Sociophobics

Cuckoo clan, – social anxiety and depression in the family genes?

by Ziggy

June 18th, 2012

My modern family is loving, supportive, funny, and totally cuckoo. Is it genes or environment?

Are social anxiety and depression hereditary? My family is wonderful, loving and supportive, full of funny and smart people, – but completely cuckoo. I still have a few decades to go in order to issue a serious challenge to the older generation for the title of head honcho of social anxiety and depression, – and have sadly observed the struggle of my little cousin who was recently diagnosed with depression.

Thankfully, she has been getting great help, showing how much we have learned about mental disorders in the last three decades.

Our daughter Hilda wasn’t that old when we picked up on her first symptoms of anxiety, which we wrote about in Children and social phobia? – Hilda goes to a swimming class. We’re so proud of how far she has come in overcoming her natural shyness and anxiety.

Yes, based on personal experience, social anxiety and depression seem to be hereditary, but what do the people in the white coats says?

“Anxiety is multidimensional, with causal roots in evolutionary, psychophysiological, cognitive, and behavioural mechanisms; and, phenomenology, it is fundamentally subjective: the angst of anxiety is constructed qualia, and this is one of its most important defining qualities.” (Corr, 2011)

What? Hmmm….basically that was geek speak for anxiety having a lot of different causes, part being DNA and part being learned thoughts and behaviors, and the way each and everyone interprets what happens to him or her. (Ever wonder if they get paid per lengthy word?)

So how much is DNA and how much is learned?

Mom, dad, anxiety and I

DNA seems to matter quite a bit in explaining the causes of anxiety. Li and his pals Sundquist and Sundquist (2008 ) have been diving regularly into Sweden’s pretty amazing collection of health records studying whether anxiety disorders are clustered in certain families (like mine, except Swedish).

They first studied anxiety in children and their parents. They found that the risk for men and women with mothers and/or fathers affected by anxiety was significantly higher compared to men and women whose mothers and/or fathers didn’t have anxiety. Risk of anxiety was slightly higher if your mother had anxiety than if it was your father, but the highest risk was found in the youngest age group and among those with both parents struggling with anxiety. Their conclusion was that the risk increase was so high that genes had to be likely to contribute, possibly modified by environmental factors.

My sister/brother, et tu?

Then Li and the Sundquists (2011) took on siblings, digging through the same pile of health records (all the way back to 1932) and discovered that siblings of people with anxiety leading to hospitalization were more likely to have anxiety themselves.

Gender seemed to matter, once again. Men had more sibling risk with agoraphobia and social phobia while women had more risk with panic disorder, generalized anxiety disorders, mixed anxiety disorder and depressive disorder and obsessive-compulsive disorder.

The scientists wondered whether this might be due to environmental or genetic factors and looked specifically at siblings with greater age difference. Family circumstances can change and subsequently the shared family environment can change. They found no connection between sibling risk and how close in age the siblings were, making them believe that the risk of anxiety is more related to genes than environmental/behavioral factors.

Plus the risk didn’t decrease with age.

Also, family risk seems to be prevalent when it comes to depression, with possible effects spanning three generations, from grandparent to parent to child. Just like anxiety, the cause of transmission between parent and child is pretty complex; partly genetics, partly physical, partly behavioral and partly environmental. (Sander & McCarty, 2005)

No giving up!

Yes, social anxiety and depression are definitely hereditary, – which can be quite a drag, and some might even say: “it’s in my genes, so why bother” (heck…even I do that in my darkest hours.) But what if my family had a history of heart disease? Would I just accept that my children would quite possibly die of heart failure and keep feeding them sugar while they played video games all day, or would I urge them to watch their diet and keep exercising?

You see, I often look at my little girl and marvel at how far she has come in tackling her anxiety, and sometimes I even admit that I have made quite some progress myself.

The thing is to face it. Not ignore it. Deal with it.

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Other articles you might find interesting:

What is social anxiety?

How to cure social anxiety? The search for a magic pill…

Starting a blog on social anxiety?

