Treating Social Phobias and Social Anxiety

Shyness And Social Anxiety System

The Shyness and Social Anxiety System is just as its name says. It is an e-book wherein in-depth discussions about the symptoms, causes and treatment for shyness and social anxiety are made. It is then written for individuals whose extreme shyness or social anxiety prevent them from enjoying a full life filled with social interactions among their family, friends and acquaintances in gatherings during holidays, outings and parties. The author Sean Cooper also suffered from shyness and social anxiety disorder so much so that he tried every trick in the book yet to no avail. And then he set out to conquer his own fears by researching into the psychology, principles and practices behind these two debilitating mental health issues. Read more...

Shyness And Social Anxiety System Summary


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My Shyness And Social Anxiety System Review

Highly Recommended

I started using this ebook straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Genetics and the Interactionist Interpretation of Shyness

Research suggesting a genetic contribution to behavioral inhibition proposes that 15 to 20 of newborns exhibit an inhibited temperament characterized by high reactivity (e.g., excessive crying and vigorous movement of head and limbs) to novel stimulation. Such infants tend to exhibit more timid behavior (e.g., playing near the primary caretaker) and have relatives who report more childhood shyness. An interactionist interpretation of trait shyness suggests that these tendencies may interact with environmental variables such as being teased or bullied, dominating older siblings, family conflict, and overprotective parenting, leading to excessive concern about social evaluation and painful self-consciousness. Finally, the development of shyness in adolescence is usually due to experiences of rejection and self-blame for perceived failure in social domains.

Social Isolation

Social interaction is integral to mental health across development. Lack of social interaction, or social isolation, not only is a painful experience but also can negatively impact child development. For infants and young children, lack of interaction with a primary caretaker can lead to marked delays in cognitive, socioemotional, linguistic, and motoric development. Furthermore, dysfunctional parent-child interaction patterns can contribute to child social incompetence and social isolation. For school-age children and adolescents, peer interaction becomes an increasingly important socializing agent that provides them with opportunities for social, emotional, and cognitive development. Through interpersonal interaction, children develop the skills of collaboration, perspective taking, empathy, and social competence, which help to promote prosocial behavior and decrease inappropriate, immature, or annoying behavior. The development of these social skills also contributes to chil Social...

Social Skills and Daily Living

Modeling by in vivo demonstration is widely used as part of social skills training. Video modeling is the staple of many standard programs. It has been the primary component in a diverse range of training programs, from teaching young, isolated children to overcome their shyness, to providing alternatives to social behavior related to drug abuse, aggression, and other illicit or unhealthy activity. For example, films of age-appropriate students coping with social pressure to smoke cigarettes have been effective in programs at junior high schools. It may be noted that the programs with greatest effectiveness are those that illustrate adaptive coping (resisting coercion without destroying friendships), not negative consequences (early, gruesome death by cancer).

Preconditions for Refraining

Despite Ryle's claims, refraining is neither circumstantially nor behaviorally empty. Certainly, it is only the negative fact that is explicitly specified when P is described as having refrained from doing such and such. But to describe P as having refrained from doing such and such is appropriate only if P is in one of a fairly limited range of practical and social situations. If a given refraining description is true, we can infer that a refraining situation applies. In this sense, P's refraining from X-ing certainly does bespeak facts about P's circumstances and what P actually does.

Characteristics of the Food

The phenomenon of conditioned food aversion is also known as conditioned taste or flavor aversion, poison-based avoidance conditioning, bait shyness, or aversion therapy depending on the interests of the investigator. A taste aversion implies that the aversion is limited to a gustatory CS that is, one that is sensed by the tongue. A flavor aversion implies that both taste and odor cues compose the CS and that both contribute to the conditioning.

Inferences from Observing Motion in Space

From abstract motion paths, adults can make further inferences about what generated the motion. In point-light films, the only thing visible is the movement of lights placed at motion junctures of, for example, the joints of people walking or along branches of bushes swaying. From point-light films, people can determine whether the motion is walking, running, or dancing, of men or of women, of friends (Cutting & Kozlowski, 1977 Johannson, 1973 Kozlowski & Cutting, 1977), ofbushes or trees (Cutting, 1986). Surprisingly, from point-light displays of action, people are better at recognizing their own movements than those of friends, suggesting that motor experience contributes to perception of motion (Prasad, Loula, & Shiffrar, 2003). Even abstract films of movements of geometric figures in sparse environments can be interpreted as complex social interactions, such as chasing and bullying, when they are especially designed for that (Heider & Simmel, 1944 Martin & Tversky,...

Summary Heuristicsquestions For Future Research

To more fully understand the nature of conscious processes would pay enormous dividends to all areas of psychiatry, illuminating many of the still well-hidden secrets within the mind-brain realms from where emotional distress arises. Such an understanding of functional neural integration in the brain would also no doubt open many new mysteries and questions. A special focus on early neurodevelopmental processes will also have crucially important implications for psychiatry (Schore, 2001), as the affective climate of early life must have a profound effect on the developing brain, substantially increasing or reducing an epigenetic vulnerability in later life to many psychiatric conditions. There is already abundant evidence from preclinical studies that positive social interactions have robust and life-long benefits for the neuroemo-tional resilience of young animals (Meaney, 2001). Such an understanding of early neurodevelopmental processes will eventually help clarify positive and...

Communicative Conventions and Courtesies

Communicative conventions and courtesies are the idiosyncratic modes of discourse that members of a social group use to communicate ideas, skills, emotions, and attitudes to each other in different situations. Capacities to learn and adapt to one's environment are developed and find expression as developed intelligence through social interactions. Consequently, individuals who engage in tasks requiring the deployment of intellectual processes must be familiar with and understand their implicit or explicit conventions and courtesies of communication.

Interactions with Other Children

Unrelated children also engage in congenial social interactions. Even infants smile and reach out to other infants, and older, but still young, children play together, with and without toys, and engage each other in true conversations. Early experience with other children of their own age, as well as with those older and younger, is often considered as important for young children's social development as association with adults. They learn the rules of a more egalitarian interaction, and by comparing themselves with others of their own age acquire knowledge of their own capabilities knowledge that contributes to their developing concept of self.

Development of Speech

Of the many activities composing the category of social behavior, speech occupies a preeminent position. Not only are newborns spoken to, but throughout the children's lives almost every subsequent contact with the parents, as well as with all other persons, is accompanied by speech. Even within the first months of life they vocalize in turn, setting the stage for a dialogue, a term that can well stand as a metaphor for all social interactions. While children are very young, adults carry the main burden of the conversation, marking their speech by a lively intonation, many repetitions, and much asking of questions. In turn, the vocalizations of the infant come to resemble the sounds and especially the intonations they hear.

Changes in ambient light

A reduction in the variation of light intensity, as experienced by cave dwellers, residents at polar latitudes, and space travellers, diminishes the influence of the environment on the circadian sleep rhythm and predisposes to a non-24-h sleep-wake rhythm. An extreme example is space travel, in which there is exposure to the sun rising and setting about 16 times in each 24-h period. The unusual pattern of activity and sleeping position in an environment with little gravitational force, and the imposed and restricted social interactions, all combine to alter circadian rhythms and sleep.

