Anxiety Attacks in Social Anxiety Disorder

“Is your Shyness, Social Anxiety or Panic Attacks Interfering with Your Life?”

Social Anxiety is surprisingly common among many age groups. We are going to have an in-depth look at it. To get started, here is an overview of what is going on by Dr. Ruy Miranda, a Brazilian psychiatrist and author of a book on the subject.  Have a look so you can appreciate if you experience social anxiety in any form, then you have lots of company. As always, we appreciate your questions and comments.

Anxiety Attacks in Social Anxiety Disorder – Incidence, Onset, History, Evolution

by Dr. Ruy Miranda, psychiatrist  

The Social Anxiety attacks will be examined from the following angles: incidence in the population, onset of the disorders (sudden or insidious), Shyness antecedents, evolution, and spontaneous remission.

Incidence – The information on the percentage of incidence in the general population ranges from 3% to 13%, and this discrepancy is understandable due to difficulty of diagnosis. In any case, this is a high incidence disorder.

Onset – Prior to the end of adolescence, in most cases. There are reports of onset in early adolescence and even in childhood. The onset is usually through a severe anxiety attack, as in the case of a teenager who, without any previous notice, was called on in the school yard to hoist the national flag before all the students.

“The world has crashed down on my head,” he said. “I don’t know how I ever got there; I saw nothing, could not think straight, shook all the time , could not really listen to the national anthem. Everybody could see I was shaking all over. All I remember is someone helping me at the end.” Experiences such as this one usually mark the onset of phobia and a sequence of humiliation stories. Yet the onset can be insidious and slow, following the progressive worsening of the pre-existing anxiety.

Personal History – In my empirical observations, all the cases show a past history of significant Shyness. To me , Shyness in any intensity expresses anxiety and Social Anxiety is expressed through more intense signs and symptoms and in the form of attacks. This does not mean that all Shyness evolves into Phobia.

It is my judgment, based on empirical observations, the self-concept in Social Anxiety sufferers seems to be more compromised than in cases of Shyness. In Social Anxiety Disorder the concepts and attitudes vis à vis oneself and other, the internal disagreements, as well as, the perceived predisposition the people have against him, are more complex than in Shyness.

On the other hand, it is common for bearers of Social Anxiety in specific situations to present parallel signs and symptoms of mild Shyness in other situations. I hasten to add many psychotherapists approach Shyness and Social Anxiety in a very similar fashion and do not use medication to treat either one.

You have probably noticed my use of the expression “ Social Phobia sufferer.” This is one more indication of my belief these people are prisoners of a psychological process, and, for this reason, can get rid of the attacks. However, I must warn many professionals and sufferers of Social Anxiety believe this problem has no solution and  the person can improve and control the crises but will always remain a “phobic.”

Evolution – Social Anxiety attacks can be circumscribed to two social situations (it is nearly impossible to be restricted to just one) or can be extended to nearly all of them. In this latter case, they receive the addition of the word generalized.

In any of the cases, suffering is in the pain of the anxiety crisis, in the humiliations, and in the obstruction to self-actualization. Moreover, there may be additions of obsessive thoughts and compulsive behaviour. Suffering induces people to avoid crisis-triggering situations, and this impoverishes their life quality.

Spontaneous remission seems possible in rare cases. My guess is some unknown circumstantial variable would have been introduced in the person’s life—enough to modify the self-concept.

The treatment can bring major relief. Once the crises are under control, work must focus on the changes in self-concept and in the concepts or perceptions about the others.