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A young woman came to see me complaining that she was unable to go to work because of overwhelming anxiety. Initially, she became nervous whenever she had to get up and speak. But as time went on, simply the anticipation of having to get up and make a public presentation made her fearful. Her fears had escalated to the point where she was avoiding going to work at all.

Her symptoms were consistent with an often underdiagnosed condition known as social anxiety disorder, or social phobia. Those who suffer from it are fearful of being scrutinized, being evaluated in a negative way or being humiliated or embarrassed.

Even the anticipation of a social situation can provoke the physical symptoms commonly associated with anxiety -- fear and worry, sweating, shaking, rapid heartbeat, sensations of choking, chest or abdominal pain, and numbness and tingling, to name just a few.

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Not surprisingly, this kind of anxiety can have a crippling impact in work and social situations.

Health Canada estimates that anxiety disorders affect about 12 per cent of the population. Often people with anxiety do not turn to their doctor for help -- in some cases, it is the symptoms themselves that keep the patient from seeking any kind of assistance.

There are several different kinds of anxiety disorders, including generalized anxiety disorder; post-traumatic stress disorders, with flashbacks and frightening ongoing thoughts in response to a terrifying experience, such as physical harm, war, natural disaster; panic disorder, with recurrent and unexpected panic attacks; and social anxiety disorder.

Social anxiety disorder is one of the most common conditions, thought to affect about 6 per cent of Canadians. Specific situations that can provoke symptoms of anxiety include public speaking, eating in front of others, playing an instrument or participating in a sport in front of others -- or even entering a room. So-called interactional situations that can spur an anxiety response include dining with friends or making small talk, going to a party, dating, asking for assistance, speaking to a boss or asking for directions.

Social phobia usually begins when a person is between 14 and 16 years old. Without diagnosis and treatment, people with the disorder are more likely never to marry (or to marry and divorce), to be unemployed or to have problems with drug and alcohol abuse. Many people with social phobia have another overlapping disorder, such as depression.

It is unclear what causes anxiety disorders, and specifically social phobia. Many researchers believe it is a combination of genetic and biological factors along with developmental factors. Other triggers include socio-economic situation and stresses from the workplace or school. One theory postulates that people learn to be anxious in social situations from initial negative experiences, such as an embarrassing moment that is reinforced by another such event. The person then begins to believe such situations will always lead to embarrassment -- as a result, he or she then starts to shy away from any potentially embarrassing setting.

Biological theories, meanwhile, focus on areas within the brain that store emotional memories and might be linked to the development of anxiety disorders. Studies show that if one identical twin develops social phobia, the likelihood of the other having the disorder is 24 per cent, whereas it is 15 per cent with fraternal twins. And 23 per cent of children who have a parent with social anxiety disorder meet the criteria for the same diagnosis.

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Only about 5 per cent of people who have social phobia seek any help -- and many people don't recognize that their symptoms are treatable.

Treatment from a trained counsellor, psychiatrist or family doctor includes something called cognitive behavioural therapy, in which you are taught how to deal with situations that cause anxiety. You are taught coping strategies such as relaxation techniques and ways to understand and challenge your own thinking patterns.

Medications are also widely used to treat anxiety disorders, with excellent success. The newer class of SSRI drugs (selective serotonin reuptake inhibitors) has been used with similar comparable success as psychological treatment.

Many patients benefit from combined treatments, medication plus cognitive therapy. And it is critical that the person continue with follow-up treatment as there is a risk of relapse.

My particular patient opted for the use of medication to control her anxiety, as well as cognitive therapy to help erase the idea that she would pass out or faint in a public situation. She is back to work on a regular basis, and gradually taking on those situations that she previously found impossible to consider.

If you are suffering from feelings of anxiety, be sure to speak to your doctor. With help, you can get rid of those crippling symptoms and overcome your fears and worries about social situations.

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Dr. Marla Shapiro can be seen Tuesdays on CTV's Canada AM. Questions about general health issues can be sent to her at: health@globeandmail.com (Please direct queries about personal health issues to your doctor.)

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