship with another. In a similar manner, those with a negativistic personality (formerly referred to as Taijin Kyoufu and Avoidant Personality Disorder Taijin kyoufu, literally interpersonal fear, is a syndrome characterized by interpersonal sensitivity and fear and avoidance of interpersonal situations (Ono et al., 1996, p. 172). Presumably, its origins lie in the belief that blushing, eye contact, ugliness, and body odor are noticeable and troubling to others. Apparently common in Japan, the disorder is recognized as a culture-bound syndrome in the DSM-IV (APA, 1994) that resembles social phobia. Such cultural distinctions make another prediction as well. You would expect that social phobia, being more concerned with embarrassment to self, would be more prevalent in individualistic societies such as the United States and...

A learned association of taste with visceral distress

Vpm Rat Brain

Also dubbed the Garcia Effect, Bait Shyness, or the B arnaise Sauce Effect (many a reader can probably offer idiosyncratic terms based on unpleasant personal experience), CTA does differ in a critical parameter from other associative learning paradigms. This parameter is the interstimulus interval (ISI), i.e. the time interval between the conditioned (CS) and the unconditioned (US) stimuli. Whereas in classical and instrumental conditioning an ISI of more than seconds commonly renders training ineffective, CTA training tolerates an ISI of several hours. It is this deviation from the widely accepted paradigm, namely that two stimuli must come close together in time in order to become associated in mind, that has led respectable psychologists to doubt the early scientific accounts of CTA.

Problems of children and adolescents with sensory impairment

Affective disorder is more prevalent in the hearing impaired. Higher rates of anxiety disorders, particularly social phobias, have been found amongst hard-of-hearing compared with deaf children 3 ' Children and adolescents with hearing impairment are also at risk of depression, and communication problems are likely to be contributory factors. Children who are able to communicate orally with their mother perceive them as communicating with them more and this enhanced communication is negatively correlated with depression. (3 ) The increased prevalence of depression and behavioural disorder in the hearing-impaired child persists into adulthood, but no increased prevalence of schizophrenia has been reported. (28

Group format for bulimia IPTG

Social phobia Unlike CBT, IPT has not yet been tested in controlled studies as a treatment for anxiety disorders. IPT is being modified for social phobia independently by Lipsitz at Columbia and by Stuart and O'Hara at the University of Iowa, with open trials progressing at both sites. Lipsitz (personal communication, 1996), having completed nine pilot cases, reports that the standard IPT ingredients, including the medical model, provision of the sick role, and the supportive therapeutic stance, appear to benefit most patients.

Theory Of Mind In Schizophrenia

Jokes About Perspective

Shyness, all it required was an understanding of shyness as a behavioral disposition (not an intentional mental state) for example, He's begging for money, but he's shy and can't face people the way normal beggars would. I have since removed this cartoon from my battery since it prompted the following unexpected responses from the same three patients. The first patient responded There's a guy asking for money to help him overcome his acute shyness problem. He's obviously a con-man trying to trick people into feeling sorry for him. The second patient responded He's got his back to the street and he's making out he's shy. He's obviously got a problem. And the third patient responded I don't think he's got a shyness problem. He's doing it to make people feel guilty so he can collect money. These three patients (all with a history of persecutory delusions) seemed oblivious to what was going on in the

Intentionality development and content

As usually in agoraphobia, or social phobia. The worry characteristic of generalized anxiety disorder, verging on panic, endless and fruitless, appears as a form of cognitive avoidance, in adults (Borkovec et al. 1991), and in children, once they develop the pre-requisite cognitive capacities (Vasey 1993). Avoidance is mandatory when situations are seen as really dangerous, as life-threatening, but for the very same reason they demand attention and vigilance paradoxical attempts to do both at the same time, in reality and in the imagination, are seen most clearly in post-traumatic stress disorder. Obsessive-compulsive disorder may represent a pre-rational coping style getting out of hand, exhibiting the characteristic, paradoxical combinations of coping and not coping, being in and out of control, and panic. The fundamental fear is being out of control where coping is essential, and this leads to excessive, out of control coping. In general, the problem and the solution become...

