Thursday, May 19, 2011

Social Anxiety : Overcoming Shyness

Ask people what they fear the most and many of them will answer, “speaking in public.” In surveys that ask people about their fears, about one person in five reports an extreme fear of public speaking.

Shyness and other forms of social anxiety are common – and they prevent people from fully experiencing life. Shyness refers to a tendency to withdraw from people, particularly people who are unfamiliar. Everyone has some degree of shyness. In fact a person without any shyness at all is probably one who does not make good judgments about maintaining appropriate boundaries between people. A bit of shyness is a good thing. But when a high level of shyness prevents a person from engaging in normal social interactions, from functioning well at work, or from developing intimate relationships, it presents a problem – which, fortunately, can be alleviated.

Shyness is one form of the broader term, social anxiety. This concept, also known as social phobia, refers to a special kind of anxiety that people feel when they are around other people. It is associated with concerns about being scrutinized. Shyness and social anxiety are closely related, but social anxiety includes other situations such as speaking in public, taking tests, sports performance, and dating. Closely related to the concepts of shyness and social anxiety are embarrassment and shame. Embarrassment is what a person feels when something unexpected happens and draws unwanted attention (such as knocking over a glass of water in a restaurant). This creates a temporary feeling of discomfort. Shame, on the other hand, is more long-lasting. Shame is a feeling that comes from being disappointed in oneself.

Who are the people most likely to suffer from social anxiety? Parents recognize that some children are easily frightened from birth on and cry a great deal, while others seem more resilient by temperament (they seldom cry, hardly ever get upset, and are less easily frightened). Some children love to explore the world around them. Others are cautious and don’t tolerate change well. Children who are inhibited are more likely to have a parent with social anxiety disorder. An anxious person is more likely to have a parent or sibling who suffers from depression. Many people with social anxiety disorder report having one or both parents who have a substance abuse problem such as drinking or come from a family in which:
  1. there is substantial conflict between the adults,
  2. parents are overly critical of the children (where things are never good enough), and
  3. there is excessive concern about what other people think.

National surveys find that about five percent of children and adolescents suffer from a social anxiety disorder. Children with an anxiety problem seldom report that they are feeling anxious. Instead, they report the presence of physical symptoms, which include headaches, stomach aches, nausea, rapid heartbeat, dry mouth, blushing, dizziness, and shortness of breath. They try to avoid the following situations – speaking in class, taking tests, reading aloud, writing on the board, inviting friends over to play, eating in front of others, going to parties, and playing sports. Children and adolescents with social anxiety disorder may go on to develop other related problems, such as loneliness, depression, and low self-esteem. Although some children will overcome their shyness in time, as interactions with others cause their fears to dissipate, others will experience a worsening of symptoms. If a child shows symptoms by the age of six that have not improved by the age of ten, it is probably time to seek a professional intervention.

Next week we'll discuss overcoming social anxiety.

Are you suffering from social anxiety? We can help! Contact us at or 941-907-0525

Friday, May 6, 2011

PTSD - Post Traumatic Stress Disorder

Most of us build our lives around the belief that we will be relatively safe. Granted, normal daily life involves many stressors, especially in these hectic times, but we expect these pressures to happen and we become accustomed to handling them. The more flexible we are and the more we know ourselves and are in touch with our abilities, the easier it is to deal with normal everyday stress.

Sometimes, however, any of us could be subjected to catastrophic stress. Our feeling of safety in these circumstances can vanish. We could experience terror and a complete inability to know how to handle these situations that are outside of the ordinary realm of experience. These catastrophic events can include rape, physical or sexual abuse, physical attack, mugging, car-jacking, natural disasters (earthquakes, hurricanes, tornadoes, floods, etc.), fires, car accidents, plane crashes, hostage situations, school shootings, military combat, or the sudden death of a loved one. It is not only the victims of these events, but also witnesses, families of victims, and helping professionals who can develop severe stress symptoms that can last for months or even years after the event.

Post-Traumatic Stress Disorder
(PTSD) is the term used to characterize people who have endured highly stressful and frightening experiences and who are undergoing distress caused by memories of that event. It is as if the person just cannot let go of the experience. The event comes back to haunt them. The anxiety experienced during or immediately after a catastrophic event is called traumatic stress. When the symptoms last several months after the event, it is called post-traumatic stress. PTSD can last for years after the original trauma and may not become evident initially. For example, an individual may witness a murder as a child, but not experience the associated stress until mid-life.