Categories Causes, Children and social anxiety, Depression, General

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Does exercise help treat depression? What the BMJ article didn’t say.

by Thora

June 8th, 2012

Does exercise help treat depression or not?

Does exercise help treat depression? A new study in The British Medical Journal by Calder and colleagues (2012) suggests that exercise added to other treatment options for depressed people doesn’t seem to help more than just the regular treatment options for depression.

Were they saying that we should just stretch out on the couch and keep those pills handy?

Our experience of exercise.

Ziggy has gone through the whole shebang: medication, therapy, and exercise. He never liked to exercise and hated sports growing up. I don’t either, even if I do like the feeling I get after a good workout or a run. However, I’ve been convinced that exercise is helpful as a treatment for mental illness. There are two reasons for that:

First, after observing how my cousin turned her life around after being diagnosed as manic depressive, through total lifestyle change of regular exercise, change in diet (no coffee, soda or sugar) and a new career.
Second, by seeing the effect exercise had on Ziggy’s mental and physical health. It was hard, requiring some investment in a weekly session with a trainer and lots of social support. He had never felt better and was so proud each time he had finished a session, – the harder, the better he felt afterwards. He managed his anxiety better. Just felt better.

A year ago, he quit exercising and I’ve seen many of the symptoms of depression and social anxiety resurface, so we had planned on getting back on track this summer.

What didn’t the BMJ article address?

After reading the BMJ article some questions popped into mind:

Does the severity of the depression matter?
Does the level of exercise intensity matter?
Is some physical activity better than nothing at all to treat depression?

…Not to mention whether we should just put our feet up and relax this summer?

Most other studies on exercise and depression have found that exercise can help treat depressive symptoms, according to a systematic review by Amanda Daley (2008). What they were sure of was that exercise as a treatment for depression was more effective than no treatment, – which the BMJ study didn’t address. The studies weren’t quite clear on exercise’s effectiveness against clinical depression (you know… the serious kind) which the BMJ study looked at. The BMJ study’s participants had to score at least 14 of 21 on something called the Beck Depression Inventory (higher score, more depressed), so they were a pretty depressed bunch requiring treatment with medication and therapy. She also found that the methodological quality of the studies could be better (not enough people in the studies, not sick enough, too sick, too much scientist or participant bias etc.) which the BMJ study definitely tried to improve on.

The BMJ study focused on getting people moving in the long term, which worked. One of the reasons was that the exercise wasn’t too intense. Too intense exercises might deter people from exercising regularly, – too hard equals not pleasant. So did that matter since the pleasure of a runner’s high usually only comes after a pretty intense workout?

Robertson and colleagues (2012) didn’t think so. They found that just walking is effective for depression, just like other forms of exercising. So the answer to whether intensity matters, – is maybe, maybe depending on the severity of the depression?

Why exercise?

None of these studies disclaim that exercise and physical activity are good for health, the heart, blood pressure, bones, metabolism, weight and general wellness.

Even without huge physical effort.

The World Health Organization (WHO) states that only 150 minutes per week of moderate to vigorous exercise can bring significantly lower health risks. Plus studies show that depression and anxiety can lead to obesity, obesity can lead to depression and anxiety, adding to weight gain being a regular side effect of antidepressants.

So, with nothing to lose and pretty much to gain, – why shouldn’t exercise be a part of any treatment program for depression?

What do you think?

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Fear of public toilets and social anxiety

by Ziggy

June 4th, 2012

My story of public toilets and San Gimignano, Tuscany.

Is social anxiety related to fear of public toilets? Hmmm… in my case, yes. Picture this: The sun had just come up. All around me were glorious green fields as far as the eye could see. I was staying at a hillside campsite in one of the most beautiful little villages in the world, San Gimignano, Tuscany. And I was obsessing about toilets.

Clean public toilets.

I had spent the day before scouting the area, cursing Thora for her great idea of a camping trip in Italy, observing the cleaning schedule and the traffic flow of people. The plan is ready and I go into operation mode.