The Biological Perspective

There is evidence that the avoidant personality has a basis in temperament. Although shyness is not specific to the avoidant personality, its presence does suggest a sense of inner shame or self-doubt characteristic of the avoidant. Kagan, Reznick, and Snidman Avoidant Personality Disorder DSM-IV Criteria (4) is preoccupied with being criticized or rejected in social situations

The Interpersonal Perspective

Anxiety often precludes the avoidant's ability to speak fluidly and coherently, causing some avoidants to conclude that it would be best to not speak at all and attempt to melt into the woodwork. Such physical manifestations of interpersonal anxiety are likely to be especially acute in forced social situations, for example, when a school demands that all students attend a graduation ceremony, and many people are milling around and talking while waiting for things to start. Formal occasions are likely to be especially dreaded because they come with amplified codes of dress and behavior. Everyone knows what to expect and everyone is trying to conform, so discrepancies become magnified and errors stick out like a sore thumb. Allison would likely wait in the restroom and pray for the event to be over.

Types Of Fatigue In Pd

Central and peripheral fatigue have been identified in PD patients.16,18 Although some believe these are distinct types of fatigue, there is evidence that central mechanisms may underlie the accelerated muscle fatigue thought to be corroboration of peripheral fatigue.17,18 Central fatigue is characterized by difficulty in initiating and sustaining mental and physical tasks in the absence of cognitive or motor impairment.18 Mental fatigue has two subdivisions mental lassitude induced either by hypo- or hypervigilance. The former occurs with repetitive and boring tasks. In PD patients, reduced stimulation due to physical dependence and social isolation consequent to the disease may result in a hypovigilant state. Sustained hypervigilance can also cause mental fatigue, for example, when keeping close track of breaking news stories and making complex decisions. Sustained emotional stressors, such as a critical illness in a close relative, may result in emotional fatigue.

Subsequent social impairment

These findings have important theoretical as well as clinical implications since they suggest that the social isolation and lack of a supporting relationship that have been found in cross-sectional studies of adult depression (Brown & Harris, 1978) may reflect social selection as much as social causation. However, none of these studies excluded the effects that childhood conduct problems, which are commonly associated with adolescent depression, could have on these outcomes. Harrington et al. (1991) found that juvenile depression seemed to have little direct impact on social functioning in adulthood, whereas comorbid conduct disorder was a strong predictor of subsequent social maladjustment. Similar findings were reported by Renouf and colleagues (Renouf et al., 1997) in an intensive longitudinal study of depressed children and non-depressed psychiatric controls. Social dysfunction associated with comorbid depression and conduct disorder seemed to be mainly related to the effects of...

General clinical description of personality disorders

According to DSM-III and its revisions, personality disorders are characterized by maladaptive traits that cause subjective distress or significant impairment in social or occupational functioning. The behaviour is deeply ingrained and inflexible, displayed in a wide range of personal and social situations, enduring rather than episodic, and has its onset by adolescence or early adulthood. Although these requirements also describe certain features of some mental state or Axis I disorders, they are not absolutely essential for their diagnosis. Little is known about the other reasons for the frequent co-occurrence of personality disorders and mental state disorders. (4) In the absence of epidemiological data, it is possible that the current statistics on the subject, which are derived from treated cases, may overstate the relationship. Those with two disorders may be more likely to seek treatment than those with only one. For patients with similar disorders, for example social phobia...

Capsule History of Psychology

Until the middle of the nineteenth century the nature of the mind was solely the concern of philosophers. Indeed, there are a number of reasons why some have argued that the scientific investigation of the mind may prove to be an impossible undertaking. One objection is that thoughts cannot be measured and without measurement, science cannot even begin. A second objection is to question how humans could objectively study their own thought processes, given the fact that science itself depends on human thinking. A final objection is that our mental life is incredibly complex and bound up with the further complexities of human social interactions perhaps cognition is simply too complex to permit successful scientific investigation.

General aetiological considerations in delusional disorders

There may be genetic links with certain severe personality disorders, especially of the paranoid and schizoid varieties, but these are difficult to substantiate. There does seem to be an excess of such disorders in relatives and premorbidly in delusional disorder patients themselves. It is suggested that paranoid and schizoid traits are particularly liable to lead to social isolation and aggravation of delusional tendencies. (27,28)

Selfmonitoring And Prodromal Changes

Disruption and irregularity in circadian rhythms, social events, and activities have been found to impact significantly on mood and can trigger affective episodes in people suffering from bipolar disorders. In support of this effect, the regulation of social interactions and balanced sleep-wake cycles have been found to be effective in preventing relapse and subsyndromal mood swings in bipolar disorders. Bipolar patients are highly sensitive to disruptions in their biological rhythms (Malkoff-Schwartz et al., 1998). The regularity of daily routines and activities, as well as the regularity of sleep-wake cycles, has been

Intervention and psychological treatment

Psychological treatments in the field of neglect have concentrated on improving parenting skills and sensitivity through direct encouragement of positive interactions in feeding, play, and general care, combined with individual therapy for parents themselves, who have frequently experienced multiply deprived childhoods. Psychiatric treatment of parental mental health problems, such as depression or substance abuse, is critical. Mobilizing community-based supports and networks to overcome social isolation, and linking neglectful mothers with other parents who can provide role modelling and support, appear to be promising approaches.

