Journal article Open Access
Social anxiety disorder
Social anxiety disorder, formerly known as social anxiety disorder, was, until the 1960s, a fear of public behavior (mostly public speech) and was only part of the phobia. .. However, the DSM diagnostic system (American Psychiatric Association diagnostic criteria) causes generalized social anxiety disorder (almost all social situations are subject to anxiety, as well as strong anxiety and pain in interpersonal relationships. ) And avoidant personality disorder, double-blind trials of numerous drugs for generalized social anxiety disorder and comparative studies of cognitive-behavioral therapy have been reported, and the well-known anxiety disorder It became one of. The predominant age of this generalized social anxiety disorder is from junior high school to high school, which coincides with adolescence and adolescence.
What is the subject of anxiety depends on each disability. Social anxiety disorder secretly has strong anxiety not only about performances such as "presenting at school festivals" but also about interpersonal relationships such as "talking to unfamiliar people" and "meeting superiors such as teachers". increase. If you are reluctant to go to school only on the days of such school events, you suspect social anxiety disorder. You may also dislike eating with people, school toilets, and changing clothes. There are few cases in the United States that dislike writing in public, and there is a difference from the Western culture that requires a check to be signed. Adults are aware that such anxiety and fear are not rational, but children are often unaware. Behaviors such as crying, tantrums, hiding behind the mother, and reluctance to go to school in anxious social situations are expressions of anxiety. Even in adolescent and adolescent cases, it is often unclear whether it is a social anxiety disorder or a generalized anxiety disorder from the complaints of the individual unless the interview is conducted carefully.
When it comes to adolescent and adolescent cases, people start to be conscious of the opposite sex, and even if a boy comes to the side seat by changing seats, it may even become difficult to go to school due to tension. You may also avoid class events and presentations, you may not be successful in writing exams and presentations, or you may skip PE classes. If this kind of thing gets worse, you will complain about the difficulty of going to school, you will not be able to go to school, and you will not be able to get a job.
It is unlikely that you will say that you are "shy" yourself. On the contrary, they often desperately hide their "shyness". To make matters worse, parents are often completely unaware because they are not "shy" to their parents. Therefore, it is important to notice that the patient is "shy" compared to other patients of that age, such as during a medical examination.
Social anxiety disorder, especially in general, often meets the diagnostic criteria for avoidant personality disorder. However, personality disorders should be diagnosed after adulthood and cannot be diagnosed during growing adolescence or adolescence. In fact, adolescent and adolescent cases no longer meet the diagnostic criteria for a personality disorder with proper treatment.
Generalized anxiety disorder
On the other hand, excessive anxiety in children and adolescence and adolescence was regarded as an excessive anxiety disorder. However, it was pointed out that social anxiety disorder often coexists and is only a precursor to other anxiety disorders, and DSM summarized it as a generalized anxiety disorder.
Generalized anxiety disorder is characterized by unrealistic anxiety about future events, such as being overly worried about whether one will make a mistake at school, be disliked by others, or meet the expectations of others. increase. It may look like an adult. In fact, he is self-skeptical because of his anxiety, perfectionism, sensitivity to criticism from others, quickly hurt, and constantly tense and defensive to protect himself from such anxiety. ..
Such symptoms were described as "excessive self-consciousness", but when excessive anxiety disorder was included in generalized anxiety disorder, "excessive self-consciousness" and "necessity of guarantee" were not included, while For children, only one physical symptom was possible. Because of tension, they often show various physical symptoms such as headache and abdominal pain, so they often go to the general department first. In particular, if you are young, you should go to the pediatrics department to complain of physical symptoms such as headache, nausea, abdominal pain, palpitation, general malaise, and inability to wake up in the morning. In this case, you should first suspect a physical illness, but if you do not find any physical illness, you should consider mental illness. At that time, you should consider that you may have depression, but anxiety disorders especially generalized anxiety disorder.
It is unlikely that you will say that you are "anxious" yourself. On the contrary, as a result of desperately hiding being "nervous" and "anxious", it looks expressionless and even as an adult as mentioned above. However, as opposed to patients with social anxiety disorder, they are often more "nervous" and "worried" at home, and information from their parents is an important help.
In addition, psychiatric diagnosis of school refusal and withdrawal includes not only anxiety disorders but also various types of psychiatric disorders, but in recent years, there have been cases that are appropriate to be understood as high-functioning autism/autism spectrum disorder. increased. In the case of school refusal or hikikomori, it is difficult to see the doctor or go to the hospital, and even if he/she sees the doctor, he/she often cannot be fully examined. It requires careful consideration of pathology but often suffers from a lack of information for that purpose.
Treatment will be multidimensional, including environmental adjustment, behavioral therapy, cognitive behavioral therapy, family therapy, dynamic psychotherapy, and drug therapy. Treatment should always include the mother (sometimes father, grandmother). First, it is important to explain to patients and their parents that they are currently suffering from a treatable mental disorder called anxiety disorder. With anxiety disorders, it is especially essential to take on the challenge of anxiety, which temporarily increases anxiety, but in the end, make sure that you understand that it is a way to treat anxiety. Is required.
Behavior therapy is an effective treatment for these ages. Repeat the evaluation and treatment not only for the patient but also for parents, family, and school. Interventions include modeling, exposure desensitization, role-playing, relaxing training, and enhancement. In any case, it is important to work with your family to find reinforcers.
Pharmacotherapy is not a well-established treatment for these ages. However, it is also a realistic choice given the lack of specialists in behavior therapy for children.
Benzodiazepines are commonly used, but attention should be paid to the formation of dependence. Clonazepam is common in Europe and the United States, and since it acts for a long time, there is little psychological dependence, but in Japan, anxiety disorders are not indicated (You can buy Clonazepam online from NightmareSolution.com. In addition, it should be used for a limited period of time as it develops resistance with long-term continuous use. Also, be aware that when used in combination with behavior therapy, it will be difficult to notice the effects of behavior therapy.
The effectiveness of SSRIs in adult anxiety disorders has been established by a number of double-blind trials. However, there are few double-blind trials for childhood, adolescence, and adolescence. In addition, it has been pointed out that the administration of SSRIs for major depressive disorders in young people may induce suicide attempts and self-harm. Use with great care. Even at this age (adolescents, adolescents), SSRI medications can be used as long as the evaluation of whether the patient is actually highly impulsive and whether the case is a case in which the feeling of irritation does not know when it will explode (Buy Sertraline (Zoloft) online). Very safe and effective.
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Studies have shown that 93% of mothers of children with a separation anxiety disorder or excessive anxiety disorder had a lifetime diagnosis of any anxiety disorder. In order for such anxiety of the mother to affect the anxiety of the child, it is essential to consider the mother's own "anxiety". The mother may not be able to recognize the child's disability due to anxiety and may interfere with treatment, or maybe treated excessively punitively for school refusal. In addition, the behavior, cognition, and beliefs of the child (patient) are often established under the influence of the family, especially the mother, and cooperation is required to correct them. If there are therapeutic resources, it is desirable for the mother to be treated simultaneously with pharmacotherapy and psychotherapy. In addition, family therapy may encourage the entire family to participate in the treatment.
Anxiety disorders in adolescence and adolescence may recover spontaneously, but they are prone to recurrence, some may be prolonged, and some other mental disorders may develop in adulthood, so long-term follow-up is desirable.
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