Efficacy Research on Psychotherapy

Posttraumatic Stress Disorder Public speaking anxiety Social Anxiety Disorder (Social Phobia) Specific Phobia Anxiety Disorders. A considerable body of evidence has shown that CBT is as effective as, or more effective than, medications in the treatment of the full range of anxiety disorders (cf. Nathan & Gorman, 1998, for a comprehensive review), Agoraphobia (e.g., Chambless, Foa, Groves, & Goldstein, 1979), Generalized Anxiety Disorder (e.g., Barlow, Rapee, & Brown, 1992), Obsessive-Compulsive Disorder (e.g., Fals-Stewart, Marks, & Schafer, 1993), Panic Disorder (e.g., Barlow, Gorman, Shear, & Woods, 2000), Social Phobia (e.g., Heimberg et al., 1998), and Posttraumatic Stress Disorder (e.g., Foa, Rothbaum, Riggs, & Murdock, 1991).

Emotional Development

Emotions play a significant role in the development of the child. Not only are they central to the process of attachment and other social interactions, but they also influence how well a child does in other developmental domains. This brief review discusses developmental theories of emotion and the developmental course of specific emotions. As the child matures, he or she gains new perspectives on how emotions are used. These processes are reviewed here.

Imaging of Other Neurotransmitter Systems

Furmark T, Tillfors M, Marteinsdottir I, et al. (2002). Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry 59 425-333. Schneider F, Weiss U, Kessler C, et al. (1999). Subcortical correlates of differential classical conditioning of aversive emotional reactions in social phobia. Biol Psychiatry 45 863-871. Stein MB, Leslie WD (1996). A brain single photon-emission computed tomography (SPECT) study of generalized social phobia. Biol Psychiatry 39 825-828. Tillfors M, Furmark T, Marteinsdottir I, et al. (2001). Cerebral blood flow in subjects with social phobia during stressful speaking tasks A PET study. Am J Psychiatry 158 1220-1226.

Clinical features

The three specific features of the syndrome are excessive daytime sleepiness, overeating and sexual disinhibition. An impaired memory, mood changes and other behavioural abnormalities are also common and fluctuate in parallel with the other symptoms. These symptoms characteristically occur in episodes lasting between two days and three weeks (usually less than one week), and occurring 2-12 times per year, although there is considerable variability both between patients and over time for individual subjects. They alternate with periods of apparent complete normality or partial remission of symptoms. Secondary psychiatric problems and social isolation are common.

Interpersonal Psychotherapy

Tested for bulimia, social phobia, Post-Traumatic Stress Disorder, and other conditions. For many of these syndromes, researchers developed new manuals to adapt IPT to the particular psychosocial needs of patients with the target diagnoses. Only in two studies of patients with substance abuse has IPT not been shown to be helpful.

Cross Cultural Aspects

Son, applied and reapplied makeup for hours a day, excessively washed her face, covered her face with her hand, and tweezed and cut her facial hair. As a result of her appearance concerns, she had dropped out of high school and then college. She avoided friends and most social interactions. Ms. A felt chronically suicidal and had attempted suicide twice because, as she stated, I'm too ugly to go on living.

Oppositional Defiant Disorder

Precursors to ODD may start very early among inflexible infants with irritable temperaments (Loeber, 1990 Sanson & Prior, 1999). Likewise, early behavioral problems, such as impulsivity, overactivity, and mild aggression, may blossom into more serious forms of disruptive behaviors, including ODD (Sanson & Prior, 1999). Children with difficult temperaments and early emerging behavioral problems are at greater risk for failing to develop positive attachments with caregivers and becoming involved in increasingly coercive interchanges with parents and significant adults, such as teachers. Likewise, parents of children with disruptive behavior problems often display high rates of harsh, inconsistent discipline, have unclear rules and expectations, and have low rates of positive involvement, adaptive discipline strategies, and problem solving skills (Lochman & Wells, 1996 Patterson, 1986). Loeber (1990) hypothesized that children begin to generalize their use of coercive behaviors...

Social Attachment and Affiliation

Fluences the mother-infant bond in humans, although correlational studies suggest that endogenous oxytocin does influence personality traits in postpartum women. Women who give birth by cesarean section have fewer oxytocin pulses during breastfeeding than those who give birth vaginally, and are less likely to describe themselves during the postpartum period as exhibiting a calm personality or high levels of sociality. In mothers delivering by cesarean section, oxytocin levels are correlated with the degree of openness to social interactions and with calmness. Like the bond between a mother and infant, strong social attachments are formed between mates in monogamous species. Prairie voles are a monogamous species of rodent and have been extensively studied as a model for understanding the neural basis of monogamy. In the prairie vole, oxytocin plays a role in formation of the bond of the female for the male. Infusion of oxytocin into the brain of a female prairie vole even in the...

Copyright 2004 National Academy of Sciences All rights reserved 105

Criterion 3 An Integration of Psychological Principles Relative to Cognition, Motivation, Development, and Social Psychology. Psychological principles such as those found in the American Psychological Association publication How Students Learn Reforming School Through Learner-Centered Education2 should be applied to the framework for content, teaching, and assessment. These psychological principles include more than learning theory. They include providing for motivation, development, and social interactions.

Behavioral Cognitive Approach

The cognitive-behavioral approach views human nature as a tabula rasa, a blank slate. The individual is motivated by environmental stimuli and social interactions (or cognitive representations of the two). Therefore, psychological maladjustment is likely to result

Susan M Congilosi Robert D Madoff

Fecal Incontinence Is the Inability to defer the passage of feces until a desired time and place. Although Incontinence of gas, liquid, or solid stool Is not a life-threatening disorder, It can dramatically affect an Individual's lifestyle and lead to social Isolation. Fortunately, most Incontinence Is amenable to medical or surgical therapy.

Cheryl Y Trepagnier1 Beth Mineo Mollica2 Sheela Stuart3 and Carole W Brown4

Unlike individuals with congenital disabilities, who have not had the benefit of typical socialization, many individuals with aphasia retain the ability to read social situations and extract information from non-language cues. Directional skills are also generally retained, such that someone may be an effective navigator without, however, being able to provide verbal directions. Preserved social and spatial abilities may be put to use for communication via gestures, mime and drawing, which are helpful for some individuals, and can improve with training (Sacchett et al., 1999). While it is possible that a communication device designed for an adult with acquired neu-romotor disability, or a device developed for young children with cerebral palsy, could be useful for someone with aphasia, that can in no way be assumed. It should also be remembered that unlike the primarily motor-impaired population, many people with aphasic communication difficulties are ambulatory and some may continue...

The Role of Individual Differences in the Association between Stress and Hypertension

Express anger more effectively, and engage in positive social interactions. As noted in Chapter 8, Franklin participated in a six-week anger management training program and was able to reduce his blood pressure significantly by learning how to express his anger more effectively. Furthermore, because the anger management training was conducted in small groups, the frequency of positive social interactions in his life increased (at least for six weeks ). Presumably, because Franklin still maintained his job as a firefighter, the blood pressure reduction that was observed resulted from reducing his vulnerability to stress, not from eliminating the sources of environmental stress in his life.

