![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by anita on August 4, 2000, at 13:23:52
Hi all,
I recently completed a survey on social anxiety for a non-profit group. Most of the questions were about, well, anxious feelings. However, a lot of my social phobia seems to be due to simply avoiding social situations because of a reluctance to interact with people, without feeling anxious about the prospect. Also, when with people I often feel quite numb and very bored, and can't think of anything to say or even want to say anything.
So I'm wondering if Avoidant personality disorder, which is often equated with social anxiety or social phobia, is really a further step in the problem, perhaps due to the past chronic anxiety, sort of like a learned response, maybe. Interestingly, anti-anxiety meds do not help my social problems.
Anybody have any thoughts?
anita
Posted by Cindy W on August 4, 2000, at 22:30:21
In reply to Social anxiety vs. Avoidant personality disorder, posted by anita on August 4, 2000, at 13:23:52
> Hi all,
>
> I recently completed a survey on social anxiety for a non-profit group. Most of the questions were about, well, anxious feelings. However, a lot of my social phobia seems to be due to simply avoiding social situations because of a reluctance to interact with people, without feeling anxious about the prospect. Also, when with people I often feel quite numb and very bored, and can't think of anything to say or even want to say anything.
>
> So I'm wondering if Avoidant personality disorder, which is often equated with social anxiety or social phobia, is really a further step in the problem, perhaps due to the past chronic anxiety, sort of like a learned response, maybe. Interestingly, anti-anxiety meds do not help my social problems.
>
> Anybody have any thoughts?
>
> anita
Anita, i can relate...i have social phobia, or social anxiety, or avoidant personality...i'm not sure i quite understand how these relate to each other, except that social phobia/anxiety is amenable to cognitive behavior therapy while avoidant personality refers to enduring personality patterns that are resistant to change. i too am quite anxious around other people unless i know them really well, and tend to avoid being around people and prefer my own company when we're just not on the same wavelength about things (because then i can think of nothing to talk about)...do i say, hey, i like frogs; how's your depression and ocd; i just don't see any point in small talk, although i try it when i'm at parties (which is pretty rare!).
Posted by SLS on August 5, 2000, at 9:33:02
In reply to Social anxiety vs. Avoidant personality disorder, posted by anita on August 4, 2000, at 13:23:52
> Hi all,
>
> I recently completed a survey on social anxiety for a non-profit group. Most of the questions were about, well, anxious feelings. However, a lot of my social phobia seems to be due to simply avoiding social situations because of a reluctance to interact with people, without feeling anxious about the prospect. Also, when with people I often feel quite numb and very bored, and can't think of anything to say or even want to say anything.
>
> So I'm wondering if Avoidant personality disorder, which is often equated with social anxiety or social phobia, is really a further step in the problem, perhaps due to the past chronic anxiety, sort of like a learned response, maybe. Interestingly, anti-anxiety meds do not help my social problems.
>
> Anybody have any thoughts?
>
> anita
Hi Anita.I recommend that you look at the DSM IV mental illness diagnostic manual for your answers. Despite the occasional appearance of cynicism regarding its utility, I find it to be of great value. If your non-profit group does not own a copy, perhaps it should purchase one.
Good luck.
- Scott
Posted by AndrewB on August 5, 2000, at 10:17:37
In reply to Social anxiety vs. Avoidant personality disorder, posted by anita on August 4, 2000, at 13:23:52
Anita,
I used to get the numbness and boredom without the anxiety. I guess it is a kind of emotional detachment from continual anxiety.
I saw a study that said social detachment was associated with dopaminergic malfunction. I've also read studies that indicate both social anxiety and extroversion have dopaminergic involvement.
Do dopaminergics still make you irritable after awhile. Did you ever find out why. How are you? How are your medications?
By the way, Avoidant Personality Disorder is described by some as a more extreme version of social anxiety, where the phobia is so strong the individual may even bunker down in their house.
Social anxiety with dysthymics was described in one book as being different in flavor form typical social phobia. While the dysthymic 'patients do fear situations in which they may be exposed to the scrutiny of others'....'they would prefer to stay home not because of social phobia but because of the lack of pleasure on enjoying contact with others, strangers and intimate people equally.’ (From 'The Spectrum of Chronic Depressions')
AndrewB
Posted by Andre Allard on August 5, 2000, at 18:29:49
In reply to Social anxiety vs. Avoidant personality disorder, posted by anita on August 4, 2000, at 13:23:52
I have, or had social anxiety disorder for a number of years which was very debilitating.