Some people are more likely to develop PTSD than others. Experts are not sure why some people develop PTSD after a relatively minor trauma while others exposed to great trauma do not. Those who are very young or very old are more vulnerable. PTSD is also associated with intelligence (those with a higher level of intelligence are less likely to suffer from PTSD). Individuals who already suffer from anxiety disorders, some personality disorders, or depression seem more likely to get PTSD after extreme trauma. It seems that the more vulnerable one feels in dealing with the world, the more likely one is to develop PTSD.

Trauma of great severity is more likely to produce PTSD than lesser traumas. For example, it was found with Vietnam War veterans that prolonged combat with sniping and air bombardment produced PTSD more often than brief exposure to combat with few weapons. It has also been found that traumas between people (such as sexual assault and muggings) are more likely to produce PTSD than natural disasters like earthquakes or floods.

Symptoms of PTSD

People can be considered to have PTSD when they have been exposed to an extreme trauma, the symptoms last at least a month in duration, and the symptoms cause excessive distress so that social functioning and job performance are impaired. One sign of PTSD is that the traumatic event is relived repeatedly in the person’s mind – and this appears in the form of “flashbacks,” recurrent images, thoughts or dreams about the event...and even nightmares. Reminders of the event can cause distress – so many people go out of their way to avoid places and events that remind them of the catastrophic occurrence. Many people experience anxiety, restlessness, concentration difficulties, decreased memory, irritability, sleeplessness, hypervigilance, or an exaggerated startle response. Some people even experience what is called “survivor’s guilt” – because they survived and others did not or because of certain things they may have had to do in order to survive.

There are three main clusters of PTSD symptoms, and all three of these groupings must be present for a diagnosis of PTSD.

Intrusive Symptoms: Intrusive and repetitive memories which stir up negative feelings experienced during the trauma can overwhelm a person. These memories can appear in the form of:
  • flashbacks (a feeling of reliving the trauma)
  • frequent, distressing memories of the trauma
  • nightmares
  • emotional and physical distress when traumatic memories are triggered.
Arousal Symptoms: PTSD sufferers experience physiological reactions, which indicate that they don’t feel safe and they are physically on the alert to deal with danger.

These can include:
  • being easily startled or feeling jumpy
  • hypervigilance (feeling “on guard” even when the situation is safe)
  • concentration difficulties
  • outbursts of anger and irritability
  • problems in falling asleep or staying asleep.

Avoidance Symptoms: People suffering from PTSD go out of their way to escape the overpowering memories and arousal symptoms. This pattern of behavior can include:
  • avoiding places, people or situations that serve as reminders of the trauma
  • avoiding thoughts or feelings associated with the trauma
  • memory loss about some aspects of the traumatic event
  • feeling emotionally numb
  • feeling estranged or detached from other people
  • feelings of hopelessness and helplessness about the future
  • decreased interest in pleasurable activities.
There are other emotional and physical problems that may accompany PTSD. Unfortunately, some people seek relief from these symptoms without dealing with the root cause so that the symptoms persist. These problems may precede PTSD, in which case they become exacerbated, or they might develop after the onset of PTSD. The emotional problems include panic disorder, agoraphobia (fear of being out in public), social anxiety (speaking in public), depression, obsessive-compulsive disorder, sleep disorders, suicidal thoughts and substance abuse (drug or alcohol abuse). The physical problems can include skin problems, pain, gastrointestinal disorders, fatigue, respiratory problems, low back pain, muscle cramps, headaches, and cardiovascular problems.

It is important to remember that PTSD is a normal reaction to a very abnormal situation. There is no shame in experiencing these symptoms, nor is having these symptoms a sign of weakness. Help is available from trained professionals so that in most cases, with the appropriate effort and courage, the symptoms can disappear completely, or at least substantially decrease and become more manageable.

Next week we'll post about getting help for PTSD. You can also visit one of our websites for more information: Dr. Quintal & Associates - Sarasota Counseling or PTSD Treatment