1) Cognitive/Psychological Symptoms - Fear of evaluation/scrutiny,
often felt with authority figures. Can be specific to giving a
speech in public or generalized to any thoughts of social
activity even while alone. (One may or may not be conscious of
this.)
- This stimulates the sympathetic nervous system potentially putting it in chronic overdrive yielding:
2) Physical Symptoms - Most distinctive feature from other
anxiety disorders is facial blushing/flushing &/or sweating
during periods of evaluation/scrutiny &/or eventually
chronically. Other common symptoms here.
Comorbidity (other coexisting or complicating conditions) -
Depression, panic disorder (can get attacks even during sleep),
Erythrophobia (fear of b/flushing & paraesthesia - associated
physical sensations like burning & tingling in affected areas), OCD/BDD.
Psychological - Childhood insecurities, abuse, perfectionism,
depression, anxiety. Social sensitivity whether extroverted or a
shy recluse.
Physical - Any physical condition that makes one overly self-conscious.
Fair skin & inflammatory skin conditions that already cause some
conspicuous redness like keratosis pilaris (often seen as bumps
on the back of the upper arms of teenagers & redness on cheeks &/or
ears) to rosacea which can cause persistent redness, visible
blood vessels/spider veins & pimples on T-zone of chin, nose, forehead and cheeks
and vasomotor instability (flushing in these areas).
1) Psychotherapy - Will help cognitive symptoms most &
hopefully physical symptoms over time. Make sure to find a
qualified doctor &/ or therapist. Can search by zip code by
clicking The Anxiety Disorders
Association of America (http://www.adaa.org) but don't be
afraid to ask questions (experience with symptoms & insurance
coverage) and shop for a good fit.
2) Medications - First meds listed will help the
peripheral physical symptoms most but may enhance cognitive symptoms by limiting the expression of
physical symptoms stopping the upward spiral of
anxiety & physical symptoms & potentially building confidence.
* Chemical names are given first rather than brand names so
as to attain consistency for international viewers. For US
viewers brand names follow in (parenthesis).
Meds that lower Sympathetic Nervous System Output & are
generally considered Hypertensive agents rather than psychotropics - {Alpha-adrenergic
Agents} - Moxonidine (Not available in US), Clonidine
Hydrochloride (Catapres), Guanfacine Hydrochloride (Tenex). {Beta-adrenergic agents} -
Atenolol (Tenormin), Propranolol (Inderal), Nadolol (Corgard).
These can start working within an hour. Alpha-agonist agents tend not to
affect the heart's ability to respond to exercise but beta-blocker agents
can. These drugs were designed to be taken daily & have a relatively
long track record of safety.
Anticholinergic/Antispasmodic - (For excessive sweating
rather than facial blushing)
- Glycopyrrolate (Robinul) , Oxybutynin Chloride (Ditropan), Hyoscyamine Sulfate
(Levsin). May not be ideal for chronic use, example http://www.planetrx.com
mentioned under warnings for Robinul & Levsin "Prolonged use causes
chronic constipation and possibly fecal impaction. Avoid unless directed by your
physician" and for antispasmodic Ditropan "Prolonged use can increase
the likelihood of adverse reactions. Careful monitoring is needed".
Psychotropics (tend to have more of an altering effect on the mind):
Tranquilizing meds that work with GABA & are generally
considered anti-anxiety or anti-convulsants - Benzodiazepines
like Diazepam (Valium), Clonazepam (Klonopin), Alprazolam (Xanax).
These can start working within an hour. Can cause dependency with
daily use over several weeks requiring a taper but have decades
of safety data. Often best used for symptoms beyond FB/FF/HH (when
unresponsive to other meds/therapy) such as phobias & panic because
of dependency potential over time.
Gabapentin (Neurontin) can start working in a week or two.
Reportedly effective for anxiety & pain but less so for FB/FF/HH.
Meds that work on Serotonin & other neurotransmitters
& are generally considered antidepressants and usually
require several weeks of daily use - SSRIs, Novels, MAOIs, Tricyclics. These tend to help more with the
central cognitive symptoms rather than
the peripheral FB/FF/HH symptoms & can cause more side
effects in some (larger side effect profile).
http://www.endsweat.com - Interesting
US ETS site. I particularly liked the diagram demonstrating how ETS could
break the vicious cycle of Cognitive to Physical Symptoms under the social
phobia page.
Many others surgeons & details already listed at these
fantastic sites:
http://dreamwater.org/etspatients/
- I encourage you to please include any predisposing psychological-physical
conditions listed above if you decide to
add your story. This can really help everyone.
Post ETS compensatory/gustatory sweating management - Alpha-adrenergic
agents listed above have been shown to help. Anticholinergic/Antispasmodic
agents listed above have been reported to help. Benzodiazepines have been
shown to help CS/GS/Phantom blushing-paraesthesia.
Other great ideas like special clothing & lotions, other treatments for
CS/HH already listed here
Sociological theories on why Social Anxiety seems more prevalent now? - Only
recently classified. Higher rates of traditional family breakdowns. Constant media images of unattainable/unsustainable
perfection. A competitive economy that often treats people as disposable
objects. Increasing technology role that communicates information rather than face to face
emotion. - But wait the internet can do good -
Good Luck, early treatment can prevent progression to
avoidance behavior & other serious complications. Remember
all treatments may have side effects but so may a lack of
treatment. Medicine is about a risk to benefit ratio so study up,
know you're not alone & share your experiences. So much
suffering could be avoided & may we all live to our
individual & collective potential -
- Best Wishes from someone who wishes this
& other sites were available years ago -
* Annoying legal disclaimer- This site is for
educational purposes and you with your doctor are still
responsible for your medical treatment