The goal? To be alone in a toilet….a restroom toilet…in a public place.

Actually, this is the part of my anxiety disorder that I‘m most comfortable with. I don‘t like to share other people‘s dirt in the bathroom. Period. No amount of CBT or medication is going to change that. For some others it might be self-consciousness, worry about noise, smells, performance anxiety, size, etiquette, time and technique using public toilets. My anxiety regarding public toilets has to do with other folks‘ dirt, bacteria, urine, fecal matter, pubic hairs.

Simply put, I want a clean public bathroom to myself.

Plenty of bacteria.

Ok, time for some justification. There is plenty of bacteria in public bathrooms. In an article published in 2011 scientists studying bacteria in public bathrooms on campus found 19 different bacterial phyla. Bacteria associated with the gut was mainly found on toilet surfaces, signifying fecal contamination. The floor had plenty of bacteria, the most of any surfaces including several typically found in soil. Bacteria linked to skin were most often found on surfaces people touched with their hands. They also discovered bacteria related to the gut and female urine at various points in the toilets which seems to indicate the frequent toilet use distributes those germs around and about.

Convinced yet? I am.

A shy bladder?

I recently discovered that there is a specific type of social anxiety disorder which manifests itself in a fear or inability to urinate in public restrooms when other persons are present or may enter the room. It‘s called paruresis and according to the DSM-IV-TR (American Psychiatric Assocation‘s bible) it is defined as social phobia or social anxiety.

Another symptom is denial of the fear, the emphasis being on the physical symptoms.

There‘s also a discussion whether parureris or ´shy bladder´ is a social anxiety disorder or what is known as a functional disorder of micturition (just not being able to urinate). (Hammelstein P., Soifer, S.,. 2006)

I did wonder for a bit whether I had this, the hypochondriac that I am, but I don’t think the symptoms fit, despite the denial and all…

My thing is the public toilet itself and other people’s dirt and bacteria.

Gender and public toilets.

Does gender matter when it comes to disliking using public toilets as a part of ones social anxiety disorder? Turk and his colleagues (1998) discovered that men with social anxiety are more likely to fear urinating in public bathrooms (…and returning goods to stores). Women with social anxiety were more likely to fear talking to someone with authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others were already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they didn‘t know very well, giving a report to a group, and giving a party.

But not using public bathrooms.

Why? Turk and co. suggested that each fear and its severity seemed to be related to the comfort level and how used men and women are to a specific social situations. Men are still more likely to work than women, and also have a higher expectancy from society of working = more used to work situations than women. Women less so and therefore have more fear of situations related to work. Same goes for fear of public toilets. Women have smaller bladders and therefore are more likely to have to use public toilets, rather than wait until they’re home plus the usual set-up in men’s public toilets can be quite anxiety inducing.

Yes, gender seems to matter when it comes to having a ‘shy bladder’.

Great coping strategies for ‘private’ public toilets.

Number 1. Don‘t go!

Lennox Archibald, MD, PhD, one of the scientists studying public toilet bacteria simply stated that he doesn‘t use public bathrooms except on very long-distance flights. This tip usually works better for men than women.

Number 2. Go right after the cleaning crew has cleaned the bathroom.

When you have to go...

If they haven‘t been nice enough to publish their schedule either ask or like I tend to do, watch out for the cleaning crew.

Number 3. Carry your own paper and/or hand towels.

Use the towels for opening the bathroom door, the toilet lid (if you need to use that), flushing and basically everything that you need to touch. Works better for women, due to bigger bags.

Number 4. Carry a little vial of hand sanitizer wherever you go.

Once again, women are real lucky to have that bag for all their stuff.

Number 5. Pick the right stall.

If you need to pick a stall keep in mind that it‘s quite natural for us to seek privacy in the bathroom. Therefore people tend to pick the stall furthest away from the entrance. So please pick the first stall, the closest to the entrance.

Why? Because there is less bacteria there, less dirt … (according to Allison Janse, the author of The Germ Freak’s Guide to Outwitting Colds and Flu: Guerilla Tactics to Keep Yourself Healthy at Home, at Work and in the World).