Indications and contraindications Areas of application

Cognitive-behavioural programmes for young people with conduct disorder and aggression usually have a strong focus on social cognitions and interpersonal problem-solving. The aim of therapy is to remedy the cognitive distortions and problem-solving deficits that have been identified in empirical research. Several programmes have been developed and most have the following features in common. Self-monitoring of behaviour enables adolescents to identify and label thoughts, emotions, and the situations in which they occur. Social perspective taking helps them to become aware of the intentions of others in social situations. (25 Use is made of case vignettes, role play, modelling, and feedback. For example, children might be asked to describe what is going on in a picture. Anger control training aims to increase awareness of the early signs of hostile arousal (e.g. remembering a past grudge) and to develop techniques for self-control.

The school is an arena for mental health promotion

Active intervention can be selective. Building on studies showing that aggressive behaviour and social isolation or rejection are risk factors for future emotional and behaviour disorders, Kellam and Rebok(35) developed the Good Behaviour Game. This is classroom based the teacher divides the class into teams and the teams earn points by minimizing their members' disruptive behaviour. Shy children have rapporteur roles to increase their social participation. Its effectiveness in reducing aggressive and shy behaviour was shown in a randomized trial across schools.(36)

Jonathan Rottenberg and Ian H Gotlib

For several reasons, the social and emotional dysfunctions observed in depression appear to be particularly good candidates with which to begin to develop such an integrative approach. It is clear, for example, that depressed individuals exhibit striking deficits in both of these domains. And perhaps more important, the social and emotional deficits in MDD appear to be interwoven. It is not difficult to imagine, for instance, that a depressed woman's inability to experience pleasure (emotion deficit) might lead her to withdraw from pleasant activities involving others (social deficit). Indeed, a growing body of research conducted with normal samples reinforces the formulation that there are strong bidirectional linkages between the social and the emotional domains (e.g., Fridja, 1986 Fridlund, 1992). Emotions are critical in coordinating the trajectory of social interactions (Ekman, 1992). In turn, social interactions set the conditions under which the majority of all emotional...

Can Schizotypal Disorder Disintergrate Into Frankschizophrenia

Psychodynamic theory would predict that schizotypals would regress to a stable, but primitive, ego state with temporary psychotic episodes. They lack a basic integration of the self and other object-representations thus they are considered a structurally defective personality. The interpersonal perspective gives another slant on the schizotypal personality that highlights their tendency to obscure fact from fantasy and their isolation that prevents them from experiencing a corrective feedback. Schizotypals seem to lack an understanding of basic social codes and norms and often miss social cues that cause them to chronically misinterpret social situations. Benjamin presents a developmental account through an interpersonal understanding that focuses on parents sending illogical or contradictory messages about the child's learning to be autonomous.

Schizoid personality disorder JLC

Schizoid Personality Criteria Dsm

Schizoid personality disorder is characterized by a persistent pattern of social withdrawal. Schizoid individuals show discomfort in social interactions and are introverted. They are seen by others as eccentric, isolated, or lonely. DSM-IV diagnostic criteria are shown in Tabl . Emotional constrant is also present in obsessive-compulsive personality disorder, but obsessional patients are more involved in everyday life and concerns, and may be worried by criticism. People with avoidant personality disorder are also detached and aloof. However, although they actively avoid interpersonal contact because of fear of rejection or being found inadequate, they have an intense desire for close relationships.

From Normality to Abnormality

Other diagnostic criteria can also be put on a continuum. The disordered individual fails to share himself or herself socially and may present a false face the normal is simply shy and reserved but also truthful. The disordered is most often an under-achiever whose social anxiety makes consistent job performance difficult the normal is more likely to maintain consistent employment but work behind the scenes. Again, Allison falls consistently more toward the pathological end of these contrasts. She is far beyond shy and reserved, as was evidenced by her false face she presented to her former boyfriend and by her ongoing attempts at anticipating and conforming to all expectations of others when she is forced into social situations. As a volunteer at the botanical gardens, she is also an underachiever. Far beyond a simple anxiety that might make consistent job performance difficult, Allison has never held a real job.

