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In the last section, we discussed three steps in treating OCD clients. These are identification; exposure; and self-talk.
Previously, in section 6, we discussed agoraphobia and its developments.
In this section, we will examine three other social avoidant behaviors more extreme than agoraphobia, which are social phobia; social skills deficit; and dysmorphophobia.
Three Social Avoidant Behaviors
♦ Behavior #1 - Social Phobia
Clients with a performance phobia are unable to make any kind of public appearance for fear of embarrassment. Also, socially phobic clients have difficulty in looking another person in the eyes and will often look away. Many of these socially phobic clients report an unusual shyness in early puberty and increase in severity later in life.
Cynthia, a thirty year old client of mine, described her social phobia, "Through college, I did not like to walk into the campus snackshop alone unless I knew there was someone there I could sit with. I have always been surprised to find myself nervous in some public situations which I had successfully handled many times before. It was as if I were "internally different," rather than the situation around me being different. More recently, negative feedback from some persons in authority about my personality have made what always was and is a real but at least partially manageable problem, an almost unmanageable one in some circumstances."
♦ Behavior #2 - Social Skills Deficits
According to a study done at the Maudsley Hospital in London, clients with social dysfunction reported their avoidance as "lifelong." Sixty-one percent reported having no friends or social contacts in high school. They also reported having difficulty in initiating and maintaining social interactions and friendships. Their most frequent activities were visiting bars in which they could drink in undisturbed isolation.
In any kind of social situation, they reported feeling awkward, silly, or ridiculed, even if this really wasn’t the case. Interestingly, more of the male clients in the study with social skills deficits were either the first born or only child in their families.
♦ Technique: Problems and Solutions
Kyle stated, "Whenever I’ve tried to break away from home, I start feeling panicked about how I’m going to get food, how will I pay the bills, and if someone will try to rob me. I feel that if I have my own place, it will just bring everyone else in and I don’t want that." To help Kyle move past his anxiety over getting his own apartment, I asked him to make a list of "Problems and Solutions." For each problem that Kyle could think of, I asked him to write down a solution. One of his problems was: "Having people invade my life."
His solution to this problem was, "I do not have to let everyone in, but I should only let in those people I feel comfortable around." After making his list, Kyle felt slightly less anxious about living on his own.
♦ Behavior #3 - Dysmorphophobia
In some cases, this disorder can amount to a delusion and can even involve several parts of the body. Some clients exhibit symptoms of schizophrenia which is the source of the delusions. However, for many clients there is no evidence for a schizophrenic disorder nor any other psychotic phenomena. Dysmorphophobic clients do not have a negative self-image, such as those clients with anorexia nervosa. Many times, simple avoidance of the social situations that they fear do not lessen their anxiety.
Often, these somatic complaints involve bodily odor or the belief that some parts of the body are too small or large. Dysmorphophobic clients will start to believe that those around them notice their defect and subsequently talk about it behind their backs. This is what causes the reclusive behavior in dysmorphophobia sufferers. Plastic surgery to amend the problem does little to lessen the anxiety.
In this section, we presented three social avoidant behaviors that are more extreme than agoraphobia, which are social phobia; social skills deficit; and dysmorphophobia.
In the next section, we will examine three characteristics of childhood agoraphobia, which are development of agoraphobia in childhood and adolescence; separation anxiety; and early exposure.
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