(A note to self: Please ignore all of this advice if you hope to get rid of the fear, since coping strategies do tend to support and feed the fear…)

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The link between obesity, depression and anxiety.

by Ziggy

May 29th, 2012

I didn’t start putting on serious weight until my social anxiety and depression took off.

Is there a link between obesity, depression and social anxiety? All my life I have struggled not only with social anxiety and depression but also with my weight. Food has been my friend and my foe as long as I can recall, my friend in time of distress, my foe as my weight has lead to lower self-esteem and body dissatisfaction in a society obsessed with thinness.

Yes, – also men’s.

I remember (maybe wrongly…) that my classmates used to differentiate between me and my namesake by calling me Fat Ziggy through most of elementary and middle school. I didn’t go to a swimming pool or a gym for many years and hate, just hate going shopping for clothes.

It is also strange now looking at old photographs and realizing that I wasn’t that heavy. I didn’t start putting on serious weight until my social anxiety and depression took off. I would binge eat to feel better in New York, eat a large Domino’s pizza and twenty hot wings or a box of Dunkin’ donuts all by my lonely self. After the birth of my older daughter things got really bad and some of the medication I was prescribed didn’t help much, with side effects such as increased appetite and weight gain.

Does obesity equal depressed and anxious?

Today, I‘m a 36.8 in the infamous body mass index (BMI). The World Health Organization (WHO) defines me as obese. BMI is calculated as mass/(height)x2, BMI between 25 and 29.99 being overweight, BMI of 30 or more as obese and BMI of 40 or more as extremely obese.

Hey, – but once again I’m not alone. In 2001 to 2002 about 65.1% of Americans had a BMI greater than 25, 30.4% had a BMI greater than 30 and 4.9% BMI greater than 40. In the past, obesity has mainly been connected to older age and socioeconomic status (poor people being more likely to be heavier) but as we have all been putting on more weight economic status matters less and less.

I’m neither poor nor old, but I suffer from both social anxiety and depression.

In 2008 Petry and colleagues published an article stating that BMI was significantly associated with most mood, anxiety, and personality disorders. People that were either obese or extremely obese were at a much greater risk of having any, just any, mood, anxiety and alcohol use disorders plus a few personality disorders.

Their results stated that being overweight, even just slightly, significantly increased the odds of either having or having had anxiety disorder. That included generalized anxiety disorder, panic disorder without agoraphobia and specific phobia. My favorite anxiety disorder… social anxiety… also seemed to correlate to obesity, in both the obese and extremely obese categories, – even when controlling for medicine that has weight gain as a side-effect.

hurraaayy…

Simply put, if you suffer from depression and social anxiety you are at a much greater risk of becoming obese. What also seems to be true is that obesity also seems to make a person much more at risk of suffering from depression and social anxiety.

What causes depression and obesity?

So which comes first, – the chicken or the egg? Obesity or depression and social anxiety? Luppino and colleagues (2010) wondered what causes depression and obesity, what links those two? It might be a stress system that is out of order or an unhealthy lifestyle (those darn donuts…) which leads a depressed person to become obese, or that obesity results in negative self- and body image which eventually leads to depression over time.

Now for the complicated stuff.

The causal factors are probably both social and biological. We all have a hormonal pathway known as the HPA axis (…not to be confused with Bush jr.’s axis of evil … much…). H stands for the hypothalamus, the tiny peanut-sized part of the brain that controls parts of the nervous system, the P stands for pituitary glands and the A, (ok… you didn’t guess it…) the adrenal glands which secrete a bunch of hormones around our bodies. The HPA axis keeps our chemical stuff in balance when we are under stress (e.g. a panic attack, full-fledged need-to-get-out-of-here feeling). It does so by releasing cortisol (a so called stress hormone) which affects how we burn energy plus a bunch of other stuff.