Social Disruption Stress Glucocorticoid Resistance and the Immune Response to an Influenza Viral Infection 321 Social

There are multiple variables that contribute to the stress response. One of the most important is the nature of the stressor. In recent studies, we have employed a social conflict paradigm to investigate how aggressive social interactions, the repeated experience of defeat, and social hierarchy influence the immune response (Avitsur et al., 2001 Stark et al., 2001). Disruption of a social hierarchy that is established when male mice are caged together is a well-recognized model for social stress in mice (Koolhaas et al., 1997). Introducing an aggressive intruder (social disruption SDR) elicited aggressive interactions and defeat of the cage residents. In response to the aggressive social interactions, corticosterone levels were

Therapeutic effects of stimulants

Numerous placebo-controlled randomized control trials (for meta-analyses see elsewhere M26, and 27)) confirm the short-term beneficial effects of stimulants. The reduction of the overt behavioural manifestations of AD-HKD, such as restlessness, is robust and often immediate. Stimulant therapy results in clear and immediate improvement in the quality of social interactions, a decrease in aggressiveness, and an increase in compliance. More information about these effects of stimulant therapy can be found in the literature.(3 , 28,,129)

Investigating Cognitive Abnormalities in Posttraumatic Stress Disorder

Clinical researchers need to increase the attention given to these issues and to realise that it is essential to differentiate between malingered and genuine PTSD symptoms. Therefore, psychometric instruments for the evaluation of malingered PTSD are needed. One promising test is the Morel Emotional Numbing Test (MENT) 40 . This is a forced-choice task to detect response bias in PTSD assessments. Updated in 2004 41 , it consists of 60 two-alternative items. Briefly, the test uses 20 coloured slides of 10 facial expressions posed by a man and a woman. Their expressions reflect happiness, frustration, sadness, anger, fear, calmness, surprise, shyness, confusion, and sleepiness. The slides are presented on a computer screen along with verbal labels describing emotions. The participant is instructed to identify the emotion word that best matches the expression portrayed on the slide. In a first series of 20 trials, participants see one slide on the computer screen and are asked to circle...

Subsyndromally depressed hospitalized elderly patients

Furthermore, IPT is increasingly being applied to a range of nonmood disorders. There are intriguing applications of IPT as treatment for bulimia (Agras et al., 2000 Fairburn et al., 1993 Wilfley et al.,1993 2000) and anorexia nervosa, social phobia (Lipsitz et al., 1999), post-traumatic stress disorder, and other conditions. Life events, the substrate of IPT, are ubiquitous, but how useful it is to focus on them may vary from disorder to disorder. There have been two negative trials of IPT for substance disorders (Carroll et al., 1991 Rounsaville et al., 1983), and it seems unlikely that an outwardly focused treatment such as IPT would be useful for such an internally focused diagnosis as obsessive compulsive disorder. In the continuing IPT tradition, clinical outcome research should clarify the question of its utility. IPT is also being modified for use in other formats for example, as group therapy (Klier et al., 2001 Wilfley et al. 1993,2000 Zlotnick et al., 2001) and as a...

Psychosocial problems strongly associated with mental disorders Violent behaviour

Despite the long-standing sociological tradition of considering suicide as a phenomenon associated with the social condition known as anomia, (14) the medical profession tends to see it primarily as a medical problem. Probably both are right. Among the demonstrated risk factors for suicide there are both social factors (anomy, old age, masculine gender, social isolation) and medical problems (chronic, painful, and incurable diseases and, most of all, psychiatric disorders and psychological problems). Several studies have indicated that approximately 80 per cent of all cases of suicide are associated with alcohol use and depression combined.(2) This indicates the appropriateness of targeting the treatment of these two conditions (another secondary prevention intervention) regarding the prevention of suicide. However, given the broad social implications of suicide, treatment of mental disorders alone has not yet produced a significant reduction of suicide rates.

Behavioural phenotypes

'Behavioural phenotypes' is a relatively new concept and in a broad sense seems to mean an association between a constellation of specific behaviours and a specific disorder, often of genetic aetiology. (3d) As most of the behavioural phenotypes described so far are associated with conditions leading to mental retardation, this concept is particularly relevant to this chapter. The behaviours that have been reported under various behavioural phenotypes could broadly be described under the following headings cognitive deficit, discrepancy in verbal and non-verbal performance, autistic-type features, speech and language abnormalities, behavioural problems, hyperactivity and lack of concentration, social anxiety, abnormal response to external stimuli, stereotyped behaviours, and sleep problems. Some have also controversially included psychiatric illness within some behavioural phenotypes. However, conceptual and methodological difficulties exist in the understanding of the concept of...

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