Struggle with the spotlight or just shy? We'll help you unpack that knotty question and more, offering a roadmap to understanding the twists and turns of social anxiety disorder. With a dash of humor to lighten the load, we share candid tales from our own lives, revealing how these personal vignettes illuminate the broader psychological concepts. We also delve into how societal norms can exacerbate or mask symptoms, and we dissect the critical six-month marker that separates fleeting worry from a diagnosable condition.
Our conversation doesn't stop at social fears; it expands to the spectrum of anxiety disorder and autism. As we explore the landscape of these conditions, we highlight the signature worries of generalized anxiety disorder and the unique social and behavioral patterns seen in autism, painting a picture of how these challenges arise from within rather than external pressures. We break down the expected age of onset for these disorders and offer insights that not only prime you for acing exams but also deepen your compassion for those living with these often invisible struggles. Tune in for an episode that's as informative as it is heartfelt, guiding you through the complexities of mental health with knowledge and empathy.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Struggle with the spotlight or just shy? We'll help you unpack that knotty question and more, offering a roadmap to understanding the twists and turns of social anxiety disorder. With a dash of humor to lighten the load, we share candid tales from our own lives, revealing how these personal vignettes illuminate the broader psychological concepts. We also delve into how societal norms can exacerbate or mask symptoms, and we dissect the critical six-month marker that separates fleeting worry from a diagnosable condition.
Our conversation doesn't stop at social fears; it expands to the spectrum of anxiety disorder and autism. As we explore the landscape of these conditions, we highlight the signature worries of generalized anxiety disorder and the unique social and behavioral patterns seen in autism, painting a picture of how these challenges arise from within rather than external pressures. We break down the expected age of onset for these disorders and offer insights that not only prime you for acing exams but also deepen your compassion for those living with these often invisible struggles. Tune in for an episode that's as informative as it is heartfelt, guiding you through the complexities of mental health with knowledge and empathy.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Dr. Hutchinson:
Hello and welcome to our demystifying disorder series here at Licensure Exams. I'm Dr Linton Hutchinson, joined by my co-host, Stacey Frost. In today's episode we'll be talking about how you can differentiate social anxiety disorder from general anxiety disorder and autism spread from disorder in the DSM-5 TR.
Stacy Frost:
Hi there everyone, and a shout out to Linda, a therapist in Berlin, germany, who suggested the topic of today's episode Wielen Dunklinde ist Freude misch, das Freude hierbei uns sind, which for you non-German speakers out there, and maybe I butchered it a little bit, but that means thanks so much. I'm glad that you're here with us today. So let's start by reviewing the diagnostic criteria for social anxiety disorder.
Dr. Hutchinson:
OK.
Stacy Frost:
The hallmark of this disorder is a persistent fear or anxiety about social situations where the client is exposed to possible scrutiny or negative evaluation by others. A few examples include performant situations like giving a speech, like a podcast, or informal social gatherings, including conversations with others, or talking to strangers for talking about a child. Their anxiety has to occur in the presence of peers, not just for the adults. The client is worried that they will appear anxious they might be stumbling over their words sweating, blushing, trembling, that kind of thing and that they'll be negatively judged by others, for example, being perceived as boring or weird, crazy, stupid. The client might even worry that their anxious behavior will offend other people, and this sort of worry tends to be common in clients who have a cultural background with strong collectivist views Right Sort of like to Cahill.
Stacy Frost:
OK, I'll bite Linton who's to Keio?
Dr. Hutchinson:
Well, I'm glad you asked To. Keio is a 25 year old Japanese American guy who has intense anxiety about going to meet his Japanese girlfriend's family. Imagine that he worries that if he appears awkward or stumbles over his words due to anxiety, it will be seen as impolite and offensive to her traditional Japanese parents. Who would have known, who would have thought that? But he is afraid that they may think he is not respecting them properly and collective cultures. There's a strong norm about not embarrassing the family or group, so social anxiety may manifest as a fear of unintentionally breaking social norms and offending others because of one's anxious symptoms. The person recognizes that fear is excessive, but they cannot control it.
Stacy Frost:
Well, that is a perfect example to illustrate how social anxiety can present differently depending on the cultural context.
Dr. Hutchinson:
Right.
Stacy Frost:
The underlying fear of negative evaluation is still there, but the specific worries that the client has are tied to social norms and they vary cross-culturally. Ok, so back to the last few bits of criteria for social anxiety disorder. In children you might see crying tantrums, although, come to think of it, you might see this behavior in adults too.
Dr. Hutchinson:
Right, especially if you're at Walmart.
Stacy Frost:
Yes, I have seen a fair bit of adult tantruming there. That's a good point, and clinging to parents as manifestations of the anxiety that the child feels. And the other criteria here is that the social situations almost always induce a fear or anxiety response.
Dr. Hutchinson:
Ok, Stacy, but that also includes situations like going to the dentist, for example.
Stacy Frost:
Oh, good one, okay yeah.
Dr. Hutchinson:
Well, just up into a few years ago I really sort of dreaded going to the dentist, but you can only avoid that so long. So you know what Beck did to help me out.
