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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jimmygold70 on April 5, 2001, at 10:59:51
I have been diagnosed for having social phobia about 7 years ago. I've tried every possible treatment for SP, all failed except for, maybe, Klonopin. Now, my new PDoc says I don't really have SP. I can really be comfortable with People, but I get into terrible stress in crouds, and that's more like PTSD I might have got when I got humiliated in elementary school.
Does this theory make sense to you people ? So what is the terrible tension I am feeling ? Hyperarousal ?
Jimmy
Posted by judy1 on April 5, 2001, at 18:20:52
In reply to Socia- Phobia-Like PTSD ?, posted by jimmygold70 on April 5, 2001, at 10:59:51
Dear Jimmy,
It sounds very much like agoraphobia (fear of crowds to me- which you can have even without actual panic attacks. Plus the fact that klonopin works for you says you probably do have some type of panic disorder. PTSD is usually a result of a trauma of such magnitude you felt your life was threatened (Vietnam Vets, child abuse survivors, etc.) I've found that shrinks who specialize in anxiety disorders are usually the most helpful. Take care, judy
Posted by kate9999 on April 6, 2001, at 2:44:04
In reply to Socia- Phobia-Like PTSD ?, posted by jimmygold70 on April 5, 2001, at 10:59:51
Re Judy's suggestions that it's agoraphobia: It might be. From what I've read you can distinguish between agoraphobia and sp - if you're afraid of having a panic attack it's more like agoraphobia. But if you're getting nervous because you feel self-conscious, watched, or "on display" that's more like social phobia.
The PTSD thing - I feel pretty strongly that your doc is wrong.
I think a lot of social phobics are social phobics at least in part because they were picked on in school. Does that make it PTSD and not social phobia? Not by the DSM criteria. Judy's right - there has to be the threat of death or serious injury (to self or other). But the rest of the criteria also require an aspect of reliving the event, as well as "Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)." Just read the description: http://www.psychologynet.org/ptsd.html
Overall PTSD really is described as a SET of severe psychological reactions to a SPECIFIC severe trauma.
I don't think it's quibbling to say that humiliation is not "severe enough." I have sp, and I also had an acute stress reaction once when I watched and a woman get hit by a train and then tried to help her. (It didn't last long enough to be ptsd). I can tell you they're 2 totally different animals. SP is all about anxiety, paralysis, and self-consciousness in certain situations. With PTSD or acute stress the effect is much more pervasive - it's like the trauma takes over your life, and everything else becomes unreal.
The simplest way I can explain it is, if it's sp you'll feel yourself once you're not with other people. PTSD is with you all the time.
What you're talking about is more like a conditioned fear response. If it's a fear of being judged or humiliated - I'm sorry - that's the ESSENCE of sp. Maybe not generalized SP, but at least a specific sp.
specific sp maybe responds to different medications than generalized social phobia - beta blockers and anti-anxiety drugs make more sense for a specific social phobia.
> I have been diagnosed for having social phobia about 7 years ago. I've tried every possible treatment for SP, all failed except for, maybe, Klonopin. Now, my new PDoc says I don't really have SP. I can really be comfortable with People, but I get into terrible stress in crouds, and that's more like PTSD I might have got when I got humiliated in elementary school.
>
> Does this theory make sense to you people ? So what is the terrible tension I am feeling ? Hyperarousal ?
>
> Jimmy
Posted by jimmygold70 on April 6, 2001, at 3:26:51
In reply to Re: Socia- Phobia-Like PTSD ?, posted by kate9999 on April 6, 2001, at 2:44:04
Thanks Kate and Judy!
Well, that was very interesting. Of course, my symptoms are more like specific SP. However, I have something interesting to add:I had fatigue for a long time, so an endocrinologist sent me to some lab tests. I have pathologic results on the Hypothalmic-Piturary-Adrenal (HPA) Axis. My cortisol levels are normal, but they don't go up in response to Insulin or Synacten (i.e. not dynamic). That's something you see in PTSD. On Panic disorder most research has shown some other kinds of HPA abnormalities, and one has shown an abnormality such as mine.