I do not believe that social phobia is related to personality. Social phobia is a disorder that is caused by low levels of seretonin, while personality traits are learned and developed over years from life experiences.
However, if social anxiety persists for many years on end, I can see how a person's cognitive distortions regarding their anxiety can lead to alterations in their personality.
All in all, I believe that the two are different from one another. Someone with an avoidant personality would most likely not suffer from intense anxiety and panic during social settings as a victim of social anxiety disorder might.
Posted by anita on August 6, 2000, at 10:42:58
In reply to Re: Social anxiety vs. Avoidant personality disorder, posted by AndrewB on August 5, 2000, at 10:17:37
Hi,
Cindy, we seem to have similar problems. I avoid almost all parties just because of the "small talk" problem!
Andrew, I haven't been on any new dopaminergic meds lately, but those are the only meds that do alleviate the social phobia. I'm doing ok on Zoloft & Lamictal, and not in any rush to start fooling around with new meds yet, as I recently had a 3-month-long depressive episode in which I slept more than I thought any human was capable of! But next on my list will be Edronax, then Mirapex. What's your regimen now?
The Spectrum of Chronic Depressions sounds like a good book -- I'll see if my library has it.My therapist did mention that PTSD is characterized by periods of extreme anxiety and periods of apathy/dullness and detachment. Wonder if there is a Social Chronic PTSD?
anita
> Anita,
>
> I used to get the numbness and boredom without the anxiety. I guess it is a kind of emotional detachment from continual anxiety.
>
> I saw a study that said social detachment was associated with dopaminergic malfunction. I've also read studies that indicate both social anxiety and extroversion have dopaminergic involvement.
>
> Do dopaminergics still make you irritable after awhile. Did you ever find out why. How are you? How are your medications?
>
> By the way, Avoidant Personality Disorder is described by some as a more extreme version of social anxiety, where the phobia is so strong the individual may even bunker down in their house.
>
> Social anxiety with dysthymics was described in one book as being different in flavor form typical social phobia. While the dysthymic 'patients do fear situations in which they may be exposed to the scrutiny of others'....'they would prefer to stay home not because of social phobia but because of the lack of pleasure on enjoying contact with others, strangers and intimate people equally.’ (From 'The Spectrum of Chronic Depressions')
>
> AndrewB
Posted by Snowie on August 6, 2000, at 12:21:29
In reply to Social anxiety vs. Avoidant personality disorder, posted by anita on August 4, 2000, at 13:23:52
Anita,
What you describe doesn't sound at all like Social Anxiety or Avoidant Personality Disorder. People with AvPD desperately want and crave interaction with other people, but they fear it at the same time because of their hypersensitivity to criticism and fear of rejection. Below is a link that discusses the personality disorders. Only you know where you really fit, if at all. Below that is a link to an excellent presentation about AvPD.
http://mentalhelp.net/personalitydisorders/symptom.htm - Discussion of Personality Disorders
http://www.arts.uwaterloo.ca/~acheyne/courses/Avoidpd.html - AvPD Presentation
Snowie
> Hi all,
>
> I recently completed a survey on social anxiety for a non-profit group. Most of the questions were about, well, anxious feelings. However, a lot of my social phobia seems to be due to simply avoiding social situations because of a reluctance to interact with people, without feeling anxious about the prospect. Also, when with people I often feel quite numb and very bored, and can't think of anything to say or even want to say anything.
>
> So I'm wondering if Avoidant personality disorder, which is often equated with social anxiety or social phobia, is really a further step in the problem, perhaps due to the past chronic anxiety, sort of like a learned response, maybe. Interestingly, anti-anxiety meds do not help my social problems.
>
> Anybody have any thoughts?
>
> anita
Posted by AndrewB on August 7, 2000, at 10:23:26
In reply to Re: Social anxiety vs. Avoidant personality disorder, posted by anita on August 6, 2000, at 10:42:58
Anita,
I'm sorry you had to go through such hell recently. Ît must be such a relief that the Lamictal is helping. I hope you can build on this recent success.
I wonder, since you are taking a mood stabilizer, you will respond differently now to dopaminergics. Or maybe you will have to add on yet another mood stabilizer first.
By the way, Akiskal is the editor of the book, The Spectrum of Chronic Depressions.
I'm now on the dopaminergics selegiline (low dose, just 5mg./day) and amisulpride. I'm in the process of trialing some arousal agents now. But really I feel very good now. I guess it is the selegiline. It is subtle, taking over a month to work, but it seems to really enhance the amisulpride. The effects of amisulpride don't tend to wilt under stress anymore. My social anxiety seems to actually be in the normal range now. I'm actually enjoying conversations and such so much. You know, just freely laughing a lot. I remember when I'd look at people laughing and talking and wonder what planet they were on (or what planet I was on!).