Stacy Frost:
Oh, yes, I remember this well. So, as I recall, beck would say that you'd be going off to the beach for the day where we are right now.
Stacy Frost:
Yep, yep. And then she'd let you get all ready and you swim the suit you know, get your towel together, your suntan lotion and then, instead of making that you know left hand turn Right, you go right and drive directly to the dentist office. Well, I always did get a big laugh and I thought of that, and I'm sure Dr Lane and his staff at distinctive dentistry did too.
Dr. Hutchinson:
Okay, okay. She only had to do that for a few decades. I finally got over my anxiety.
Stacy Frost:
A little bit of exposure therapy. Okay, well, a bit of a slow learner though, aren't we, linton? Alright, but back to your question. Your fear of going to the dentist office would be classified as a specific phobia, not social anxiety disorder. But, linton, I also wonder if you developed a fear of going to the beach as a result of Beck's intervention.
Dr. Hutchinson:
No, I didn't like. For example, we're here right now.
Stacy Frost:
Okay, all right. Well, I'll take your word on that one. Linton, you do have, you know, one of your backgrounds up, so I can't really tell where you are. So, just like depressive symptoms, anxiety can manifest in different ways depending on the client's age. You'll also see avoidant behavior. The client avoids social situations where they feel exposed. Or if they have to be in those situations, they endure them with an intense fear or anxiety. And finally, the client's fear or anxiety is way out of proportion to the actual threat posed by the situation.
Dr. Hutchinson:
Wait, wait, there's one more Duration. Oh okay, yes, that's right Very very important.
Stacy Frost:
Yes, yeah, very important part of the criteria. So the anxiety about social situations and avoidant behavior typically lasts for at least six months or more.
Dr. Hutchinson:
Okay, remember that six months or longer is important. You may have to have that as a Criteria, this on an exam. So what about really shy people, though not to name any names? There is safety, yes.
Stacy Frost:
Well, shyness is a pretty common personality trait, linton, although I'm pretty sure that you have never been shy a day in your life. Dr Extraverge, you could initiate a friendly conversation. It's just about anyone, even the most reserved or standoffish person. I'm sure, because I've been with you at the public's checkout when you ask people what their favorite animals yes, and I've gotten some pretty interesting responses from that question.
Dr. Hutchinson:
Ziggy, who works in the meat department, was Thanks, and John actually has a pet octopus. Guess where he works. Oh, let's see oh no, he doesn't work at the seafood counter.
Stacy Frost:
Very interesting, I wonder the person who works a dairy with their favorite animals. All right, so back to your original question. Okay, no shyness by itself is not pathological.
Dr. Hutchinson:
Right, okay, I'll just have to take your word.
Stacy Frost:
Well, like all disorders in the DSM 5 TR, when the symptoms, in this case fear or anxiety cause problems with Relational, occupational, social or educational functioning, that's when you should start considering a disorder, in this case a diagnosis of social anxiety. Okay, so to sum it all up, social anxiety disorder involves an intense fear of social situations that leads to avoidance or distress that interferes with normal functioning, and that fear, anxiety or avoidance persists for six months or more.
Dr. Hutchinson:
Okay, remember that. Six months or more. That's right now. I've got a question for you, stacey, you're getting a little anxious there.
Stacy Frost:
Oh, whenever you ask questions, all right, go on, tell me what's your question.
Dr. Hutchinson:
Okay, what if your client only gets really anxious about performing in public? Maybe they have to give a presentation, let's say like a podcast, for example, or perhaps their musician dancer or an athlete, but aside from that, they don't have any other issues with social situations. Do they have social anxiety disorder? Who is that singer? Was it Barbara Streisand?
Stacy Frost:
I don't know. I think she did Social anxiety disorder. I imagine it's actually more common than we think. I mean, you know it's a it takes a special skill set, I think, to go up in front of thousands of people, especially singing Okay, so you're going to love this Linton. So in this case, you're going to be looking at a specifier.
Dr. Hutchinson:
Oh no, why are I surprised? Your favorite, Specifiers.
Stacy Frost:
Well, it wasn't terribly long ago that I would have said a big no to recording podcasts and webinars, but after working with you these past 10 plus years, I think I'm going on like 13 years now, linton. Yeah, and giving talks at conferences, posting webinars and doing these lovely podcasts together. I think I'm pretty well past my own performance anxiety. But you know, when I think about this, I look back and I say this was your plan all along, wasn't it?
Dr. Hutchinson:
Right, Well, you've got me there. Stacey, you know we are planning to go to the Florida Mental Health Counseling Association annual meeting next year. That you missed this year.
Stacy Frost:
Oh, I guess that must have slipped my mind.
Dr. Hutchinson:
Maybe, I should have told you that we were going to go to the beach instead.
Stacy Frost:
Well, the beach actually sounds really nice. Right about now it's about like 35 degrees outside where I am.
Dr. Hutchinson:
Oh really, it's 69 right now. That's your.
Stacy Frost:
Hawaiian shirt on.
Dr. Hutchinson:
I love it, I do.