Depression and Behavioral Disorders

Although many healthcare providers may believe that high rates of depression or behavioral disorders are common in cancer survivors, there is little evidence that this is the case. While parents tend to see higher than average levels of somatic symptoms in children (e.g. headaches, stomachaches, toileting issues 39, 43 ), most research indicates no unusual levels of psychological symptoms in survivors during childhood and adolescence. Across a number of studies, overall rates of depression 42 ,behavioral disorders 41,43 and other general psychological symptoms 9, 31, 55 reported by children and their parents have been comparable to rates reported by children who have never had cancer. Similarly, survivors appear to have no more social anxiety, loneliness or body image concerns than do their never-ill peers 46 , and they may even have a more positive self-image than their peers 3,35 .

For Actions And The Understanding Of Intentions

What does the presence of mirror neurons in different species of primates such as macaques and humans tell us about the evolution of social cognition Monkeys may exploit the mirror neuron system to optimize their social interactions. At least, the evidence collected so far seems to suggest that the mirror neuron system for actions is enough sophisticated to enable

Social Consequences for Survivors of CNS Malignancies

As reviewed above, CNS malignancies appear to present a specific vulnerability for psychological late effects, above and beyond the cognitive changes that are usually associated with CNS disease and treatment 50 . This vulnerability appears to be particularly associated with deficits in the area of social development. Several studies of children who were treated for brain tumors identify difficulties in social competence and communication with peers they also cite reports of social isolation 12,18,47,59 . In one study, classmates continued to see brain tumor survivors as sick, even many years after treatment had ended 59 . It is likely that compromises in social competence are related to the cognitive changes that many brain tumor survivors experience as a result of their disease and treatment. Cognitive impairments may impede a child's ability to understand and respond appropriately to social cues. Indeed, in one study of brain tumor survivors, verbal memory and learning problems...

Social activity and relationships

Young adulthood is a time of increased vulnerability to stress and social pressures and presents cancer survivors with major developmental challenges above and beyond those faced by other young people (Hobbie etal. 2000). For example, negotiating interpersonal relationships (including intimacy and forming families), as well as educational and employment decisions and achievements, often requires a focus, perhaps for the first time, on the medical, social, cognitive or psychological effects of cancer treatment. It is not uncommon for adolescents and young adults with cancer to experience changes in friendships and perhaps a sense of isolation from friends due to lengthy time away from home, school or work for treatments many friendships may fall by the wayside over time (Schultz Adams 2003). Adolescents and young adults with cancer may become isolated from friends who they feel may no longer be able to relate to their life situation. These young patients and survivors report that their...

School Refusal Behavior

Many cases of school refusal behavior involve diverse symptoms. For example, these youth often have general and social anxiety, fear, depression, somatic complaints (e.g., headaches and stomachaches), and withdrawal. In addition, however, these youth also show many disruptive behaviors such as noncompliance, defiance, aggression, tantrums, clinging, refusal to move, and running away from school or home. In many cases of school refusal behavior, a mixture of these symptoms is present. In general, school refusal behavior is not largely related to gender, income level, or race, although dropout rates tend to be highest for Hispanics and African Americans.

SSRI Spectrum of Therapeutic Action

The efficacy of SSRIs in the treatment of major depression, panic disorder, and obsessive-compulsive disorder has clearly been demonstrated. In addition, data is accumulating on the therapeutic effects of SSRIs in conditions of obesity, eating disorders, post-traumatic stress disorder, social phobia, premenstrual dysphoric disorder and trichotillomania. How can one class of medications work for such a seemingly diverse group of illnesses Are these agents in fact nonspecific and work as a steroid might for a multitude of inflammatory conditions Or alternatively, is there an underlying psychopathology, relating to 5-HT, that represents a common neurochemical theme among these conditions Our methods of classification in psychiatry are clinical and descriptive and may relate poorly to actual brain function.

Definition and Categories

Shyness is a universal human emotion, sometimes viewed as a blend of fear and interest. As a personality trait, shyness is defined as excessive self-consciousness characterized by negative self-evaluation, discomfort, and or inhibition in social situations that interferes with pursuing interpersonal or professional goals. Shyness can occur at any or all of the following levels cognitive (e.g., excessive negative self-evaluation), affective (e.g., heightened feelings of anxiety or embarrassment), physiological (e.g., racing heart), and behavioral (e.g., failure to respond appropriately). Shyness may be triggered by a variety of situational cues. Among the most typical situations are interactions with authorities, strangers, members of the opposite sex, and unstructured social settings. Although similar in expression, introverts, like extraverts, do not fear social situations but simply prefer solitary activities. Shy individuals prefer to be with others but are restrained by evaluation...

Analyzing and Documenting

Video analysis of facial expression is a highly developed methodology that has been extended to social interactions. With enough resources, video allows any level of analysis once a coding system has been operationalized. It is also possible to take video (moving) X rays for medical clarification in such situations as the inability to swallow.

Models of Human Development

Although this example takes a stage-like view of human development, another tradition looks to the work of Vygotsky and his followers, seeing development more as a process of internalization from social situations that scaffold for the thinking of the participant (1978). In addition to its Pi-agetian emphasis, the work of Adey and Shayer draws upon social scaffolding. Scar-damalia and colleagues developed an initiative initially called CSILE (Computer Supported Intentional Learning Environments) and now Knowledge Forum, that engages students in the collaborative construction of knowledge through an online environment that permits building complex knowledge structures and labels for many important epistemic elements such as hypotheses and evidence (Scardamalia, et al., 1989). The social character of the enterprise and the forms of discourse it externalizes through the online environment create conditions for Vygotskian internalization of patterns of thinking. Studies of impact have...

Computerassisted Psychotherapy

Hand-held computers also have been found to be useful for computer-assisted psychotherapy. Newman and coworkers (1997) found that long-term outcome of computerassisted CBT for Panic Disorder was equal to standard CBT, even though clinician contact time was reduced to four sessions in those that received the computer adjunct. Gruber and associates (2001) demonstrated the efficacy and cost saving potential of a hand-held computer program added to cognitive-behavioral group treatment for social phobia. Computer-controlled, interactive voice response systems are another possible application of computer technology to perform psychotherapy functions (Greist et al., 2002 Marks et al., 1998). These systems use a conventional telephone instead of a computer terminal or a hand-held device to communicate with the user. Interactive voice response programs for Obsessive-Compulsive Disorder (BT Steps) and depression (Cope with Life) have been developed and tested by a team of British and American...

Document 7 Last Testament of Marco Datini of Prato Italy June 1 1348

The plague and its poison spread to SarmTn. It reviled the Sunni and the Shi'i Shi'ite . It sharpened its spearheads for the Sunni and advanced like an army. The plague was spread in the land of the Shi'i with a ruinous effect. To Antioch the plague gave its share. Then, it left there quickly with a shyness like a man who has forgotten the memory of his beloved. Next, it said to Shayzar and to al-HaTrim Do not fear me. Before I come and after I go, you can easily disregard me because of your wretchedness. And the ruined places will recover from the time of the plague. Afterward, the plague humbled 'Azaz, and took from the people of al-BaTb its men of learning. It ravished Tel Bashar. The plague subjected Dhulul and went straight through the lowlands and the mountain. It uprooted many people from their homes.

