Sunday, January 31, 2010



In my outpatient psychology practice, I see eight things every
day--they show up again and again, presenting in one form or another.
One of the bigger and more negative experiences clients have is anxiety.
In addition, the first thing clients want to know is whether they have
an anxiety disorder, in this case Social Anxiety Disorder. First, here
is a rather clinical description of what anxiety is, according to an
older but very accurate source, the Diagnostic and Statistical Manual
of Mental Disorders, Third Edition:

"...An apprehension, tension, or uneasiness that stems from the
anticipation of danger, which may be internal or external. Some
definitions of anxiety distinguish it from fear by limiting it to
anticipation of a danger whose source is largely unknown whereas fear
is the response to a consciously recognized and usually external threat
or danger. The manifestations of anxiety and fear are the same and
include motor tension, autonomic hyperactivity, apprehensive expectation,
vigilance and scanning. Anxiety may be focused on an object, situation,
or activity, which is avoided (phobia), or may be not focused
(free-floating anxiety). It may be experienced in discrete periods of
sudden onset and be accompanied by physical symptoms. When anxiety is
focused on physical signs or symptoms and causes preoccupation with the
fear or belief of having a disease, it is termed hypochondriasis."

Anxiety pervades almost all of our experiences in every venue.
Most of the time, it is in the background. It turns out we need some
very basic "tension" to exist and a little more to be motivated to do
things. We psychologists call this ergic tension. You could not sit
up or read this article if you had no ergic tension. It is normal.

However, many people have more anxiety than this, which still could
be good in some circumstances, like in sports or just before an important
speech or even right before a major test in school. This keeps us
focused and helps us appropriately utilize the extra adrenaline that
accompanies such events. We are still in the normal range of anxiety
if we understand and can manage it during and then after the specific
event, presumably when our anxiety drops back to lower levels.

Some people have more anxiety than this, and it does not go back
to "mark headings." These are the folks who probably have an anxiety
disorder. Social Phobia is the sixth category in my ebook, which makes
it pretty serious. There are seven major categories of anxiety disorders,
depending upon the cluster of symptoms and their manifestations.
I have written about these in my ebook, How To Diagnose and Treat Your
Anxiety. Here's the categories as I listed them: Worrisome Personality,
then the more progressive and I think more serious clinical categories
follow: Generalized Anxiety Disorder, Adjustment Disorder with Anxiety,
Post Traumatic Stress Disorder, Panic Attacks, Phobia Disorder and
Obsessive Compulsive Disorder. I made up the first category because I
see this a lot in my practice, but it is not in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (the latest version
of this manuscript, which is the Bible of mental health professionals).
The last six categories are clinical categories
and are found in the DSM IV.

And, here is how anxiety typically manifests (symptoms):

...Trembling, twitching, or feeling shaky, muscle tension and aches or
soreness (including chest pains), restlessness, easy fatiguing...or...
shortness of breath or smothering sensations, palpitations or accelerated
heart rate, sweating or cold clammy hands, dry mouth, dizziness or
lightheadedness, nausea, diarrhea, or other abdominal distress, flushing,
hot flashes, chills, frequent urinations, trouble swallowing, or...
feeling keyed up and on edge, exaggerated startle response, difficulty
concentrating or having your mind "going blank," trouble falling or
staying asleep, or being excessively irritable.

According to the DSM IV, Social Anxiety Disorder, now called Social

" ... is a marked and persistent fear of social or performance situations
in which embarrassment may occur. Exposure to the social or performance
situation almost invariably provokes an immediate anxiety response
(see above symptoms). This response may take the form of a situationally
bound or situationally predisposed Panic Attack. Although adolescents
and adults with this disorder recognize that their fear is excessive or
unreasonable, this may not be the case with children. Most often, the
social or performance situation is avoided, although it is sometimes
endured with dread..."

Social Phobia is one of many kinds or categories of anxiety.
I have written specifically about this and other versions of anxiety
in my ebook on How To Diagnose and Treat Your Anxiety. This is a
publication that shows you how to think about any anxiety, disordered
or not, how to assess your symptoms and more importantly, what to do
about it. Here is what I wrote about phobias, which included the phobic
version described above:

"A phobia is a persistent fear of a specific object(s) or situation(s)
other than the fear of having a panic attack. In other words, the stimulus
is external, not internal in most cases. (Once you are having a phobic
experience, then there usually arise internal fears, for instance, that
you will further lose control, and your symptoms will increase in intensity,
etc. This is called secondary anxiety and it can occur in any of the
symptom categories, but for our purposes it is not diagnostic with respect
to the categories listed here.) The most common situations or objects
reported are fears of animals, elevators, heights, enclosed or open places,
air travel, blood, or public speaking or just being out "exposed" in a
public place. (Some people are afraid to make contact with others,
regardless of venue. This is Social Phobia, as opposed to simple shyness.)
Exposure to the feared stimulus causes the above anxiety symptoms to be
experienced, usually in direct proportion to the perceived inevitability of
directly contacting the stimulus. Again, people typically experience four
anxiety symptoms from the list above, and usually five or more when they are
having intense anxiety reactions. Incidentally, not only can the symptoms
be very intense during the initial phobic response, but also they can linger
at less intense levels for very long periods of time in-between phobic
reactions, proper. The mere thought of having another encounter with this
group of symptoms can by itself evoke a renewed commitment to not being
phobic. Obviously, these symptoms cause you to avoid the situation(s) or
object(s), thereby altering your routine or customary way of dealing with
things, sometimes in very dramatic ways. As in the case of panic attacks,
people usually recognize that this fear or avoidance is irrational, but
nonetheless cannot explain it nor make the symptoms go away by an act of

In sum, Social Phobia sufferers have a major version of anxiety disorder,
one that can cause considerable discomfort. You have to think about
your symptoms in a very specific and different way to diagnose whether
or not you have ANY anxiety disorder, Social Phobia included. I show you
how, step by step, in my ebook, and how to deal with it.

Dr. Griggs

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