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Social Anxiety Disorder

Evi Aki, Brooke Babbitt, Kelli Slemp, Marketia
White, Ashley Ontiveros, Mark Vickers
Case Study:
Frannie
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Frannie
Frannie is a 7 year old girl who was brought to a mental health outpatient clinic by her mother
because of her difficulties with peer relationships. Fannies second grade teacher let her mom know
of classroom problems with Frannie not interacting with other children in the class. Frannie does not
play at recess and has a lot of difficulty even responding to classmates. It has been 6 months since
the beginning of school. At home, Frannie is warm and outgoing with her family, laughing and talking
normally.
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Defining Social Anxiety
Anxiety ( as defined by the book) is a mood
state that is characterized by strong
negative emotion and bodily symptoms of
tension in which a child apprehensively
anticipates future danger or misfortune.

strong negative emotion

fear

When a child experiences these feelings in an
excessive amount is when the feelings become
classified as a disorder.

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Defining Social Anxiety
Continued
Also, Frannie is able to communicate and
interact while being warm and outgoing with
her family. Therefore, it is solely based on
the environment in which she is placed.
social.


Although there are many different types
of anxiety, Frannie is specifically
experiencing Social Anxiety.


http://www.youtube.com/watch?v=i7EAsMNZ6uA
Discomfort interacting with peers
Withdrawn/nervous around other children
Shake and cry when expected to interact

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Social Anxiety Disorder
Emotional Symptoms/Diagnosis/Criteria
A. Marked fear or anxiety of social situations
B. Fear that they will show anxiety symptoms and be negatively judged
C. Social situations almost always provoke fear or anxiety
D. Social situations are avoided or endured with intense fear
E. Fear or anxiety are out of proportion
F. Fear typically last for more then 6 months
G. Fear, anxiety, or avoidance causes clinically significant distress or
impairment
H. The fear, anxiety or avoidance is not attributable to the effects of a
substance or medical condition
I. Not better explained by another mental disorder
J. If another medical condition stuttering, Parkinson's disease, obesity,
disfigurement from burns or injury is present fear anxiety are ok
K. *special note* can not be performance only fear
+ Reasons for Diagnoses
Social Anxiety
Teacher notices marked fear or anxiety
Symptoms have continued for at least 6 months
Going to neighbors house provokes fear through
shown through her crying
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Social Anxiety
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Symptoms of Social Disorder
Heart Palpitations-71%
Trembling or Shaking-67%
Chills- 63%
Sweating or Hot Flashes- 54%
Upset Stomach or Nausea- 54%
Red face or blushing
Shortness of breath
Physical Symptoms
http://www.helpguide.org/mental/social_anxiety_support_symptom_causes_treatment.htm
Racing Heart
Tightness in Chest
Accidental Bowel
Movements
Dizziness
Fainting
Crying
Panic Attack
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Symptoms of Social Anxiety
Avoiding social situations to a degree that limits usual activities
or disrupts a normal life
Staying quiet or hiding in the background in order to escape
notice and embarrassment
A need to not feel alone (a friend)
Behavioral
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Causal Factors
Direct conditioning/ Learned behavior- a child may learn to
become socially avoidant by a parent who exhibits shyness or
an avoidant personality
Traumatic experience in a social environment may create
anxiety from all social encounters after that experience
Parental overprotection and/or rejection have been associated
with social anxiety disorder
An anxious temperament in the home

+ Causal Factors Continued
Genetics
-Anxiety disorders tend to run in families
-A history of shyness and chronic illness can increase the risk
Brain Function/Chemistry
- An overactive amygdala: this can cause someone to have an
increased fear response which can cause anxiety in social
situations
- An imbalance in serotonin- those with social anxiety disorder can
be extra sensitive to the effects of serotonin in the brain.
Serotonin is responsible for mood and emotional control

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Triggers for Social Anxiety
Meeting new people
Being the center of attention
Being watched while doing something
Making small talk
Public speaking
Performing on stage
Being criticized
Attending parties or other social
gatherings
Talking with important people
Being called on in class
Going on a date
Making phone calls
Using public restrooms
Taking exams
Eating or drinking in public
Speaking in a meeting

http://helpguide.org/mental/social_anxiety_support_symptom_causes_treatment.htm
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Therapy
Cognitive Behavioral Therapy
Exposure Therapy
Virtual Reality Therapy
http://www.youtube.com/watch?v=i7E
AsMNZ6uA
Treatments and Roadblocks
to Social Anxiety
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Medication
Anti depressant medication
-Selective Serotonin Reuptake Inhibitors (SSRIs)
- escitalopram
- sertraline
-Cons
becomes worse before it gets better, does not work right away
Beta blockers
-Cons
work better with short-lived anxiety.
Benzodiazepines
-Cons
addictive, lose effect shortly after taking them, drowsy
Medicine not taken for long
Treatments &
Roadblocks to
Social Anxiety
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Social Anxiety & Co-Occuring
Disorders
The most common co-occuring disorders are:

depression
generalized anxiety disorder
selective mutism (preadolescent)
substance abuse (adolescent)

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(Co-occuring) Diagnosis
Selective mutism (SM) is an anxiety disorder in which a child is
unable to speak in public situations where speaking is expected.
Children with SM often speak normally in familiar situations, such
as at home or alone with parents; but cannot speak at all or above
a whisper, in other social or public settings such as parks,
shopping malls, restaurants, or school.

Studies and research often indicate children with SM suffer from
social anxiety, far beyond normal shyness, which affects not only
their ability to converse in public, but also interferes with their
academic and social development. (Dummit et al, May 1997, J Am Acad
Child Adol Psychiatry)

In the Case Study of Frannie
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(Co-occuring) Diagnosis
Frannies mother tried repeatedly to get her involved with other
children in the neighborhood. She would take Frannie by the
hand and lead her to neighbors home where there were
children of the same age. When she did this, Frannie would
start to shake or cry and would not be able to say a word to
the neighbors child.
The teacher reports that in the classroom, Frannie never
initiates conversation with the other children and has great
difficulty responding even when approached by another
child.
At home, Frannie is warm and outgoing with her family.
In the Case Study of Frannie
http://www.youtube.com/watch?v=gmEJEfy5f50&feature=youtu.be
Kaylas story / Example of SM

+ The End!