Best wishes,
AndrewB
Posted by Archangel_Michael on August 7, 2000, at 14:26:32
In reply to Re: Social anxiety vs. Avoidant personality disorder » anita, posted by Snowie on August 6, 2000, at 12:21:29
Geeze Snowie, you hit the nail squarely on the head as far as one of my problems is concerned. I really do desperately want to interact with "the humans" (you see, long ago I got to the point where I began to doubt my own humanity). I crave social interaction, yet my fear is so overwhelming that I'm nearly paralyzed. My inability to overcome the fear adds to my feelings of inadequacy. I find myself in a feed-back loop which is difficult to break.
Some years ago I ran into an old high school acquaintance. We had a great conversation. He said he was actually surprised by our conversation because when we were in high school, he thought I was "stuck up." My silence years ago, which he mistook as conceit, was one of the manifestations of my APD or SAD. I went home and cried about that. How many other class-mates ignored me because they thought I was "stuck up"? It still hurts when I think about the opportunities for friendships lost.
I've been lurking on this board for a while. Even here, I find it extremely difficult to participate. Psycho-Babble is a very social place, and here too, I feel out of place. I mostly enjoy reading the posts of a less clinical, more personal nature. I long to join in the conversations, yet I cannot. Every now and then I suck up my courage and submit a response, but that's a rare occurrence.
Thank you for the links. I book-marked them.
Best regards,
Michael (the digital wall-flower)--------------------------------------------------
> Anita,
>
> What you describe doesn't sound at all like Social Anxiety or Avoidant Personality Disorder. People with AvPD desperately want and crave interaction with other people, but they fear it at the same time because of their hypersensitivity to criticism and fear of rejection. Below is a link that discusses the personality disorders. Only you know where you really fit, if at all. Below that is a link to an excellent presentation about AvPD.
>
> http://mentalhelp.net/personalitydisorders/symptom.htm - Discussion of Personality Disorders
>
> http://www.arts.uwaterloo.ca/~acheyne/courses/Avoidpd.html - AvPD Presentation
>
> Snowie
>
>
Posted by anita on August 7, 2000, at 17:32:18
In reply to Re: Soical detachment: Anita, posted by AndrewB on August 7, 2000, at 10:23:26
Hi Andrew,
I am glad to have gotten over that episode, but I still fear it coming back, since I still have some bad days like that.
I've actually been on Lamictal for 3 years. When I've upped my dose, I get zombielike and unemotional.
I have a new theory about dopamine & my irritability side-effect: I wonder if the irritability is caused by the increased noradrenaline that is synthesized from dopamine. Perhaps adding something like clonidine to a dopaminergic med might help... I'm going to look at the differences between the norep and dopamine pathways in the brain today. Any thoughts?
I'm glad the selegiline is helping you. I haven't really considered it because of the short half-life of its amphetamine-like metabolite -- I'm very sensitive to that, getting terrible "downs" --- which is what happened with Parnate & Ritalin. BTW, I have a friend who takes selegiline recreationally (2.5-5mg), and he loves it.
anita
> Anita,
>
> I'm sorry you had to go through such hell recently. Ît must be such a relief that the Lamictal is helping. I hope you can build on this recent success.
>
> I wonder, since you are taking a mood stabilizer, you will respond differently now to dopaminergics. Or maybe you will have to add on yet another mood stabilizer first.
>
> By the way, Akiskal is the editor of the book, The Spectrum of Chronic Depressions.
>
> I'm now on the dopaminergics selegiline (low dose, just 5mg./day) and amisulpride. I'm in the process of trialing some arousal agents now. But really I feel very good now. I guess it is the selegiline. It is subtle, taking over a month to work, but it seems to really enhance the amisulpride. The effects of amisulpride don't tend to wilt under stress anymore. My social anxiety seems to actually be in the normal range now. I'm actually enjoying conversations and such so much. You know, just freely laughing a lot. I remember when I'd look at people laughing and talking and wonder what planet they were on (or what planet I was on!).
>
> Best wishes,
>
> AndrewB
Posted by anita on August 7, 2000, at 17:40:43
In reply to Re: Social anxiety vs. Avoidant personality disorder » Snowie, posted by Archangel_Michael on August 7, 2000, at 14:26:32
Hi Michael,
I'm glad you felt comfortable enough for a while to contribute! The great thing about this board, and other mental health boards, is that generally people are very accepting and understanding, as long as you're not hostile.
