People with Social Anxiety Disorder typically report that their central fear is that they will be judged negatively by other people.  They often report that they are afraid that they will "make a fool of myself", "do something embarrassing" or "others will notice that I am anxious". As a consequence they display a persistent fear of social or performance situations in which they are exposed to unfamiliar others or where they might be the centre of attention. Due to their anxiety, social situations are often avoided altogether. 

 

Avoidance and fear of social situations may take many forms including fear or avoidance of eating, drinking or writing in public, using public restrooms, initiating and maintaining conversations, talking on the phone in front of others, attending small groups, attending social gatherings such as parties, and speaking to authority figures or the opposite sex.

People with Social Anxiety Disorder invariably report physical symptoms of anxiety some of which include increased heart rate, shaking, muscle tension, blushing, gastrointestinal discomfort or diarrhea. Socially anxious people may report having panic attacks whilst in the situation. 

 

Panic attack symptoms

To experience a full panic attack people must have four or more of the following symptoms: rapid heart rate, shortness of breath or difficulties breathing, dizziness, blurred vision, shaking, nausea, choking sensations, sweating, hot flushes or chills, numbness or tingling sensations, chest pain or discomfort, derealisation (feeling as if the world is unreal), depersonalisation (feeling outside one's body) and fear of losing control or going crazy.

 

Feeling apprehensive and fearful, embarrassed and self-conscious.

 

Sense of confusion, mind going blank, difficulties concentrating.

Thought processes focused on the judgment of others such as "they think I am weird", "they think I am stupid", "they will notice I am anxious", "they think I am boring", "others are thinking that I am weak or incompetent", "no one will like me", "I will stumble on my words", "I am unlikeable".

 

Avoidance-Complete avoidance of feared social situations

Safety Behaviours- Attending feared events whilst subtly avoiding attention or judgment. For example, speaking quietly, not giving opinions, reduced eye contact, attending events only with friends, wearing excessive make-up, staying on the outside of groups.

Research suggests that those with Social Anxiety Disorder are likely to have inherited a genetic predisposition to develop this problem. However, whilst approximately 50% of the tendency to be anxious can be attributed to biological factors, approximately 50% is learned through our environment.

A large body of research suggests that the treatment of choice for Social Anxiety Disorder is Cognitive Behavioural Therapy. Medication such as Selective Serotonin Reuptake Inhibitors (SSRI) has also been shown to be effective in the treatment of Social Anxiety Disorder.

 

Obsessive-Compulsive Disorder (OCD) is characterised by recurrent obsessions or compulsions that are time consuming or cause significant distress. Obsessions are recurring intrusive thoughts, impulses or images that are experienced as unacceptable and disturbing. Compulsions are repetitive behaviours (overt) or mental processess (covert) that are usually designed to neutralise or reduce the distress caused by the intrusive ideas.

 

The most common examples of unwanted intrusive ideas include fear of germs or being contaminated, unwanted sexual imagery, images of harm coming to others, aggressive or horrific images, doubts about whether one has run over someone on the road or locked the doors and windows, needing objects to be ordered in a symmetrical way. The need for symmetry is often associated with a sense that something bad will happen if things are not ordered specifically.

 

People with OCD may become involved in time consuming rituals (such as washing or checking over and over) to make them feel better about their fears, however these rituals typically serve to keep them in an ever increasing cycle of doubts and anxiety. Due to their anxiety, situations that trigger obsessions and compuslions (rituals) are typically avoided. For instance, someone with a fear of germs may avoid touching certain objects or public restrooms or someone with intrusive images of violence may avoid being around knives.

 

A less common but equally distressing obsession involves recurrent thoughts and doubts about one's sexuality. People with this obsession may report homosexual images and intrusive thoughts about being attracted to the same sex. This is experienced as disturbing and unacceptable and leads to a cycle of constant checking and monitoring of one's attraction to same and opposite sex people, with doubts about sexuality rarely being resolved without treatment. Inevitably this cycle may lead to avoidance of same sex friendships and may affect heterosexual relationships due to ongoing distress and anxiety. Invariably, a person with this type of OCD's sexuality is heterosexual, however the doubts, intrusive thoughts and anxiety make it hard for the sufferer to be sure about their sexuality.

People with OCD may experience some panic sensations or experience a full panic attack when confronted by their fearful situations or thoughts. 

 

To experience a full panic attack people must have four or more of the following symptoms: rapid heart rate, shortness of breath or difficulties breathing, dizziness, blurred vision, shaking, nausea, choking sensations, sweating, hot flushes or chills, numbness or tingling sensations, chest pain or discomfort, derealisation (feeling as if the world is unreal), depersonalisation (feeling outside one's body) and fear of losing control or going crazy.

 

People with OCD experience intense feelings of dread and apprehension when confronted by their obsessions. They often report that their anxiety is unbearable and fear that unless they reduce their anxiety by ritualising, that it will go on forever. Due to the nature of most obsessions, people with OCD report feeling shame and embarrassment. As a consequence they often avoid telling others about their difficulties and may suffer in silence for many years. 

 

Intrusive thoughts/images and covert (mental) rituals typically make up the landscape of a person with OCD's mental processes. These obsessions can occur frequently and the sufferer is often in a fight with them to distract, suppress or neutralise them. Attempts to neutralise the anxiety about the thought or image may include any number of mental processess such as praying, counting or repeating words over and over.

 

People with OCD often think their intrusive thoughts/images are a sign that there is something wrong with their character, that there is something bad or wrong with them. This is often reported with those who have intrusive sexual or violent images. For instance, some may come to believe that they are "bad, wicked or evil" people.

 

Avoidance- People with OCD will often completely avoid situations that might trigger intrusive thoughts or fears

Safety behaviours-At other times difficult situations may be endured with the use of behaviours designed to "keep one safe" from the fear. For instance, someone with a fear of germs may use tissues or gloves so they don't have to touch fears objects or they may have others touch or move things for them.

Asking for reassurance-some OCD sufferers (often children) ask others to reassure them that things will be ok. For instance, someone who fears they have not locked the windows or doors may ask someone to check for them or reassure them that they have done it to alleviate their anxiety.

Research suggests that those with OCD are likely to have inherited a genetic predisposition to develop this problem. Research also suggests that the difficulties that OCD sufferers have in shifting their attention away from their intrusive thoughts and doubts, is due to a brain based dysfunction, where there is a deficit in parts of the brain used in shifting attention. However, whilst approximately 50% of the tendency to OCD can be attributed to biological factors, approximately 50% is learned through our environment.

A large body of research suggests that the treatment of choice for OCD is Cognitive Behavioural Therapy. Cognitive Behavioural Therapists, among other treatment strategies, assist OCD sufferers to realise that their obsessions are just thoughts that do not necessarily reflect reality and do not reflect on their character. Exposure and Response Prevention is also used to assist those with OCD to face their fears and break the cycle of constant checking and ritualising.

 

Medication has been shown to be equally as effective in the treatment of OCD as therapy. Often in more severe cases a combination of medication and therapy is required to assist with alleviation of symptoms.