Adolescent Sex Offenders

Earlier studies on the etiologies ofjuvenile sexual abuse revealed that the adolescent child molester is a loner, has few friends or social peers, prefers interaction with younger children, has a limited occupational history, is an under-achiever, is immature, and identifies with a dominating mother. More recent research has suggested other clinical dimensions of the adolescent offender (i.e., feelings of male inadequacy low self-esteem fear of rejection anger toward women aberrant erotic fantasies and identification with adult models of aggression, violence, and intimidation). A central characteristic of the offender is poor psychological adjustment and adaptation, which is evident in poor social skills, social isolation, lack of appropriate assertiveness, and deficits in communication skills.

Communication Skills Training

Communication skills training usually is focused upon two broad sets of interpersonal skills skills for interacting with one or more persons, and skills involving interpersonal or shared problem solving. Conversational skill training is directed toward the enhancement of an individual's ability to initiate and maintain conversations with other people. This form of training has been employed with institutionalized and formerly institutionalized persons and with individuals experiencing social anxiety. Communication skills training is a central component of most assertiveness-training procedures, since effective communication is seen as an important precursor to assertive behavior.

Photic and Nonphotic Zeitgebers

Social rhythms are maintained by a variety of factors such as occupation, marital status, presence or absence of children, and recreational activities. Thus, interruption of these factors has the potential for disruption of normal circadian timing. The mechanism by which social rhythms participate in entrainment of biological rhythms is unknown. Some authors have suggested, based on animal studies, that social interactions or behavioral activity might cause a nonspecific increase in arousal, which could then feedback on the pacemaker in the SCN (Mrosovsky, Reebs, Honrado, & Salmon, 1989 Turek & Losee-Olsen, 1986 Van Reeth & Turek, 1989). Recently, Moore and Card (1990) proposed that social Zeitgebers may entrain the SCN through a specific neuropeptide Y pathway that involves the inter-geniculate leaflet. It has also been suggested that nonphot-ically entrainable oscillators may exist outside the SCN (Mikkelsen, Vrand, & Mrosovsky, 1998 Mistlberger, 1992).

Evidence That People are Biased in Favor of the Physically Attractive

Attractive and unattractive people do seem to differ in one critical respect, however. The good-looking appear to be more confident in romantic and social situations and to possess more social skills than their peers. People expect the good-looking to be charming, so they treat them as if they are. As a consequence, the good-looking become more socially skilled.

Monoamine Reuptake Inhibitors

Is produced rapidly in humans, with peak plasma levels of up to 3 times those of bupropion and a half-life of 24 hr. Therefore, orally administered bupropion is likely to lead to significant NE reuptake inhibition and relatively less DA reuptake inhibition. Bupropion increases locomotor activity and causes stereotyped behaviors in laboratory animals. In humans, it can cause restlessness, insomnia, anorexia, and psychosis. Bupropion is structurally related to phenylethylamines and unrelated to the TCAs, SSRIs, or MAOIs. It has no significant potency at binding to any known neurotransmitter receptors. Clinical studies have demonstrated that bupropion is effective in the treatment of major depressive episodes (Depression Guideline Panel, 1993). While early studies suggested that bupropion might be less likely to cause hypomania or mania in bipolar patients, subsequent studies suggested that it can cause mania and psychosis in bipolar patients, especially those with high pretreatment...

Obsessive Compulsive Disorder

BDD has many similarities to OCD, most notably prominent obsessions and repetitive behaviors. BDD has been considered to be an obsessive-compulsive spectrum disorder (Hollander 1993 McElroy et al. 1994), and it is probably more closely related to OCD than to the somatoform disorders with which it is classified. In a study that compared BDD and OCD, the disorders were similar in terms of sex ratio, illness severity, course of illness, and comorbidity (Phillips et al. 1998b). In addition, two neuropsycho-logical studies found that BDD patients had deficits similar to those reported for OCD (Deckersbach et al. 2000 Hanes 1998), although BDD and OCD patients were directly compared in only one of the studies (Hanes 1998). However, the study comparing OCD and BDD found that BDD patients were less likely to be married, had poorer insight, and were more likely to have had suicidal ideation or made a suicide attempt because of their disorder (Phillips et al. 1998b). They also had earlier onset...

Neuropsychiatric Applications

Emotional dysregulation is especially prominent in Anxiety and Mood Disorders. Patients with various .Anxiety Disorders have been scanned during symptom provocation to elucidate the pathophysiology of anxiety. Metabolic abnormalities in the orbitofrontal cortex, the cingulate, and the caudate nucleus have been noted in Obsessive-Compulsive Disorder (Rauch & Shin, 1997). For other Anxiety Disorders, findings are mixed although the anterior paralimbic cortex and the amygdala region have been implicated, particularly in Posttraumatic Stress Disorder (Rauch & Shin, 1997), and Social Phobia (Tillfors et al., 2001). The amygdala region may be a common site of action for behavioral and pharmacological treatments of Social Phobia (Furmark et al., 2002).

Neuroscience Perspectives

There are significant genetic contributions to anxiety (Plomin, DeFries, McClearn, & Rutter, 1997). Twin studies have shown heritability in children for a dimension of fear-fulness called behavioral inhibition, as well as shyness, and in adults for the personality characteristics of neuroticism. Behavioral inhibition before 1 year of age is associated with an increased cortisol and heart rate response (Kagan, 1997) consistent with the setting of lower thresholds for stress response system activation previously noted. However, twin studies also show a significant role for the environment (e.g., a proportion of behaviorally inhibited infants improve by age seven, whereas some noninhibited infants acquire this response at age seven).

Ultrapositivistic Psychopharmacology Era 1970present

With the recognition that one of the main targets of these agents were recently characterized dopamine systems of the brain (Arvid Carlsson, 2001, Nobel Prize in 2000), and the discovery of the various receptor molecules for dopamine transmitters, the specificity and potency of antipsychotics were honed by creative pharmacologists such as Paul Janssen in Belgium (discoverer of haloperidol, or Haldol, and also risperidone, or Risperdal). This led to our current array of atypical antipsychotics (Chapter 10), which can also alleviate some of the negative symptoms of schizophrenia (the anhedonic flattening of affect, the social isolation, and cognitive impairments often characterized as formal thought disorders). These newer drugs also have the advantage of few troublesome long-term side effects such as motor dyskinesias that consistently emerged after long-term treatment with the earlier, more potent anti-dopaminergic antipsychotics. Within a few years of the discovery of chlorpromazine,...

Separation Distressanxiety

The literature on childhood anxiety has recently emphasized the important influence of temperament factors (Kagan, Resnick, Clarke, Snidman, & Garcia-Coll, 1984) in this area. It has been found that the incidence of childhood anxiety disorders is greater in children who exhibit the temperamental characteristic of behavioral inhibition (Bie-derman et al., 1990). This characteristic, described as the tendency to withdraw from novel or social situations, may be related to separation anxiety.

Other Anxiety Disorders Definitions

The DSM-IV diagnostic system includes the following anxiety disorders separation anxiety disorder, panic disorder, agoraphobia, specific phobias, social phobia, obsessive-compulsive disorder, and generalized anxiety disorders, as well as the previously considered posttraumatic stress disorder and acute stress disorder (see Ref. 164 for review). Separation anxiety disorder is defined by excessive and developmentally inappropriate anxiety about separation from parents or other primary attachment figures. Typically less common in adolescents than younger children, a relationship between separation anxiety disorder and adolescent SUD has not been established. Panic disorder and agoraphobia are rare in adolescent samples. Specific phobias are relatively common but probably not a factor in SUD development. Social phobia is nearly as common in adolescent as in adult samples and may influence SUD development and course. Obsessive-compulsive disorder often begins during adolescence, but a...

