Why the Long Face?

1. Why the Long Face? by Tara Hogan

2. Social Anxiety Disorder often seems like what one might say “a tough nut to crack”, but that is quite the contrary. Luckily, Social Anxiety Disorder, as well as all mood and anxiety disorders, are quite approachable and easily identified. There are plentiful resources for more than adequate treatment.

3. However, one must be diagnosed correctly sooner rather than later to avoid the morbidity and anguish that one can experience entering into adulthood (sans treatment); causing mental and emotional scars that cannot ever be fully repaired.

4. What is Social Anxiety Disorder? • The most specific and simple definition of S.A.D. is the fear of being socially scrutinized, normally resulting in the avoidance of social situations likely of such results. • Many with such anxiety disorders hold the majority of life’s activities under the light of chaos and failure. For this reason they end up depriving themselves of countless priceless experiences and revert into a skewed perspective of reality.

5. What is Social Anxiety? Cont. Social Anxiety Disorder is considered a member of the phobic family of disorders, hence why it is also commonly referred to as Social Phobia. This phobia causes feelings like apprehension and inferiority, oftentimes even dizziness and nausea.

6. Shy v. Anxious Being shy is a very normal and widespread personality trait. However, once shyness starts to take over standard functionality we can see the transformation from a common trait to an onset of anxiety disorder.

7. Shy v. Anxious cont. In October 2011, the National Comorbidity Survey – Adolescent Supplement, sponsored by The National Institute of Mental Health, was administered to 10,000 young adults ranging from 13 to 18 years old. Half of them were self-identified as shy. 12% of the self-identified group also met the criterion for social anxiety along with 5% from that of the second half.

9. A study conducted in North America in 2006 via what is called the Mini International Neuropsychiatric Interview showed that those who “earned” a MINI via positive diagnoses were typically (Vermani, p.10): • Young • Members of a lower income class • Less educated • Often single or living alone

10. The same study revealed that many patients who were not diagnosed with S.A.D. by their primary healthcare professional yet earned a MINI diagnosis displayed other mental and physical ailments such as: • Worry • Stress • Headaches • Back aches • Chronic pain • Insomnia • Diarrhea • Constipation The same group of initially undiagnosed patients reported alcohol use, abuse or addiction and often had a hard time holding a steady job. (Vermani, p.12)

11. Human Behavior Misconstrued Anxiety disorders can often be confused with other anxiety disorders. Many anxiety disorders correlate closely in terms of criteria. For example, there is what the International Statistical Classification of Diseases and Related Health Problems calls anankastic personality disorder, which isconsidered a less intense form of O.C.D., that is often diagnosed in place of social anxiety disorder.

12. Anankastic (Obsessive-Compulsive) Personality Disorder Social Anxiety Disorder Sense of doubt, caution, self-conscious- ness, tension

13. Human Behavior Misconstrued Cont. There is also the theory that simple shyness is diagnosed as anxiety disorder to increase the sales of psychotropic drugs. Suffice it to say that many patients have been misdiagnosed and prescribed medication even when the patients themselves were hesitant to believe they truly needed them.

14. Misdiagnosis The percentage of those who earned a MINI diagnosis that were not diagnosed by their own care providers before or after the study was so high that they didn’t even share the total figure. We can say that non-detection rates by primary healthcare providers for people with social anxiety disorder specifically was up to 97.8% as of 2006.

15. Diagnostics According to Dr. Murray B. Stein, there are two widely used sets of criteria for the detection of anxiety disorders. The 1stis presented via the Diagnostic and Statistical Manual of Mental Disorders (DSM): • Persistent fear of social performance situation with exposure to unfamiliar people and possible scrutiny by others. • Fear of doing something humiliating or embarrassing. • Exposure to feared social situations provoke anxiety, which can often take the form of a panic attack. • The person recognizes that their fear is excessive or otherwise unreasonable.

16. (DSM Criteria Cont.) • Said feared social or performance situations are either avoided or endured in a state of intense anxiety and stress. • Anxious condition interferes with normal routine, including occupational and academic functionality. • Notable distress about having the phobia. • If a general medical condition (or another mental disorder) is present, the social or performance fear is unrelated to it. • Condition is specified as generalized if fears include most social situations.