So, DSM-IV shows Diagnostic Criteria and not etiology. Maybe there are types of Social Phobia, which are unique in etiology and more similar in symptoms and etiology to very mild, subclinical PTSD?
I mean, I have fear of humiliation in public, not fear of death or dying, so that rules out PD. Something I do have that SP doesn't is flat affect.
Jimmy
Posted by judy1 on April 6, 2001, at 12:24:08
In reply to Re: Socia- Phobia-Like PTSD ?, posted by jimmygold70 on April 6, 2001, at 3:26:51
I think Kate gave a wonderful discription of PTSD; as one who suffers from it, it is a debilatating and pervasive state- by it's very nature you can't have a 'mild case' (if you have subsyndromal PTSD you still have to fulfill the criteria of a situation where you or other was exposed to threat/actual death) or like Kate have less than 1 month duration and be dxed with acute stress disorder. You definitely have an anxiety disorder which are often comorbid with depression and hence the 'flat affect'. I really would seek out a specialist in this area, I'm sure getting the proper dx would really help. take care, judy
Posted by jimmygold70 on April 6, 2001, at 17:14:59
In reply to Re: Socia- Phobia-Like PTSD ? » jimmygold70, posted by judy1 on April 6, 2001, at 12:24:08
Judy - I can feel the support from your writing
(-:Actually, I've seen one of the top experts here. I know it's the social support group, but if you're still interested, that's what I'm taking right now:
* Risperdal for intrusive thoughts
* Depakene for the tensionI'm supposed to be on Effexor as well, but listen to the way the story goes... I were taking Celexa, and went to friends. We smoked a joint or so, and I've got to a really bad acute manic state. I manged to get home and call 911. They got me with an ambulance to the ER. That was the point were I lost my grasp of reality. I started moving very fast, was completely convinced that I am going to die, and that that I've been involved in a car accident. I was sure that the paramedic is fooling me to think I'm not injured when he said I'm going to see a PDoc at the E.R.
Eventually, I got to the ER, and then for some reason I got naked. They gave me some Haledol, and sent me to a psychiatric hospital where I spent the night. I got home alive, but I still have those terrible memories from that traumatic incidence. I thought acute mania is supposed to be "euphoric". I was just agitated and paranoid...
That's all for now. Hope I haven't made you tired...
Jimmy
> I think Kate gave a wonderful discription of PTSD; as one who suffers from it, it is a debilatating and pervasive state- by it's very nature you can't have a 'mild case' (if you have subsyndromal PTSD you still have to fulfill the criteria of a situation where you or other was exposed to threat/actual death) or like Kate have less than 1 month duration and be dxed with acute stress disorder. You definitely have an anxiety disorder which are often comorbid with depression and hence the 'flat affect'. I really would seek out a specialist in this area, I'm sure getting the proper dx would really help. take care, judy
Posted by judy1 on April 6, 2001, at 20:44:51
In reply to Re: Socia- Phobia-Like PTSD ?, posted by jimmygold70 on April 6, 2001, at 17:14:59
Are you bipolar? Sorry, I haven't been following threads here and am not familiar with your psych history. You are on a mood stabilizer and antipsychotic- the proper treatment for bipolar 1 disorder - have you been told this?- a very confused judy
Posted by jimmygold70 on April 7, 2001, at 3:36:39
In reply to whoa » jimmygold70, posted by judy1 on April 6, 2001, at 20:44:51
Judy,
No, I'm not bipolar, though I have some family history of that. My PDoc suggests that I had some mild hypomanic symptoms, like good mood, on Celexa. It is something common, occuring in 8% of people taking it (casual side effect). The combination of Celexa+marijuanna trigerred ths manic episode. I would not have had it otherwise.