Possible Mechanisms for Blunted GH Secretion to GH Secretagogues in Anxiety and Mood Disorders

Blunted GH responses to GH secretagogues, such as cloni-dine, desipramine, the insulin tolerance test, and others, were thought to detect down-regulation of postsynaptic alpha-2 receptors following excessive central noradrenaline (NA) activity in major depressive disorder (Coplan et al., 1995 Siever et al., 1982). That GH responses are blunted in response to both clonidine and growth hormone releasing factor (GRF) in Panic Disorder (PD) refuted the view that reduced GH response to clonidine simply reflects a specific alpha-2 abnormality. Uhde, Tancer, and Rubinow (1992) have reviewed the possible site(s) where blunting of GH may occur. These include (1) reduced availability of pituitary GH stores secondary to reduced synthesis or excessive secretion (this option seems unlikely as GH responses to the dopamine agonist, apomorphine, are exaggerated in PD) (2) overall hypersecretion of GH with secondary inhibition of GH secretion to secretory stimuli (3) an abnormally enhanced negative...

Studies of Cerebral Metabolism and Blood Flow in Anxiety Disorders

Relatively few imaging studies have investigated specific phobias. Most have employed PET imaging. While one study failed to demonstrate changes in rCBF (Mountz et al., 1989), results from others suggested activation of anterior-paralimbic regions (Rauch et al., 1995a) and sensory cortex (Fredrikson et al., 1995 Wik et al., 1993) corresponding to stimulus inflow associated with a symptomatic state. Although such results are consistent with a hypersensitive system for assessment of or response to specific threat-related cues, they do not provide clear anatomic substrates for the pathophysiology of specific phobia. Whereas one SPECT study of patients with social phobia and healthy control subjects found no significant between-group difference during resting conditions (Stein and Leslie, 1996), more recent cognitive activation neuroimaging studies revealed exaggerated respon-sivity of medial temporal lobe structures to human face stimuli (Birbaumer et al.,...

Treatment of Anxiety Disorders

First, patients are encouraged to expose themselves to the situations they fear until their fear subsides. For example, individuals with Social Anxiety Disorder may practice meeting new people, engaging in conversations, or purposely making minor mistakes in social situations. Individuals with Panic Disorder are encouraged to expose themselves to the physical feelings they fear (e.g., running in place until their fear of a racing heart decreases), in addition to the feared agoraphobic situations. In the case of OCD, the exposure is combined with prevention of the compulsive rituals (e.g., touching contaminated objects without washing one's hands). Third, treatment may include teaching the individual other relevant skills. For example, people with GAD often benefit from relaxation or meditation-based treatments. Individuals with Social Anxiety Disorder may benefit from learning to communicate more effectively.

Demographic Features of the Anxiety Disorders

Anxiety disorders can occur across a wide range of cultures, ages, sexes, and income levels. In most cases, anxiety disorders are more common in women than in men. The more frequent occurrence in women is most pronounced for Panic Disorder with Agoraphobia and certain specific phobias (particularly animals and storms). For other anxiety disorders, such as Social Anxiety Disorder, blood and needle phobias, and Obsessive-Compulsive Disorder (OCD), the differences between men and women are smaller. The typical onset of anxiety disorders varies, with some tending to begin in early childhood (e.g., animal phobias), others beginning, on average, during the teen years (e.g., Social Anxiety Disorder, OCD), and others tending to begin in early adulthood (e.g., Panic Disorder).

Goals of Cross Cultural Psychology

Social context has been notoriously difficult to opera-tionalize (Markus & Kitayama, 1998). The study of social context has been an active research focus for cross-cultural psychologists (Cole & Means, 1981 Kagitcibasi, 1997). In their own culture, investigators are so close to the same social contexts as the participants in their research projects that separation of person from context is difficult. In other cultures, since visiting investigators have not had much experience with various everyday social contexts, they can more easily separate themselves from social situations and formulate hypotheses about the relative contributions of individual and contextual factors (Hall, 1977 Brislin, 2000).

The Categorical Versus Dimensional Debate

A., & Kutchins, H. (1992). The selling of DSM. The rhetoric of science in psychiatry. Hawthorne, NY Aldine de Gruyter. Klein, D. N., & Riso, L. P. (1993). Psychiatric disorders Problems of boundaries and comorbidity. In C. G. Costello (Ed.), Basic issues inpsychopathology (pp. 19-66). New York Guilford Press. Magee, W. J., Eaton, W. W., Wittchen, H.-U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and Social Phobia in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159-168. Robins, E., & Guze, S. (1970). Establishment of diagnostic validity in psychiatric illnesses Its application to Schizophrenia. American Journal of Psychiatry, 126, 983-987. Spitzer, R. L., Endicott, J., & Robins, E. (1975). Research diagnos

Implicit Theories of Intelligence

Dictionaries, but most of us still have our own implicit (unstated) ideas about what it means to be smart that is, we have our own implicit theories of intelligence. We use our implicit theories in many social situations, such as when we meet people or when we describe people we know as being very smart or not so smart.

Neurotransmitter Correlates

Valzelli first documented that decreased turnover of the neurotransmitter serotonin (induced by either selective breeding, pharmacological manipulations, or social isolation) reliably increased aggressive behavior in mice and rats (Valzelli, 1980). The fact that early social isolation can reduce brain serotonin in animal models and that cerebrospinal serotonergic indices show only moderate heritability ( 30 percent) in humans suggests that serotonergic function responds both to genetic and environmental contingencies (Heinz et al., 2001). One indirect measure of brain serotonin function in humans involves administering a spinal tap and extracting a serotonin metabolite called 5-hydroxyindoleacetic acid from the cerebrospinal fluid (CSF 5-HIAA). An initial study that reported an association between low CSF 5-HIAA and history of violent suicides (Asberg et al., 1976) was followed by a string of reported associations between low CSF 5-HIAA with other impulsive aggressive behavioral...

Treatment Implications

Screening for anxiety disorders may be useful in evaluating SUD adolescents, particularly since these disorders may be neglected in clinical assessment (121). Structured interview methods developed for children and adolescents (e.g., the K-SADS) (154) typically include assessment of the relevant anxiety disorders. In addition to evaluating diagnoses, questionnaire measures may provide useful information on the severity and course of anxiety and phobia symptoms in SUD adolescents. Measures of social phobia and general anxiety are available and have been validated for adolescents (e.g., Social Phobia and Anxiety Inventory (174), State Trait Anxiety Inventory for Children (175), Hamilton Anxiety Rating Scale (176). disorders, periods of abstinence have been associated with improvements in anxiety (115,177). Anxiety and phobias may also alter response to treatment. For example, social phobia may lead to less willingness to participate in group interventions. When anxiety symptoms persist,...