17. “(T)he (DSM) is considered the standard classification of mental disorders used by mental health professionals in the United States.” (Stein)

18. The DSM criterion are fairly extensive. Being thorough is well worth the effort for diagnosis. However, other mental disorders are definitely related to social phobia, to the contrary of the DSM standard. Research shows that people with social anxiety disorder almost always end up developing other, more complicated mental disorders when untreated. Sadly, they are also likely to acquire some form of drug addiction in later life.

19. Now, the 2nd set of criteria for social phobia come from the International Statistical Classification of Diseases: ‘Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of criticism. Patients might present with a complaint of blushing, hand tremor, nausea, or urgency of micturition, sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms can progress to panic attacks.’

20. Gender Prevalence Social Anxiety Disorder is most prevalent in females. Outside of its natural presence inside the human body, estrogen is often used on a medical level to moderate or balance serotonin levels in the brain. However, the consequential imbalance of estrogen almost always has adverse effects.

21. Gender Prevalence Cont. Additionally, women are more likely to be the victims of physical, sexual, and mental abuse. This abuse is most likely to occur throughout one’s childhood, negatively adding to the chemical changes that are already happening in the brain during that stage of life. Such interruption leads to anxiety disorder.

22. Many studies conducted have found that prevalence rates point toward younger patients (18-30). However, it begins at an even younger age than many might think. According to the Society for Research of Child Development: “Adolescence is a key time to investigate how early social experiences contribute to brain development because it's a period of dramatic changes in brain function, brain structure, and social context, and it's when many psychiatric disorders first appear. But few studies have addressed this important area because of the need for longitudinal data to investigate long-term associations between early social experiences and later brain development.”

23. Unfortunately, most people deal with symptoms of Social Anxiety Disorder for decades before pursuing treatment.

24. Age: The Neurological Perspective Martha Farah, a PhD working in cognitive neuroscience, stated that, “Early cognitive stimulation appears to predict the thickness of parts of the human cortex in adolescence..” She goes further to say that experiences at age four have a greater impact than those at age eight. Therefore, the thinner (less developed) the cortex, the easier it is to manipulate its growth.

26. In 2010, The National Academy of Sciences took 31 people and gave them an MRI while they played a computerized version of catch (somehow, the subjects were under the impression they were playing with real people). During the process, they simulated the other players excluding the study subject and focused on how the subjects reacted to social rejection.

27. During the MRI, the researchers involved kept their attention on the dorsal anterior cingulate cortex and the anterior insula, two areas known for responding to social stresses.

28. The results of the experiment brought these great scientists to the conclusion that individuals who exhibited greater neural activity during social rejection in the brain scanner also exhibited greater increases in inflammatory activity when exposed to acute social stress in general. Therefore, the more neurologically sensitive the subject the more susceptible to unnecessary social anxiety.

29. Why adolescence? After all of the information presented in this report, it ought to be easy to recognize the importance of early diagnosis. It’s high time that we as a worldwide community take action on the knowledge we have today and prevent the deterioration of not only the brain, but also our social and moral structures.

30. Works Cited • Amin, Zenab; Canli, Turhan; Epperson, C. Neill. Effectof Estrogen-Serotonin Interactions on Mood and Cognition, p1 • Burstein M, Ameli-Grillon L, Merikangas M. Shyness versus socialphobia in U.S. youth. Pediatrics. Online aheadofprintOct 17, 2011. • Stein, Murray B.; Stein, Daniel. Seminar: SocialAnxietyDisorder, Lancet 2008; 371: 1115–25 • MonicaVermani, MadalynMarcus, and Martin A. Katzman, (2006) RatesofDetectionofMood and AnxietyDisorders in Primary Care: A Descriptive, Cross-SectionalStudy, p1-26 • Nauert, R. (2006). Anxiety More Common in Women. Psych Central • Society forNeuroscience (SfN). "Developing brain is source of stability and instabilty in adolescence." ScienceDaily, 15 Oct. 2012. Web. 23 Oct. 2013. • Society forResearch in ChildDevelopment. "Brain-behaviorassociations: Researcherslookattiesbetween early socialexperiences and adolescent brain function." ScienceDaily, 18 Apr. 2013. Web. 23 Oct. 2013 • WHO. International StatisticalClassificationofDiseases and RelatedHealthProblems, 10th Revision. WorldHealthOrganization, 2007.