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Anxiety Attacks in Social Anxiety Disorder - Incidence, Onset, History, Evolution

Ruy Miranda
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The Social Anxiety attacks will be examined from the following angles: incidence in the population, onset of the disorders (sudden or insidious), Shyness antecedents, evolution, and spontaneous remission.


Incidence – The information on the percentage of the incidence in the general population ranges from 3% to 13%, and this discrepancy is understandable due to difficulty of diagnosis. In any case, this is a high incidence disorder.

Onset – Prior to the end of adolescence, in most cases. There are reports of onset in early adolescence and even in childhood.

The onset is usually through a severe anxiety attack, as in the case of a teenager who, without any previous notice, was called on in the school yard to hoist the national flag before all the students.

"The world has crashed down on my head," he said. "I don't know how I ever got there; I saw nothing, could not think straight, shook all the time , could not really listen to the national anthem. Everybody could see I was shaking all over. All I remember is someone helping me at the end." Experiences such as this one usually mark the onset of Phobia and a sequence of humiliation stories.

Yet the onset can be insidious and slow, following the progressive worsening of the pre-existing anxiety.

Personal History – In my empirical observations, all the cases show a past history of significant Shyness. To me , Shyness in any intensity expresses anxiety and Social Anxiety is expressed through more intense signs and symptoms and in the form of attacks. This does not mean that all Shyness evolves into Phobia.


It is my judgment, based on empirical observations, that the self-concept in Social Anxiety sufferers seems to be more compromised than in cases of Shyness. In Social Anxiety Disorder the concepts and attitudes vis à vis oneself and other, the internal desagreements, as well as the predisposition the people have against him, are more omplex than in Shyness.


On the other hand, it is common for bearers of Social Anxiety in specific situations to present parallel signs and symptoms of mild Shyness in other situations. I hasten to add that many psychotherapists approach Shyness and Social Anxiety in a very similar fashion and do not use medication to treat either one.


You have probably noticed my use of the expression “ Social Phobia sufferer.” This is one more indication of my belief that these people are prisoners of a psychological process, and, for this reason, can be rid of the attacks. However, I must warn that many professionals and sufferers of Social Anxiety believe that this problem has no solution and that the person can improve and control the crises but will always remain a "phobic."

Evolution – Social Anxiety attacks can be circumscribed to two social situations (it is nearly impossible to be restricted to just one) or can be extended to nearly all of them. In this latter case, they receive the addition of the word generalized.


In any of the cases, suffering is in the pain of the anxiety crisis, in the humiliations, and in the obstruction to self-actualization. Moreover, there may be additions of obsessive thoughts and compulsive behavior. Suffering induces people to avoid crisis-triggering situations, and this impoverishes their life quality.


Spontaneous remission seems possible in rare cases. My guess is that some unknown circumstantial variable would have been introduced in the person's life—enough to modify the self-concept.


The treatment can bring major relief. Once the crises are under control, work must focus on the changes in self-concept and in the concepts about the others.

May, 2004.

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This web site, the Social Anxiety Disorder and Shyness Directory and these articles contained on this web site are not solicitations, are not medical advice and are not intended as medical advice. This web site, the Social Anxiety Disorder and Shyness Directory and these articles are intended to provide only general, non-specific medical information and are not intended to cover all the issues related to the topics discussed. This web site, the Social Anxiety Disorder and Shyness Directory and these articles do not create any physician-client relationship between Ruy Miranda and you, and they do not replace the eventual relationship between you and your physician, psychologist, or other healthcare professional. This article�s author recommends no particular medication and does not represent the interests of any person, company or pharmaceutical laboratory.

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You may want to read other articles on Social Anxiety Disorder / Social Phobia and Shyness:

Basic Articles:

Self-Concept/Self- Actualization – Shyness Nucleus

Self-concept, Body Image, Self-depreciation and Shyness

Shyness and Social Anxiety Disorder: Neurophysiological Approach

Shyness Articles:

What Is Shyness? Fear, Anxiety, Anguish?

Questions and Answers on Shyness

Humiliation Stories, School Spankings: Examples of Shyness Causes

Social Anxiety Disorder Articles:

Social Anxiety Disorder: What It Is, The Anxiety Attack Symptoms

Social Anxiety Attacks: Incidence, Onset, History, Evolution

Social Phobia / Anxiety Disorder: Treatment

Social Phobia / Anxiety Disorder: Differential Diagnosis

Avoidant Personality Disorder

Medications in Social Phobia: Side Effects - Part 1

Antidepressants Tricyclics: Side Effects - Part 2

Metabolic Pathways Individual Differences and Medications Side Effects - Part 3

Genetic Changes: Medications Side Effects - Part 4

First Line Antidepressants - Side Effects - Part 5

Social Anxiety and Shyness Articles:

Panic Disorder, Shyness, Social Phobia - Differences

Why Self-Help in Shyness and Social Anxiety Disorder / Social Phobia Doesn�t Help You

Shyness and Social Anxiety Disorder:Medication Action

Facial Blushing, Redness of the Face, Ears and Neck

Psychoses, Shyness and Social Phobia

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