I had a similar experience: an old college aquaintance once told me that he was interested in being friends with me, but that he thought I was kinda "stuck up" and didn't like people or something. I do realize I may have come across that way, but when I was in college, I felt I was always craving human contact and friendliness, but I thought I had to protect myself from making that obvious to others!
anita
> Geeze Snowie, you hit the nail squarely on the head as far as one of my problems is concerned. I really do desperately want to interact with "the humans" (you see, long ago I got to the point where I began to doubt my own humanity). I crave social interaction, yet my fear is so overwhelming that I'm nearly paralyzed. My inability to overcome the fear adds to my feelings of inadequacy. I find myself in a feed-back loop which is difficult to break.
>
> Some years ago I ran into an old high school acquaintance. We had a great conversation. He said he was actually surprised by our conversation because when we were in high school, he thought I was "stuck up." My silence years ago, which he mistook as conceit, was one of the manifestations of my APD or SAD. I went home and cried about that. How many other class-mates ignored me because they thought I was "stuck up"? It still hurts when I think about the opportunities for friendships lost.
>
> I've been lurking on this board for a while. Even here, I find it extremely difficult to participate. Psycho-Babble is a very social place, and here too, I feel out of place. I mostly enjoy reading the posts of a less clinical, more personal nature. I long to join in the conversations, yet I cannot. Every now and then I suck up my courage and submit a response, but that's a rare occurrence.
>
> Thank you for the links. I book-marked them.
>
> Best regards,
> Michael (the digital wall-flower)
>
Posted by anita on August 7, 2000, at 17:45:06
In reply to Re: Social anxiety vs. Avoidant personality disorder » anita, posted by Snowie on August 6, 2000, at 12:21:29
Hi Snowie,
Oh, I definately have AvPd, no question. It's just in the past 5 years or so that the sense of detachment and boredom has outstripped my anxiety, and that my literal avoidance of people has outstripped my desire for contact, and I'm curious as to why this has happened.
Great AvPD link!
anita
> Anita,
>
> What you describe doesn't sound at all like Social Anxiety or Avoidant Personality Disorder. People with AvPD desperately want and crave interaction with other people, but they fear it at the same time because of their hypersensitivity to criticism and fear of rejection. Below is a link that discusses the personality disorders. Only you know where you really fit, if at all. Below that is a link to an excellent presentation about AvPD.
>
> http://mentalhelp.net/personalitydisorders/symptom.htm - Discussion of Personality Disorders
>
> http://www.arts.uwaterloo.ca/~acheyne/courses/Avoidpd.html - AvPD Presentation
>
> Snowie
>
Posted by Snowie on August 7, 2000, at 19:00:10
In reply to Re: Social anxiety vs. Avoidant personality disorder » Snowie, posted by anita on August 7, 2000, at 17:45:06
Hi, Anita,
Since I don't know you, I certainly won't dispute your self-diagnosis. However, I've been a member of several AvPD lists over the last two years, and I've never heard of anyone whose fears of rejection, criticism, and unworthiness ever led to a sense of boredom in social situations, which appears to be the exact opposite of AvPD. At age 43, my fears have only increased over the years. I suggest you get an evaluation by a mental health professional. Although I was recently "diagnosed" with social anxiety disorder, I think my fears are much deeper than that, and cognitive-behavioral therapy (which is recommended for social phobia) didn't help me at all. I have an apointment with a psychologist who specializes in the personality disorders, and I'm anxious to get his evaluation and diagnosis.
Snowie
> Hi Snowie,
>
> Oh, I definately have AvPd, no question. It's just in the past 5 years or so that the sense of detachment and boredom has outstripped my anxiety, and that my literal avoidance of people has outstripped my desire for contact, and I'm curious as to why this has happened.
>
> Great AvPD link!
>
> anita
>
>
> > Anita,
> >
> > What you describe doesn't sound at all like Social Anxiety or Avoidant Personality Disorder. People with AvPD desperately want and crave interaction with other people, but they fear it at the same time because of their hypersensitivity to criticism and fear of rejection. Below is a link that discusses the personality disorders. Only you know where you really fit, if at all. Below that is a link to an excellent presentation about AvPD.
