Social Anxiety Disorder (SAD)

Social Anxiety Disorder is a very common problem, and including the very mild forms may affect near 10% of the population. SAD is mainly defined as fear of social situations in which embarrassment may occur. It may be generalized to many social situations or circumscribed to one or two specific situations. The most common form is intense anxiety in public speaking. The person may get red and flustered and shaking in voice and hands. Other situations can include fear of meeting new people, fear of going to public toilets, and fear of drinking, eating, or writing in public. Situations are avoided and there can be much subjective distress and significant impairment in one’s functioning. There is a tendency for Social Phobia to run in families.

The psychological mechanism is that the person has some sense of low self-esteem and they project this onto the people they are speaking to and meeting with which amplifies their anxiety.

Education, exposure training, psychotherapy and medication may all be beneficial in this disorder which usually responds well to treatment.

Obsessive-Compulsive Disorder (OCD)

There are 2 forms of Obsessive-Compulsive Disorder. One is where the person mainly has obsessions, the other is where the person has obsessions and compulsions to act on the obsessions. These must be time consuming or cause significant distress and/or impairment, and the person is aware of their excessive nature.

Obsessions are recurrent and persistent thoughts, impulses, or images. These tend to be related to contamination, e.g., that one has touched some contaminated object, repeated doubts (e.g., that one may have harmed someone else in an accident, that the electric lines are emitting dangerous waves, needing things in a strict order, or impulses that one might harm or kill someone, etc.). Persons with excessive hording of old newspapers or garbage in their homes often have OCD and are unable to relinquish the doubt that there might be an important item in the garbage they might someday need.

Compulsions are repetitive acts often in response to the obsessions in order to suppress or neutralize them, (e.g., hand washing, counting, checking, praying, etc. ) and there may be rituals (e.g., making a round of the house windows and locks 5 times before one can leave the house). These compulsions are often very difficult for a partner or spouse to live with often causing conflict.

You can see that obsessions and compulsions are extreme and pathological versions of thoughts and behaviors that most normal persons have to some slight degree and that may cause severe problems in social and occupational functioning. Many of these persons first have symptoms before adulthood, there is a greater incidence of OCD in ones relatives than in the general population, and a greater concordance in monozygotic vs. dizygotic twins suggesting some genetic predisposition. As noted above, you can do a search of “obsessive compulsive disorder and brain scans" in the Pub Med web site of the U.S. National Library of Medicine or other sites to get a picture of the biologic findings in OCD.

Education, exposure training to the fears, behavioral modification for the compulsions, psychotherapy, and medication may all be beneficial for OCD. A percentage of persons with OCD may be partially or fully resistant to various combinations of therapy and require intensive and complicated therapy regimens.

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