Jimmy
> Are you bipolar? Sorry, I haven't been following threads here and am not familiar with your psych history. You are on a mood stabilizer and antipsychotic- the proper treatment for bipolar 1 disorder - have you been told this?- a very confused judy
Posted by judy1 on April 9, 2001, at 14:15:44
In reply to Re: whoa, posted by jimmygold70 on April 7, 2001, at 3:36:39
Not to burst your balloon, but if you have a family hx of bipolar and an AD and marijuana set off a PSYCHOTIC manic episode (you mentioned haldol), then a dx of bipolar 3 is automatically given by most bp experts. I really would hope that this dx would be the primary concern and your treatment given accordingly. Anxiety disorders are often comorbid with mood disorders. What dosages of meds are you taking now? Hope you are well- judy
Posted by jimmygold70 on April 13, 2001, at 17:41:31
In reply to Re: whoa » jimmygold70, posted by judy1 on April 9, 2001, at 14:15:44
Dear Judy,
I'm tekaing 600mg Depakene and 1mg Risperdal. That's about it. My PDoc describes me as having "Emotionally unstable personality + Personality Disorder of some sort" (My psychologist says I'm borderline), so, that very much like saying Bipolar III in other words...
Jimmy
> Not to burst your balloon, but if you have a family hx of bipolar and an AD and marijuana set off a PSYCHOTIC manic episode (you mentioned haldol), then a dx of bipolar 3 is automatically given by most bp experts. I really would hope that this dx would be the primary concern and your treatment given accordingly. Anxiety disorders are often comorbid with mood disorders. What dosages of meds are you taking now? Hope you are well- judy
Posted by judy1 on April 13, 2001, at 18:59:37
In reply to Re: whoa, posted by jimmygold70 on April 13, 2001, at 17:41:31
Do you know what your blood levels are, that's a pretty low dose of depakote. Normally the therapeutic range is 50-100u and to achieve that I had to take about 1000mgs/day. Why risperdal? Are you having psychotic symptoms now? Klonopin is a great med for anxiety and some pdocs consider it a second line mood stabilizer. I take risperdal only when experiencing psychotic symptoms. People with bipolar disorder are more prone to EPS then those with other disorders. How are you feeling?- judy
Posted by jimmygold70 on April 16, 2001, at 5:44:16
In reply to Hi Jimmy, posted by judy1 on April 13, 2001, at 18:59:37
Hi Judy !
> Do you know what your blood levels are, that's > a pretty low dose of depakote. Normally the
> therapeutic range is 50-100u and to achieve
> that I had to take about 1000mgs/day.Well, I'm only in the beginning of therapy, my doc gets the dose up slowly. I should have blood monitoring the day after tommorow.
> Why risperdal? Are you having psychotic
> symptoms now? Klonopin is a great med for
> anxiety and some pdocs consider it a second
> line mood stabilizer. I take risperdal only
> when experiencing psychotic symptoms. People
> with bipolar disorder are more prone to EPS
> then those with other disorders. How are you
> feeling?- judyKlonopin was very good for me, but it "erases" my memory, so I can't function as a student. I take Risperdal for intrusive thoughts... It has to be combined with an AD. My PDoc took me off the AD since my manic episde, but he'll probably put me on Effexor or Celexa soon.
I'm feeling bad. I do function, but the intrusive thoughts are quite bad now, I hae extremely low self esteem since my last manic episode... I used to pick up women easily on my hypomanic episoded (esp. when combined with alochol :-)
Now, things are harder...Jimmy
Posted by judy1 on April 16, 2001, at 12:14:45
In reply to Re: Hi Jimmy, posted by jimmygold70 on April 16, 2001, at 5:44:16
how your blood levels are. It sounds like your pdoc is doing everything right, getting your mood stabilizer up before adding the AD- I hope that combo works for you. Lots of people have the memory problem with klonopin, I'm sorry you are one. Actually risperdal works really well for me too, but I usually take 4-6 mg/day when I'm on it and the risk of EPS is probably nonexistant at your dose. Wow, do I ever identify with the self-esteem thing following the 'crash'. The last time i was manic and hit on my pdoc, it took me a month to see him again because I was so embarrassed. It sounds as if you're depressed and I'm sorry- the roller coaster world of bipolar disorder. Maybe a positive note- now that it's spring I'm starting to feel better (not hypomanic- maybe a 6 on the 1-10 scale). That seasonal thing has always been with me, maybe you'll find it true for yourself. Take care, judy
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