> >
> > http://mentalhelp.net/personalitydisorders/symptom.htm - Discussion of Personality Disorders
> >
> > http://www.arts.uwaterloo.ca/~acheyne/courses/Avoidpd.html - AvPD Presentation
> >
> > Snowie
> >
Posted by Snowie on August 7, 2000, at 22:09:55
In reply to Re: Social anxiety vs. Avoidant personality disorder » Snowie, posted by Archangel_Michael on August 7, 2000, at 14:26:32
Angel Michael,
Glad the links I posted were helpful. FWIW, your feelings and memories are very similar to mine. Since Social Anxiety Disorder and Avoidant Personality Disorder overlap in many areas, it's difficult to find good information on the net that explains the differences between the two in detail. I did one find link that might be helpful ... see below.
http://www.lightdarkness.com/schizoid/conditions.html
Good luck!
Snowie
> Geeze Snowie, you hit the nail squarely on the head as far as one of my problems is concerned. I really do desperately want to interact with "the humans" (you see, long ago I got to the point where I began to doubt my own humanity). I crave social interaction, yet my fear is so overwhelming that I'm nearly paralyzed. My inability to overcome the fear adds to my feelings of inadequacy. I find myself in a feed-back loop which is difficult to break.
>
> Some years ago I ran into an old high school acquaintance. We had a great conversation. He said he was actually surprised by our conversation because when we were in high school, he thought I was "stuck up." My silence years ago, which he mistook as conceit, was one of the manifestations of my APD or SAD. I went home and cried about that. How many other class-mates ignored me because they thought I was "stuck up"? It still hurts when I think about the opportunities for friendships lost.
>
> I've been lurking on this board for a while. Even here, I find it extremely difficult to participate. Psycho-Babble is a very social place, and here too, I feel out of place. I mostly enjoy reading the posts of a less clinical, more personal nature. I long to join in the conversations, yet I cannot. Every now and then I suck up my courage and submit a response, but that's a rare occurrence.
>
> Thank you for the links. I book-marked them.
>
> Best regards,
> Michael (the digital wall-flower)
>
> --------------------------------------------------
>
> > Anita,
> >
> > What you describe doesn't sound at all like Social Anxiety or Avoidant Personality Disorder. People with AvPD desperately want and crave interaction with other people, but they fear it at the same time because of their hypersensitivity to criticism and fear of rejection. Below is a link that discusses the personality disorders. Only you know where you really fit, if at all. Below that is a link to an excellent presentation about AvPD.
> >
> > http://mentalhelp.net/personalitydisorders/symptom.htm - Discussion of Personality Disorders
> >
> > http://www.arts.uwaterloo.ca/~acheyne/courses/Avoidpd.html - AvPD Presentation
> >
> > Snowie
Posted by AndrewB on August 9, 2000, at 10:09:48
In reply to Re: Soical detachment: Anita » AndrewB, posted by anita on August 7, 2000, at 17:32:18
> Hi Andrew,
>
> I have a new theory about dopamine & my irritability side-effect: I wonder if the irritability is caused by the increased noradrenaline that is synthesized from dopamine. Perhaps adding something like clonidine to a dopaminergic med might help... I'm going to look at the differences between the norep and dopamine pathways in the brain today. Any thoughts?Interesting idea! You could try the clonodine with a dopaminergic. A quick look on the web revealed that it can take away anger attacks with PTSD patients. Tolerance can develop, then one can switch to guanfacine.
Another possiblility is a andrenergic beta bocker like propranolol. Again the net said it helped calm the PSTD patients.
I've been taking a little clonazepam (.5 to 1mg) a few hours before I go to sleep, even though I don't have problems sleeping. I don't know what it all means, but I've been in great spirits lately. The clono. has been used with CFS patients, sometimes a little at night (up to 1.5mgs) makes for better energy during the day. I don't know, maybe it gives some people a better sleep.
I keep on wondering with you, however, if you still don't need another mood stabilizer or calcium channel blocker to go with the lamotrigine. The calcium channel blocker nimodipine sometimes helps as a mood stablizer adjunct. All I can say is that I've tried it and it doesn't have any (nasty) side effects.
These are all just loose ideas though Anita. I wish I could be more of an authoritative resource for you!
>
> I'm glad the selegiline is helping you. I haven't really considered it because of the short half-life of its amphetamine-like metabolite -- I'm very sensitive to that, getting terrible "downs" --- which is what happened with Parnate & Ritalin. BTW, I have a friend who takes selegiline recreationally (2.5-5mg), and he loves it.I haven't noticed what would seem like any amphetamine like effects with selegiline. Everything is super smooth and natural. Maybe that is because I am taking it with amisulpride.
AndrewB
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.