An added bonus is that cortisol prompts the body to deposit fat around the abdomen, – or in my case creating the world’s warmest and softest tummy, at least according to my wife and my two daughters . Unfortunately, weight around the abdomen is also the worst kind and can be quite hazardous to a person’s health. Chronic stress can also lead to depression, – wow…no kidding.

Social factors can lead to depression and obesity, e.g. fat Ziggy = teasing, feeling miserable not conforming to society’s ideals of beauty equals thinness = not going to a swimming pool, a gym or even a clothing store for years etc.

Weight gain and my walking treatment

When Thora and I started this blog we said that we hoped our readers would learn from our mistakes and our victories. Sometimes when I read what I have written I wonder who am I to advice others.

I’m still battling with my social anxiety, my depression, my weight gain, – but then I realize that maybe the best way for me to learn, for anyone to learn is from the mistakes, from the failures.

I have learned that those donuts don’t help at all. I have learned that physical and social activities are the two things that help me most to deal with my issues.

When I’m totally stressed, I go for a walk. When I’m really down in the dumps, I go for a walk. When I feel like eating every single sweet thing in the house, I go for a walk. Sometimes by myself, – sometimes with my girls.

WHO might define me as obese, but I’m trying to make sure that doesn’t define who I am.

Same goes for my social anxiety and depression.

Just one day at a time.

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Other articles you might find interesting:

My battle with depression and social anxiety.

How to make friends if socially anxious in a new city?

Loving someone with social anxiety disorder.

Categories Depression, General, Health, Treatment

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Phone phobia and social anxiety

by Ziggy

May 20th, 2012

What is it about phone calls that I don’t like? Well, making them, receiving them and everything in between.

Phone phobia and social anxiety seem to go together for me like cheese and crackers, apple and pie, or love and marriage. In the past, I had a hate, hate relationship with phones, – just any phone. Today it is more of a love/dislike relationship thanks to therapy and … yes, hmmm…my new Samsung Galaxy SII phone…with its nice Internet connection, Kindle, WordPress, Facebook and Twitter apps.

I still don’t like the phone part.

What is it about phone calls that I don’t like? Well, making them, receiving them and everything in between. Simply, they make me uncomfortable, stressed, irritated. I used to spend a lot of time trying to plan out the whole conversation in my head before making a phone call. I would get stomachaches, sweat profusely (…those emotions pop up just writing these words…) and other stress symptoms. Of course, I never wrote anything down…much better to keep all those negative and difficult thoughts within my own skull.

(Just think if someone might see that note…)

A major part of my discomfort with phones might be my heavy reliance on reading people’s thoughts through their visual expressions and body language. I’m actually quite good at that, even if I say so myself, – due to extensive training from an early age.

But on the phone you just get the voice.

I can’t recall a time that I did like to make phone calls.

Phone phobia = love and marriage?

My phone phobia was a major stumbling block to love and marriage with Thora. I would spend days planning my conversations with her (which anyone that knows her could have told me was a major waste of time…). It is a true testimony to the strength of my attraction and feelings for her that I actually made those phone calls and showed up on those dates.

My social anxiety and phone phobia in the disguise of the evil stepmother and stepsister would have gotten their just rewards in Grimm’s fairytale world and we lived happily ever after.

Nothing is quite as simple in real life.

Thora and I used to have major rows over phone calls. She would ask me to call someone, my bank, the doctor or just any other everyday phone call, and I would come up with endless excuses not to make that phone call. I would send an e-mail (…those I definitely like) and when they didn’t reply I would do my best to get her to call.

And she just didn’t understand what the big deal was.

Why I couldn’t just call.

It took a major depressive episode, drugs and therapy before I could talk to her about my feelings towards phones. Today, I have a few weapons at my disposal for dealing with my phone phobia. It’s not easy, but I’m better, much better.

Hopefully those can help you, too

Tricks for phone phobia

Number 1: Don’t think, just call!

If you manage to make the call before you start thinking about it, you’re into the conversation before you realize it. That doesn’t mean the conversation will go according to plan (well, they rarely do anyway, no matter how much you plan them), but at least you get it over with.

