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 Overview

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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.

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...

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...

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

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.

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.

The Interplay of Culture

Jenna, a first-year graduate student in psychology, was required to write up her impressions of a videotaped therapy session featuring a beginning therapist and a female Asian student referred by her instructor for excessive shyness. Eventually, Jenna noticed that regardless of what the therapist said, the student always seemed to agree. At the end of the session, the therapist was interviewed and asked for his impressions. The therapist reinforced the instructor's opinion about the student's shyness and felt change would be fast because the student offered little resistance. As Jenna's instructor pointed out, this conclusion was incorrect. In fact, the much younger female student was prevented from disagreeing with the much older male therapist because of cultural norms. Once the student was empowered to disagree, it was discovered that conventions appropriate to her reference group largely accounted for her behavior with her instructor, not long-standing personality traits....

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...

Managing anxiety and other emotional sequelae resulting from impaired cognition

Other groups for memory-impaired people can be useful in reducing social isolation, which is also common in people with memory problems. (31) Wilson and Moffat(38) describe several kinds of groups for patients. Moffat (39> reports on a relative' memory group for people with dementia, and Wearing (31 offers suggestions for setting up self -help groups. Evans and Wilson point out the social value of memory groups as well as their effect in reducing anxiety.

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.

Role of the cAMP Pathway and CREB in the Nucleus Accumbens

As stated earlier, the mesolimbic dopamine system is a major neural substrate for the motivational and rewarding effects of opiates. This occurs via two mechanisms (3). Opiates increase dopaminergic transmission to the NAc by activating VTA dopamine neurons. This occurs indirectly through opiate inhibition of GABAergic interneurons within the VTA that inhibit the dopamine neurons. Opiates also act directly on opioid receptors expressed by NAc neurons. The rewarding effects of other drugs of abuse are mediated via similar actions in the VTA-NAc pathway, although each drug produces these effects via drug-specific mechanisms (1,24). In addition, the mesolimbic dopamine system appears to be play a similar role in mediating the actions of natural reinforc-ers, such as food, drink, sex, and social interactions.

Why do people take drugs

Alcoholics will point to anxiety as their reason for drinking (1) indeed, social anxiety is one of the most common causes of alcoholism in young men.(2) If this can be treated (e.g. by selective serotonin reuptake inhibitors) then they are frequently able to become abstinent or even drink normally. Social anxiety is also a common reason for the use of stimulants by the young. Another psychiatric disorder associated with drug misuse is depression, which is particularly likely to lead to excess alcohol intake. A vicious cycle then develops because both alcohol and its withdrawal are depressogenic. Alcohol is also one of the most serious risk factors for suicide. There is increasing use of stimulants and cannabis by schizophrenic patients. In part this reflects the behaviour of their peer group but the use of stimulants may be in part due to the fact that they can offset some of the more negative aspects of neuroleptic treatment, especially the loss of drive and motivation. As both types...

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...

Psychological factors Personality

Community and clinical epidemiology findings point to the presence of other psychiatric disorders as one of the most significant psychological risk factors in alcoholism. The risk is particularly high in persons with schizophrenia, bipolar disorder, major depression, social phobia, panic disorder, post-traumatic stress, attention-deficit hyperactivity disorder, and antisocial and borderline personality disorders. (40)

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.

Earlyonset frontal damage

Most of these patients as young adults, long after the onset of their lesions. As in the adult-onset group, the cause is quite varied and the damage can be bilateral or unilateral (Fig. 4). And as with the adult-onset group, these patients are of normal intelligence and their sensory and motor skills, conventional memory, speech and language are normal too. As young children, they exhibit dysfunctional social interactions, both at school and at home. They show difficult behavior control and are insensitive to punishment. In spite of their normal intelligence, they usually need special schooling because of poor working habits. They do not make friends. The neuropsychological profile of these patients is normal, similar to what happens in the adult-onset group, but they too show hypo-emotionality and a remarkable absence of social emotions, and their IGT is abnormal. The remarkable difference, relative to the adult-onset group, appears in the results of tasks measuring social...

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...

Comorbidity and differential diagnosis

Social phobia may increase the risk for other psychiatric disorders. (9,2 21.> In the National Comorbidity Survey (NCS), 81 per cent of persons with primary social phobia met the criteria for at least one other lifetime psychiatric disorder.(22) Odds ratios for other DSM-IIIR disorders given social phobia were 7.75 for simple phobia, 7.06 for agoraphobia, 4.83 for panic disorder, 3.77 for generalized anxiety disorder, 2.69 for post-traumatic stress disorder, 3.69 for major depression, 3.15 for dysthymia, and 2.01 for substance abuse 22) In persons with comorbid diagnoses in the Epidemiological Catchment Area Study (ECA), social phobia preceded the comorbid disorder in 76.8 per cent and onset in the same year in 7.2 per cent of cases.(9) Differential diagnosis is complicated by the fact that certain Axis I disorders both resemble and co-occur with social phobia. However, the distinction among disorders is clinically important because pharmacological and psychological treatments may...

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...