Pathological laughing and crying

Pathological laughing and crying is a phenomenon characterized by outbursts of emotion which are out of proportion to the underlying feelings of happiness and sadness (Wilson 1923). The clinical manifestations of pathological emotions may range from facial expressions of happiness or sadness to loud and uncontrolled outbursts of laughing or weeping. These uncontrolled outbursts of pseudoemotion are almost uniformly embarrassing to patients. Fears of developing uncontrollable emotional display can lead to social phobia and withdrawal. This phenomenon has been referred to by a variety of names including pathological emotions, emotional lability, emotional incontinence, and emotionalism as well as pseudobulbar affect (Lawson and Macleod 1969 Wolf et al. 1979 Ross and Stewart 1987 Hanger 1993). This condition has also been associated with a variety of neurological disorders including stroke, multiple sclerosis, traumatic brain injury, amyotrophic lateral sclerosis, central pontine,...

The Use of SSRIs to Treat Conditions Other Than Depression

Social phobia is another anxiety-related condition for which the SSRIs are being evaluated. In open-label, clinical trials, both sertraline and fluoxetine have been reported to be effective for the treatment of social phobia.86,87 The improvement observed in both trials was moderate. Moreover, efficacy was less pronounced in more socially phobic patients87 and in those patients where the disorder was of the longest standing.86 In the more rigorous setting of a double-blind placebo-controlled clinical study, fluoxetine has been shown to produce significant improvements in the anxiety associated with social phobia, but not social avoidance.88 Based on the limited data available from clinical trials, it is likely that, analogous to their efficacy in alleviating depression, clinically significant amelioration of phobic symptoms will occur only after several weeks of SSRI treatment. Although on this basis, it would appear that the SSRIs are unlikely to constitute a major step forward in...

Selfconcept body image sexual identity

Cancer has the potential to influence development of self-concept, a key task, among young people (Rowland 1990). Alterations in physical appearance, including weight changes, hair loss, amputations, placement of catheters to facilitate treatment administration, scars and alterations in skin colouration and texture, not only make children and teens feel different from peers but also may represent frightening changes in the body with an adverse impact on self-esteem. Fears that the body will never return to its original appearance, of not being recognized by others or of being mistaken for an individual of the opposite sex, often lead to shame, social isolation, and regressive behaviours (Die-Trill and Stuber 1998). These sometimes sudden alterations in body image are often perceived by patients as a threat to their well-being, causing anxiety. Also, self-image and life outlook appear to be worse among survivors who perceive treatment-related physical limitation as being moderate to...

Cognitive Behavioral Therapy

CBT is a promising approach for treating BDD. Early case reports indicated a successful outcome with exposure therapy (Marks and Mishan 1988 Schmidt and Harrington 1995), audiovisual self-confrontation (Klages and Hartwich 1982), systematic desen-sitization (Munjack 1978), and cognitive plus behavioral techniques (Cromarty and Marks 1995 Gomez-Perez et al. 1994 Newell and Schrubb 1994). Studies using exposure (e.g., exposing the perceived defect in social situations and preventing avoidance behaviors), response prevention (e.g., helping the patient avoid compulsive behaviors, such as mirror checking), and cognitive restructuring have found these approaches to be effective for a majority of patients. In a report of 5 patients, 4 improved using these techniques in 90-minute sessions 1 or 5 days per week (with the total number of sessions ranging from 12 to 48) (Neziroglu and Yaryura-Tobias 1993). Techniques included covering or removing mirrors, limiting grooming time, stopping use of...

The Primary Psychopath

Cleckley was persuaded that this syndrome results from some deep and probably constitutional defect involving an inability to experience the normal affective accompaniments of experience. Alternatively, it has been suggested that this type of psychopath is distinguished by nothing more exotic than a low fear IQ. All mammals can experience fear and can learn to associate anxiety with impulses that have been punished or with other stimuli that signal danger. Some people develop conditioned fear responses much more readily than other people do and have high fear IQs. Achild at the low end of this same continuum will be difficult to socialize by the usual techniques of discipline that depend so heavily upon the use of fear and punishment. He may frustrate and antagonize his parents so as to be deprived of the important experience of that prototypic love. It is possible that the average child learns to identify with others as part of a self-protective effort to predict their behavior....

Animal Models

At the more biological end of the continuum of behavioral neuroscience and psychological research and application, the use of animal models finds general acceptance and is largely noncontroversial. These uses include research on neural mechanisms of reflexes, motivation, emotion, learning, perception, and memory. Animal models are an established integral component of the progress of understanding in these areas. Contemporary animal models make clear that neuroscience, emotion, and behavior do not exist in a linear chain from one to the other but in a continuously interdependent interacting circle. More controversially, animal models have been and continue to be extended with success into the behavioral neuroscience of memory dysfunction in aging, problem solving and thinking, social interactions and cultural structures, drug dependency and addiction, psychopharmacology, and psychiatry.

Learning Experiences

Learning experiences are salient characteristics of intellectual tasks in which the child engages as well as the nature and quality of the social interactions in which he or she participates while doing such tasks. It is through the frequency and consistency of learning experiences over time that biologically constrained intellectual potentials are transformed into culturally dependent developed intelligence.

Prevalence and Costs

Depression tends to be a cyclical disorder. Among those who have one episode, the probability of a second episode is 50 , and among those with two episodes, the probability of a third episode is 75-80 . After the third episode, the disorder is likely to plague the person on a chronic basis, although episodes of the disorder may come and go even without treatment. The episodes are painful for the individuals with the disorder and those around them. As noted, the disorder interferes with functioning in both social situations and jobs. The costs are enormous to both the individual and society for example, MDD is regularly rated among the top five most expensive health problems.

The Three Clusters

The Diagnostic and Statistical Manual of Psychiatric Disorders-IV (DSM-IV) (1) groups the various personality disorders into three clusters. Although each personality disorder has a unique flavor, personality disorders from the same cluster share some common features. Cluster A includes personality disorders characterized by odd or eccentric personality traits. The personality disorders in this cluster are paranoid, schizoid, and schizotypal. Persons with these particular personality disorders have a reduced capacity for developing and maintaining healthy relationships with other people. Undue suspicious-ness, aloof detachment, or intense feelings of discomfort color their social interactions. Cluster B includes personality disorders characterized by dramatic, emotional, or erratic personality styles. Antisocial, borderline, narcissistic, and histrionic personality disorders make up Cluster B. Persons with Cluster B disorders have problems conforming to social norms, difficulties with...


A majority of patients have ideas or delusions of reference, thinking that other people take special notice of the supposed defect, perhaps staring at it, talking about it, or mocking it (Phillips et al. 1993). Referential thinking can be a prominent aspect of the clinical picture and can significantly contribute to the social isolation that BDD usually causes.


Most patients with BDD seen in psychiatric settings have other mental disorders. The disorder most often comorbid with BDD is major depression. In one study, a rate of approximately 60 and a lifetime rate of more than 80 was reported (Phillips and Diaz 1997). This study found that BDD usually began before depression, with the depressive symptoms often appearing secondary to BDD. It also found that other commonly comorbid disorders are social phobia, with a lifetime rate of 38 substance use disorders, with a lifetime rate of 36 and OCD, with a lifetime rate of 30 . Other studies have reported lower comorbidity rates (Veale et al. 1996a), which may reflect the treatment setting, referral sources, or other factors. Reported rates of a personality disorder in BDD patients seen in psychiatric settings range from 57 to 100 , with avoidant personality disorder most common (Neziroglu et al. 1996 Phillips and McElroy 2000 Veale et al. 1996a).