Stacy Frost:
All right. So how about a case to illustrate social anxiety disorder for our test takers, Linton?
Dr. Hutchinson:
Okay, let's talk about Daniel, and Daniel describes experience intense anxiety when having to interact with others, especially people that he doesn't know too well. He's particularly anxious about giving a presentation at work, going on any job interviews or speaking up in meetings. Daniel worries that he will say something embarrassing or people just think he's ridiculous. He mentions that he experienced a panic attack on more than one occasion. His anxiety builds as soon as he knows that one of these social situations is coming up. He loses sleep the night before to excessive worrying. When in the anxiety producing situation his heart races, he starts sweating profusely and his mind just goes totally blank. Afterward he is plagued by thoughts about how poorly the interaction went. Due to that anxiety. He's turned down a couple job promotions at work that require more public speaking and leadership kind of a role. He avoids attending any social functions, refuses to date anybody and has trouble forming close relationships. He reports feeling, of course you can imagine lonely and to set aside with his life.
Stacy Frost:
Okay, I think I've got the key points there, so I've got a question for you now, linton.
Dr. Hutchinson:
Oh, no what.
Stacy Frost:
Feeling a little nervous, a little anxious. Okay, so why is social anxiety disorder a better fit for Daniel than, say, generalized anxiety disorder?
Dr. Hutchinson:
Okay, well, you know this is the kind of session that you might find on an examination that you have to do. Okay, so you have to think. There's a few key reasons why Daniel's symptoms fit better with social anxiety disorder rather than generalized anxiety disorders. And what are they? The main trigger for Daniel's anxiety and avoidance is social situations, especially those involving potential negative evaluation or judgments from anybody else. His fear is focused on social context. Specifically, he does not endorse excessive worry about routine life circumstances like health, finances or household responsibilities, safety of loved ones and hypothetical future events. If Daniel mentioned those kind of concerns in a session, that would be more indicative of what Of generalized anxiety disorder and and Daniel's anxiety spikes in anticipation of specific feared social situations, whereas generalized anxiety is more persistent and unprovoked. It just is there.
Stacy Frost:
Okay, alright, here's another one. So what about autism spectrum disorder? Both ASD and social anxiety disorder involve challenges and difficulties with social interactions.
Dr. Hutchinson:
I see. Well, Stacey, why don't you tell me about that?
Stacy Frost:
Alright, turn the tables back on me, alright. Well, this is important information for you guys to know, because there are gonna be choices, you know, like this, on a licensure exam right, so you have to distinguish between disorders, Alright. The critical difference, Linton, is that in social anxiety disorder, the social difficulties stem from a fear of negative judgment.
Dr. Hutchinson:
In contrast, the social challenges associated with autism spectrum disorder are due to core deficits in social communication interactions and inflexible, restricted behaviors, such as deficits in social emotional reciprocity, abnormalities in eye contact and body length, and overall difficulties in developing, maintaining and understanding relationships.
Stacy Frost:
Oh, that was a mouthful, Linton.
Dr. Hutchinson:
Oh man.
Stacy Frost:
Yeah, so something else that provides a clue to autism spectrum disorder is the age of onset.
Dr. Hutchinson:
Yeah, that would.
Stacy Frost:
Yeah, yeah, so if the client symptoms appear later in adolescence, then that's more supporting evidence of an anxiety disorder. The typical age of onset for autism spectrum disorder is during early childhood and that disorder autism is classified as a neurodevelopmental disorder. So the age of onset for those disorders tends to be in the early childhood developmental stage.
Dr. Hutchinson:
So that would be a good differentiating criteria for these two, wouldn't?
Stacy Frost:
it? Yeah, absolutely. If you knew the age when this kind of stuff started for the client, then you could. It would help more support one disorder versus the other.
Dr. Hutchinson:
Okay, so how about giving us a brief summary of what we've discussed in this episode? Okay?
Stacy Frost:
Alright, sure thing. So put simply, clients with social anxiety disorder feel afraid or anxious in social situations where other people might judge them or think badly, and this makes the person want to avoid being around people or they feel really uncomfortable when they have to be around people in social situations. Now there's a specifier performance only that can be used with social anxiety disorder, when the anxiety is limited to public speaking or performing publicly.
Dr. Hutchinson:
Right.
Stacy Frost:
Alright, and so a few differentials that we talked about were generalized anxiety disorder, which involves excessive worrying about a variety of topics like health, finances, family safety, and that the anxiety is much more constant and it's unprovoked, unlike social anxiety disorder, where anxiety spikes around specific social interactions. And then there's autism spectrum disorder, which involves core deficits in social communication interaction and restrictive, repetitive behaviors. The social difficulties stem from these core deficits rather than a fear of negative evaluation, as we would see with social anxiety disorder. And finally, yeah, the age of onset also provides us with a big clue here. Social anxiety disorder typically appears for the first time in adolescence, while autism spectrum disorder symptoms emerge in early childhood.
Dr. Hutchinson:
Well, that was a great summary. Thanks, Stacey and all of you. Please join us next time as we continue to review topics together so you can pass your exam with flying colors. Until next time, remember, it's in there, it's in there.