Application to Paranoid Personality Disorder

They hypothesize that typical social interactions keep our suspicions at bay and reinforce our trust in others. In those individuals where their paranoid predispositions are higher than normal, their paranoia and suspi-ciousness further isolates them from social interactions that might otherwise ameliorate their paranoid tendencies.

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,...

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.

Intentionality in psychiatric disorder

After all an extensive analysis of the man in the field with the bull was based upon the judgement of the observer as to what might be expected. If that judgement is highly individual, then my analysis and yours may differ substantially, and our capacity to describe what is going on will be limited. However for most purposes our judgements of the expected behaviour of others is good, because we are good at guessing at their thoughts, attitudes and emotions. Indeed if it were not, our capacity to cope socially would be very limited as we would not be able to predict the behaviour of others, nor moderate our behaviours in relation to the expectations of others. We are generally good monitors of the intentionality of other people. (Some indication of the consequences of a deficit in this ability may be seen in conditions such as autism or Asperger's Syndrome where the capacity to understand the rules of social interaction and the likely state of mind...

Why do negative thoughts and beliefs persist

Early conditioning theorists identified avoidance of, and escape from, feared stimuli as important factors in the maintenance of anxiety disorders. It is easy to see how avoidance of a feared situation (e.g. a supermarket for an agoraphobic) or escape from the situation before a feared event (e.g. a panic attack) occurs could prevent phobics from disconfirming their fears. However, situational avoidance escape is not so obviously relevant to non-phobic anxiety and some phobics (especially those with social phobia) regularly endure feared situations without marked improvement in their fears. Salkovskis (18) introduced the concept of in-situation safety behaviours to deal with this problem. In particular, Salkovskis suggested that while in feared situations most patients engage in a variety of (often subtle) behaviours that are intended to prevent, or minimize, a feared outcome. For example, cardiac concerned panic disorder patients may sit down, rest, and slow down their breathing...

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...

Variations of the Schizoid Personality

Such individuals are often seen among the homeless, the chronically institutionalized, and the residents of halfway houses. Whereas the basic schizoid is aloof and insensitive to emotional experience, remote schizoids may express a measure of social anxiety as well as frequent behavioral eccentricities, autistic thinking, and depersonal-ization. At best, their low self-esteem and deficits in social competence allow them only a peripheral, but dependent, role in interpersonal and familial relationships. Most seek solitude and go through life as detached observers closed off from sources of growth and gratification. Some earn a marginal livelihood in low-status jobs, but most follow a meaningless, ineffectual, and idle pattern, drifting aimlessly on the periphery of social life. Many are totally dependent on public support.

The Cognitive Perspective

The plight of the schizoid self is easily understood. The self is not a substance or a soul but a mental construct, and like any other construct, its contents can be either highly defined or poorly articulated. Identity develops over time as a result of interpersonal experience. Or, as social interactionism would say, the self consists of the reflected appraisals of others. Relatedness is fundamental, and individual identity develops out of social interactions. In time, our cognitive capacities mature to the point that we can reflect on our own experiences and preferences and draw conclusions about our own unique nature. Even extreme introverts, who shy away from social interaction, may nevertheless develop a highly articulated sense of identity. Despite their introversion, their capacity for emotion and interpersonal relatedness is preserved, and their fantasies contain interpersonal themes, even though their lives may not.

From Normality to Abnormality

The remaining diagnostic criteria can also be put on a continuum (see Sperry, 1995). Whereas the disordered tend to lack close friends (see criterion 8) to the point of being suspicious and paranoid (see criterion 5), those with the style are nourished by an internal belief system and do not require that this system be validated by others. Whereas the disordered exhibit a constricted or inappropriate affect (see criterion 6), those with the style have some awareness of the responses that society is most likely to require or reward. Whereas the disordered may look or act in ways that are peculiar, odd, or exceedingly strange (see criterion 7), those with the style are simply unconventional because of their disregard of social standards. Finally, whereas the disordered exhibit excessive social anxiety that is not extinguished as familiarity increases (see criterion 9), those with the style are simply very observant and aware of the actions and feelings of others. Again, when compared to...

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...

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.

Agency and Intersubjectivity

Mammals are usually in mutual relationship with conspecifics. This social attitude is particularly developed among primates. Macaque monkeys live in groups characterized by several sophisticated social interactions, such as grooming (see Dunbar 1993), that are usually disciplined by a well delineated hierarchical organization. It is therefore very important for each member of a given social group to be able to recognize the presence of another individual performing an action, to identify his social rank, to discriminate the observed action from others, and to understand'' the meaning of the observed action in order to react to it appropriately.

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.

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...

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

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.

Variations of the Avoidant Personality

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 that avoidant personality disorder, taijin kyoufu, would have a higher prevalence rate in collectivist societies such as Japan. Although there are no studies of differential prevalence rates between these two countries, Ono and his colleagues (1996) offer data showing that the avoidant personality was the most...

A learned association of taste with visceral distress

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

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...

Application to Antisocial Histrionic Narcissistic Dependent and Avoidant Personality Disorders

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.

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 (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...

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)

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