Patients with BDD typically experience severe distress over their perceived appearance flaws. Referential thinking, anxiety caused by BDD-related behaviors, and feelings of rejection and social isolation all appear to contribute to this distress. DeMarco et al. Although functioning varies, nearly all individuals with BDD experience impairment in social and academic or occupational functioning (Phillips et al. 1993). They may avoid dating and other social interactions, have few or no friends, or get divorced because of BDD. Impairment in academic or occupational functioning is common and may be caused by poor concentration caused by BDD obsessions, time-consuming BDD-related behaviors, or self-consciousness about being seen. In a series of 33 children and adolescents with BDD, 18 had dropped out of school because of BDD (Albertini and Phillips 1999). In a series of adults with BDD, 8 were on disability primarily because of BDD (K. A. Phillips, unpublished data). More than a quarter of...

Free will

These concerns are based on dichotomous concepts as unrewarding as the view of behavior that posits either nature or nurture as its cause. Brains are made of cells cells are made of molecules. What brains do must therefore follow natural laws. Brains are physical devices, constructed from genetic blueprints crafted in evolutionary time and tuned and programmed through individual experience. Alternative behaviors are the product of this involved history as it interacts with immediate sensory experience, but there is no reason to suppose that this vast complexity places behavior beyond the reach, ultimately, of scientific explanation. If free will implies choice that is utterly decoupled from these formative events, it locates volition outside of science. It is the very complexity of behavior, however, that creates the illusion of complete freedom. The choices we make, both large and small, are so numerous, the full range of sensory experience so unpredictable, competing motivations so...


These age-related declines in hearing may have additional behavioral consequences (e.g., social isolation or depression). Individuals may become irritated with their hearing difficulties and the speech characteristics of others that interfere with auditory perception. Further, older adults may even become paranoid about what others may be saying about them, perceiving others as mumbling or speaking softly to purposefully exclude the older listener.

Neurological Bases

The neurological foundation of shyness is centered in the amygdala and hippocampus. The amygdala appears to be implicated in the association of specific stimuli with fear. The more general pervasive conditioning of background factors related to the conditioning stimuli is known as contextual conditioning. This diffuse contextual conditioning occurs more slowly and lasts longer than traditional classical conditioning. It is experienced as general apprehension


Cross-cultural research confirms the universality of shyness. A large proportion of participants in all cultures reported experiencing shyness from a low of 31 in Israel to a high of 57 in Japan and 55 in Taiwan. In Mexico, Germany, India, and Canada, shyness was closer to the 40 reported in the United States. Explanations of cultural differences in shyness have focused on the distinction between collectivist cultures, which promote interdependence, thus fostering concerns about giving offense, and individualistic cultures, which promote independence, fostering self-presentational concerns. How cultures assign credit for successful actions and blame for failures also contributes to the experience of shyness if credit is externalized and blame internalized.

Suggested Readings

Shyness A bold new approach. New York HarperCollins. Henderson, L. M., & Zimbardo, P. G. (2002). Shyness as a clinical condition The Stanford model. In R. Crozier & L. Alden (Eds.), The international handbook of social anxiety (pp. 431-447). New York Wiley. Zimbardo, P. G. (1998). Shyness What it is, what to do about it. Reading, MA Perseus. Lynne M. Henderson The Shyness Institute

Single Parenthood

Finer (1974) set forth a comprehensive international report on single-parent families. The report noted that single-parent families were faced with problems such as social isolation and loneliness, financial hardships, and pressures on children to be responsible for domestic duties that are beyond their capabilities.

Social Neuroscience

The notion of a social neuroscience is not as oxymoronic as it might first seem. Evolutionary forces operating over thousands of years have sculpted the human genome to be sensitive to and succoring of relationships with others. Affiliation and nurturant social relationships, for instance, are essential for physical and psychological well-being across the lifespan (Cacioppo, Berntson, Sheridan, & Mc-Clintock, 2000). Disruptions of social connections, whether through ridicule, separation, divorce, or bereavement, are among the most stressful events that people endure (Gardner, Gabriel, & Diekman, 2000), and social isolation is as large a risk factor for broad-based morbidity and mortality as are high blood pressure, obesity, and sedentary lifestyles even after statistically controlling for known biological risk factors, social status, and baseline measures of health (House, Landis, & Umberson, 1988). The case of Phineas Gage in the late 1800s vividly established the importance...


Some forms of lateralization are notable for their persistence across species and thus evolutionary time. Here I have shown that this is the case for the specialisation of the right hemisphere for agonistic responses, and perhaps other immediate social interactions, and the left hemisphere for feeding and other responses based on making a considered decision. Once certain forms of lateralization had evolved, they were retained as a highly conserved feature of the vertebrate brain. This does not imply that they are solely genetically programmed characteristics experience is known to establish at least some forms of lateralization (e.g., agonistic and feeding responses in the chick reviewed by Rogers, 1996). In fact, the development of lateralization in the chick is influenced by experience and hormonal condition (Rogers, 1996) and the same appears to be true for short-term fluctuations in lateralization (Rogers, 1998). Whether a relation exists between experience in one sensory...


Several animal models have been suggested for autism. One model involves bilateral lesions of the amygdala of monkey neonates. These lesions can produce social isolation, poor eye contact, reduced facial expressivity, and motor stereotypies that emerge gradually during later development, reminiscent of the natural history of autistic symptoms (Bachevalier, 1994). These monkeys, when imaged in adulthood, have abnormalities in the concentrations of neurotransmitter metabolites within frontal cortex and altered dopaminergic activity in both frontal and basal ganglia regions (Bertolino et al., 1997 Saunders et al., 1998). Amygdala damage in adults does not produce these kinds of behavioral or metabolic disturbances. Findings from this animal model suggest that early developmental disturbances in the limbic system are capable of generating behavioral abnormalities in animals that have at least superficial similarities to the symptoms of autism. Another animal...

Other Symptoms

Other disorders can cooccur with PTSD, ASD, or adjustment disorder. One of the most commonly cooccurring disorders is depression. In a national survey of more than 5,000 individuals, nearly half of individuals meeting criteria for PTSD also met criteria for depression (Kessler et al., 1995). PTSD has also been associated with higher rates of substance use, especially among war veterans (Kulka et al., 1990). In addition, PTSD has been associated with other anxiety disorders, such as panic disorder, social phobia, and generalized anxiety disorder (Kessler et al., 1995).


Trichotillomania is a disorder that involves the repeated pulling of one's hair, resulting in noticeable hair loss. Individuals with trichotillomania experience internal sensations of anxiety or tension that immediately precede pulling (and or an attempt to resist pulling) and subside only after pulling. Cosmetic complaints resulting from hair loss are a primary concern for persons with trichotillomania, but complications in social, occupational, psychological, and medical functioning are also common. Although hair pulling is rarely performed in public, hair loss often results in negative social interactions and the avoidance of many social and occupational settings. In addition to these social and occupational disturbances, a variety of physical and psychological sequelae can accompany trichotillomania. Gastrointestinal problems resulting from trichobezoars (hairballs) associated with trichophagia (eating of hair), dermatological problems, and comorbid psychological problems such as...