Number 2: Imagine what is the worst that could happen.

If you have to think about it, just think of the worst that could happen. And write it down. Reading your own thoughts on paper often makes you realize just how silly they can be. This is something I still have a big problem with, but it does help.

Number 3: Start with the easiest one.

If you have to make a number of calls, and you have to talk yourself into calling, start with the easiest one. That can get the ball moving and subsequent calls are easier to make.

Number 4: Totally ignore number 3.

If you are feeling brave and are in the “no-thinking-just-calling” zone, start with the most difficult call. If you get through that one alive, the others will be a piece of cake.

Number 5: Show up in person!

If you absolutely, positively cannot make the call, show up in person. Seriously, even I have sometimes found that to be easier than calling.

Repeat in any order as needed.

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Other articles you might find interesting:

My battle with depression and social anxiety

Loving someone with social anxiety disorder

What is social anxiety?

Categories Fear, General, Phobia, Treatment

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My battle with depression and social anxiety.

by Ziggy

May 13th, 2012

I didn't have the energy to go after my precious baby daughter.

Depression. Don’t you just feel how that word presses down on you, deeepreesssed? I had been socially anxious from an early age, but it wasn’t until I had developed full-fledged depression that I sought help.

It is scary how little I remember about that period when I think back. I was numb, couldn’t move, didn‘t have any energy. Thora has described it as coming home day after day from work and finding me still in my spotty green terry robe, lying on our old beige sofa.

My wake-up call came the day I was watching Hilda who was 1 or 2 years old. We lived in a new neighborhood and behind our apartment was an open field. We lived on the ground floor and had a small open yard outside. She was playing there and I was in my regular daze inside, pretending to keep an eye on her.

Suddenly, she was gone.

I went outside to look for her and saw that she had gone behind the building and into the field. What shocked me out of my stupor wasn’t that I had lost my child, but my feeling of utter exhaustion. I just didn’t have the energy to go after her. I just stood there watching her and couldn’t find the strength to walk to her and get my precious baby daughter back to safety.

My lethargy and tiredness had reached new heights. My depression towered over me, threatened my child and who I was.

And I just felt numb.

I did go after her eventually, but it must have shocked me enough to reach out. To say something to Thora. To ask for help. Read More →

Categories Depression, General, Health

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So true…

by Ziggy

April 15th, 2012

Categories Depression, General, SAD humor

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Loving someone with social anxiety disorder

by Thora

April 6th, 2012

What to do when someone you love has social anxiety disorder or social phobia? I have often wondered if is good

or bad for someone with social anxiety disorder (SAD) to live with someone like me that isn‘t always very nice or accommodating… who has never really accepted her husband’s shyness or anxiousness. Someone that tends to push, tease or cajole him into being the great person he truly is.

Ziggy has often said that it helps… even when it irritates the heck out of him…but still I wonder.

He sometimes calls me his private life-long shock therapy.

Why? It might have something to do with the fact that I hate planning, tend to reorganize the furniture when I clean and get bored doing repetitive things. That might have something to do with the fact that we move regularly, change jobs ever so often and the living room couch has been in at least five different places in the last ten months… Read More →

Categories General, Marriage, Treatment

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Does social anxiety cause insomnia?

by Ziggy

March 18th, 2012

Does social anxiety lead to sleep deprivation

Oh, - to sleep like a baby again...

So does social anxiety lead to insomnia or sleep deprivation? People visiting sleep disorder clinics, complaining of insomnia or difficulty sleeping, often have another underlying mental health problem. Sleep is not something I used to think much about, – when I got plenty of sleep and awoke each morning feeling refreshed.

However, during some of my most difficult periods of social anxiety and depression, I discovered that it could both lead me to sleep too little or too much. Read More →

Categories General, Health

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Does exercise help treat depression? What the BMJ article didn’t say.

Our experience of exercise.

What didn’t the BMJ article address?

Why exercise?

My battle with depression and social anxiety.

So true…

Loving someone with social anxiety disorder

Does social anxiety cause insomnia?

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