Case history
Case history #1
A 53-year-old woman has long-standing social anxiety, dating back to childhood. She always feels shy and self-conscious around others, and never feels that she knows what to say or how to act. She has never dated, and reports few friendships over her life. She works as a computer programmer so that she does not have to interact with others face to face. She has passed up advancement opportunities at work as these would have placed her in a more interactive role with others. She often feels physically tense, nervous, nauseous, and flushed, even during casual interactions. After these situations, she will often replay these events in her head in an extremely self-critical manner. She spends most of her time alone and lacks social skills. She is sometimes described by others as 'odd' or 'a loner'. She avoids almost all social situations.
Case history #2
A first-year male student reports increasing stress at university. Although historically he has done well academically and appears quite extroverted, the transition to university has been difficult and his grades have been suffering. He is afraid of drawing attention to himself in his classes by asking 'stupid questions' and has avoided meeting with his professors and teaching assistants. He experiences particular difficulty in seminars and tutorials, where there is less opportunity to hide than in a lecture theatre. He feels his mouth getting dry and his heart racing when even thinking about trying to get help. He has become more withdrawn, is starting to feel more depressed, and recently began missing classes.
Other presentations
Many individuals with social anxiety will often report panic-like sensations brought on by the anticipation of, or actual engagement in, feared situations. The scope of the anxiety may be focused on specific types of social situations or generalised to almost any social encounter. Relative to other anxiety disorders, social anxiety is associated with a high risk of comorbid depressive and substance-use related disorders.[1][2] In more severe presentations, the social anxiety is often long-standing and the individual may be avoidant of almost any social encounter, thereby making treatment engagement difficult. Childhood presentations of social anxiety may include behavioural inhibition, crying, tantrums, school refusal, and separation anxiety from caregivers that would be considered developmentally abnormal.
Selective mutism shows some overlap with symptoms of social anxiety in children. Children with selective mutism consistently fail to speak in specific social situations where there is an expectation to speak (e.g., school), despite speaking in other situations.[3] Studies suggest selective mutism may be characterised by higher levels of social anxiety in specific situations.[4]
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