Language Network

As discussed under cortical motor networks, language may have evolved from the action observation system, perhaps as primates increased their social interactions for survival in hostile environments. Social isolation may follow the loss of language function in aphasic patients. The traditional aphasia syndromes correlate in a general way with damage to specific sites, but many aphasiologists have questioned the extent to which the traditional aphasia subtype classification (see Table 5-5) relates to localization.366 Wernicke's region in BA 37, 39, and 40 and Broca's region in BA 44 and 45 and their surrounds are tissues of relative specialization. These areas cannot simply be dichotomized as receptive and expressive language zones. Indeed, the left posterior ventral frontal area that is called Broca's and the left posterior superior temporal gyrus that is called Wernicke's have at least several functional subdivisions with variations in their connectivity.367 Language requires at...

The southern ape

Wherever it goes, trade leaves no genes far behind. By its very nature, trade intensifies the frequency of communication and interaction between strangers. Reclusion and shyness are not attributes to be selected for in a species of traders - of which we humans are the sole example. By comparison, the baboons neither trade nor do they show much interest in communication with neighbors and strangers of their own species. Indeed, commenting on the frequency of communication among troop members of wild hamadryas baboons, Hans Kummer (1997 146) provides the following account

Avoidant Personality

Avoidant personality, or Avoidant Personality Disorder (APD), is a label included in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association to describe a condition in which a person 4. Is preoccupied with being criticized or rejected in social situations Avoidant Personality Disorder is found in approximately 1 of the general population and in 10 of individuals Personality types characterized by social sensitivity and withdrawal appear in earlier clinical descriptions of personality disorders however, contemporary views of avoidant personality disorder have their origins in Theodore Millon's biosocial learning theory. In his book Disorders of Personality (1981), Millon proposed that the avoidant pattern develops when a child with a fearful or anxious temperament is exposed to early social experiences characterized by persistent deprecation, rejection, and humiliation. Avoidant individuals learn what Millon labeled an active-detached coping...

Conduct Disorder

Loeber (1990) hypothesized that children begin to generalize their use of coercive behaviors to other social interactions, leading to increasingly aggressive behavior with peers and adults and to dysfunctional social-cognitive processes, which in turn serve to maintain problem behavior sequences. For example, aggressive children tend to have hostile attributional biases and problem-solving strategies that rely on forceful, direct action rather than verbal, negotiation strategies, and they expect that aggressive solutions will work (Crick & Dodge, 1994). These information-processing difficulties are made worse for aggressive children because of their dominance-oriented social goals, pervasive schema-based expectations for others' behavior, and strong physiological reactivity in response to provocation (Dodge, Lochman, Harnish, Bates, & Pettit, 1997 Lochman & Dodge, 1998 Lochman & Szczepanski, 1999), as well as their poor verbal fluency and abstract reasoning abilities...

Play Therapy

Other therapeutic approaches grant play a somewhat incidental role, rather than a central one. For example, play can be an adjunct to cognitive-behavioral therapy that has a primary goal of teaching new cognitions about the social world and new ways of coping with emotions and social interactions. Kendall and Braswell (1993) suggested that playing out problematic social interactions can reveal children's perspectives and their problematic cognitions that should be corrected. Knell (1993) proposed a cognitive-behavioral approach to play therapy in which therapists structure the child's play, which is integrated into educational techniques such as modeling, role-playing, and reinforcement of adaptive thoughts and behavior.


It lasts 8-10 weeks and consists of weekly 2.5-hour sessions, 45 minutes of homework daily, and one all-day session on a weekend. It covers a variety of topics related to mindfulness, including different forms of meditation, yoga positions, and practicing mindfulness in stressful situations and social interactions.


The childhood and adolescence of sexually sadistic criminals are characterized by a blend of violence, sex, and social isolation. A number of sexually sadistic criminals have an ambivalent relationship (love hate) with their mothers. In addition, a number of sexually sadistic criminals reported that they were physically victimized by an authoritarian father. Following these inadequate interactions with their parents, they developed an inadequate attachment style characterized by a withdrawn attitude and social isolation (Brittain, 1970). During adolescence, they developed a low self-esteem due to failures in social and sexual interactions. Then, deviant sexual fantasies and paraphilic be


The behavioral consequences of the foregoing problems can be quite significant. The increased difficulty in seeing objects in reduced light and greater susceptibility to glare can lead individuals to increasingly restrict their evening driving and walking. These changes in vision can also lead to increased accidents and falls resulting from failure to see hazardous objects, and diminished self-esteem resulting from such accidents and restrictions incurred from low vision. Changes in color perception can create difficulties in correctly matching clothing and facial makeup, and sometimes cause others to question the individual's aesthetic sensibilities (Whitbourne, 1998). These changes can also affect one's understanding of color-coded information and diminish one's appreciation of artwork, movies, and scenery. The diminished visual acuity can lead to difficulty reading, watching television, recognizing friends, and learning and remembering the distinctive features of the faces of new...


Arather wide scope of antinormative behaviors has been associated with individuation and deindividuation. For example, drug abuse has been associated with social isolation from friends and family. Riots, lynchings, and other forms of mob violence have been attributed to deindividuation. A loss of inhibitions by members of encounter, marathon, and other noncognitive therapy groups has frequently been observed, and this may also be attributed to a loss of self-awareness.


BDD appears relatively common in clinical settings. In a study in a dermatology setting, 12 of patients screened positive for BDD (Phillips et al. 2000b). In cosmetic surgery settings, rates of 6 , 7 , and 15 have been reported (Ishigooka et al. 1998 Sarwer et al. 1998a, 1998b). Reported rates of BDD are 8 -37 in patients with obsessive-compulsive disorder (OCD) (Brawman-Mintzer et al. 1995 Hollander et al. 1993 Phillips et al. 1998b Piggott et al. 1994 Simeon et al. 1995 Wilhelm et al. 1997), 11 -13 in patients with social phobia (Brawman-Mintzer et al. 1995 Wilhelm et al. 1997), 26 in patients with trichotillomania (Soriano et al. 1996), and 14 -42 in patients with atypical major depression (Perugi et al. 1998 Phillips et al. 1996a). In one study on atypical depression, BDD was more than twice as common as OCD (Phillips et al. 1996a), and in another study (Perugi et al. 1998), BDD was more common than many other disorders, including OCD, social phobia, simple phobia, generalized...

Basic Concepts

Negative symptoms, such as blunted affect, alogia, loss of motivation, asociality, anhedonia, and inattention, may also worsen during acute episodes of illness. In contrast to active psychotic symptoms, negative symptoms respond slowly to treatment, and may not return to their previous baseline following an acute episode of illness, even with aggressive medication and psychosocial management. Deterioration in social and occupational function are highly correlated with persistent negative symptoms (5,6), which can progress during acute phases of the illness (7). At present, the most effective intervention to minimize the long-term deterioration in function associated with schizophrenia appears to be prevention of, or early intervention in, acute psychotic episodes (8). Negative symptoms may worsen during acute schizophrenic episodes in conjunction with active psychosis. Increased social isolation and withdrawal, lack of motivation for work and recreation, inattention to social...

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