Anxiety hottest topic in psychiatry

New clinic, program treat social disorder

Maria Cook

The Ottawa Citizen

 

Bruno Schlumberger, The Ottawa Citizen / Dr. George Fraser, seated, is a psychiatrist and director of the Ottawa Anxiety and Trauma Clinic. Also pictured are clinic staff Shelley Jordan, left, Ellie Kanigsberg and Ken Welburn.

 

Feel nervous speaking to groups, going to parties or being the centre of attention? This was called excessive shyness in the past, but psychiatrists have now billed it "social anxiety disorder" -- and it's one of the hottest new topics in psychiatry.

 

The Ottawa Anxiety and Trauma Clinic, a new clinic that opened in Ottawa recently, will specialize in this type of anxiety. Social anxiety will also be a focus for the new anxiety disorders program at the Royal Ottawa Hospital, which began three months ago.

 

"For some people it's very specific, like stage fright," says Dr. George Fraser, a psychiatrist and director of the Ottawa Anxiety and Trauma Clinic. "Others have 'everything fright.' They don't function well in any social situation. Even speaking to a bank teller is a horrendous experience for them."

 

But social anxiety disorder has at least one skeptic. Dr. Peter Breggin, an American psychiatrist, author and critic of psychiatric drugs doesn't believe in it. "It's a marketing ploy by drug companies," he says.

 

"We're all nervous dealing with people. Some people are more nervous than others."

 

Yet, psychiatrists estimate that three to four per cent of the population at any given time -- up to 30,000 of the region's 750,000 people -- suffers from social anxiety disorder. It's also called social phobia.

 

Recently, Dr. Fraser treated a doctor, a schoolteacher, and a high-tech professional who is terrified of making presentations to groups. Dr. Fraser has also treated professional singers and musicians.

 

"It's like a secret out there," said Dr. Fraser, explaining that many sufferers hide high anxiety by avoiding stressful situations. Some patients have even given up job promotions that called for public speaking. "Many people are embarrassed to seek help because they think it's a character flaw."

 

Meeting new people, eating in restaurants or even using public restrooms -- a condition known as "bashful bladder" -- can be overwhelming. Sufferers react by blushing, stammering, trembling or feeling panicky or sick to their stomach, says Dr. Fraser.

 

Anxious people are afraid of being judged negatively by other people and petrified of being embarrassed in public. 

 

This makes it tough to develop friendships or function well at school or work. It strains family relations. According to doctors, extreme shyness often goes hand-in-hand with depression, panic disorder or alcohol or drug problems.

 

Research in the past few years on social anxiety has boosted the profile of the disorder. And a year ago, Health Canada approved the first treatment for social anxiety disorder -- an anti-depressant called Paxil, which is being advertised widely in medical journals.(SmithKline Beecham, the makers of Paxil, will not reveal how many prescriptions have been written for social anxiety disorder.) 

 

"It's a disorder that's starting to get its due attention," says Dr. Jacques Bradwejn, chief of psychiatry at the Royal Ottawa Hospital. "It's still very much unrecognized and undiagnosed in the community."

 

Doctors predict that demand for treatment will grow in the next few years as the public and medial community learn that help is available for the faint-hearted.

 

In addition to drugs like Paxil (which has a long list of potential side effects such as nausea, sleepiness and tremor) treatment can include hypnosis, psychotherapy and cognitive behaviour therapy: Psychologists practise handshakes, teach relaxation skills and try to convince the patient that everybody is not staring at them. 

 

Dr. Fraser has even sent some patients to Toastmasters to practise public speaking, and has prescribed beta blockers, a heart drug, to performers to cut down on that sickening feeling of a pounding heart and pouring sweat. Researchers have suggested that social anxiety disorder may be the result of a subtle change in one or more of the brain's neurotransmitters, the chemicals that regulate thinking and mood. It can be caused by a traumatic incident in childhood such as being teased or embarrassed. There is also a genetic predisposition.

 

While social phobia was recognized as a medical condition in 1980, there was little that could be done and it was often misdiagnosed as avoidant personality disorder. "People just stayed at home," said Dr. Fraser. Dr. Bradwejn said he expects hundreds and possibly thousands of social anxiety patients to be referred by doctors to the Royal Ottawa Hospital in the next couple of years. 

 

They will be treated by a nine-member team, including doctors, nurses, psychologists and social workers. Patients must be referred by a doctor.

 

ROH doctors also plan to spread the world among physicians in Ottawa-Carleton about social anxiety disorder. A new research group at the hospital will study stress and anxiety.

 

Dr. Fraser expects as many as 400 social anxiety patients a year at his clinic, located at Billings Bridge Plaza.

 

The clinic's brochure even advises patients who get panicky in malls that there is a quiet entrance in the rear of the building. 

 

Dr. Fraser and his five team members, which include psychiatrists, psychologists and an occupational therapist, worked together at the ROH in the past.

 

Psychiatric fees are covered by OHIP, but referrals to psychiatrists must be made by a physician. Other clinic members accept self-referrals and their fees range from $85 to $120 a session.

 

Dr. Fraser plans to start group therapy next month for social anxiety disorder.

 

According to medical literature, one in seven people will suffer from social anxiety disorder at some point in their life. 

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