Abstract– Mental health is linked with the positive personality and social development of adolescents, and it is an issue that receives more and more attention by the whole society. Social anxiety disorder (SAD) is a chronic mental health condition characterized by an intense fear of social situations, leading to significant distress and functional impairment. Negative life events can contribute to the development and exacerbation of Social Anxiety Disorder (SAD). Homoeopathic medicine treats the person as a whole, medicine prescription based on the totality of symptoms. Here is a case of social anxiety disorder that was successfully treated with homoeopathic medicines, which indicates the efficiency of homoeopathic medicines in the treatment of social anxiety disorder.
Key words- social anxiety disorder, mental disease, homeopathy, individuation.
Introduction –
Social anxiety disorder (also referred to as social phobia) involves the fear of social situations, including situations that involve scrutiny or contact with strangers. The term social anxiety reflects the distinct differentiation of social anxiety disorder from specific phobia, which is the intense and persistent fear of an object or situation. People with social anxiety disorder fearful of embarrassing themselves in social situation (i.e, social gatherings, oral presentations, meeting new people). They may have specific fears about performing specific activities such as eating or speaking in front of others, or they may experience a vague, nonspecific fear of “embarrassing oneself”1.
Social phobia is characterized by the appearances of incapacitating anxiety in particular social situations with resultant desire for escape or avoidance.
Despite increasing recognition of social anxiety disorder as common, impairing, yet treatable, it often remains undiagnosed .In feared situations, patients with social anxiety disorder typically experience self-consciousness, embarrassment, and difficulty speaking. Autonomic arousal symptoms, such as blushing, sweating, trembling, and palpitations, are sometimes prominent. Thoughts often dwell on inferiority to others, desire to flee, and anticipated negative evaluation by others. Weeks of anticipatory anxiety may precede a social event, with self-deprecating thoughts and demoralization in its aftermath. The clinician should recognize that at least some degree of social anxiety or self- consciousness is common in the general population.
Epidemiology-
Various studies have reported a lifetime prevalence ranging from 3 to 13 percent for social phobia. The 6-month prevalence is about 2 to 3 per 100 persons. The 2008 National
Comorbidity Survey – Replication (NCS-R) provides prevalence estimates of 12 month and lifetime prevalence of DSM-IV SAD as 7.1% and 12.1% respectively with a higher prevalence in females 5. The current prevalence of all anxiety disorders from NMHS was already published as 2.57% 6 .The incidence of SAD in India is 2.79% and the prevalence of 1.47 % (2004) 7 . lifetime prevalence ranges from 2 to 13%. Females are affected more than males. Onset is in mid-teenage years, but the patients do not seek treatment until they are in their 30s 2.
Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important 8. In India, the main documented cause of anxiety among school children and adolescents is parent’s high educational expectations and pressure for academic achievement. After the secondary examination, all students appear in the Class XII Board examination. Competition is again ferocious, as performance in this examination determines the University entrance. Admission to courses in Medicine, Engineering and Management are the most preferred choices for parents because these qualifications seem to guarantee future job prospects 9 . Negative life events refer to challenging or distressing experiences that individuals may encounter during their lives. These events can have a significant impact on a person’s mental and emotional well-being.
The DSM-5 diagnostic criteria used for social anxiety disorder. The clinician should recognize that at least some degree of social anxiety or self-consciousness is common in the general population. Community studies suggest that roughly one- third of all persons considered themselves to be far more anxious than other people in social situations .
Some people have one specific fear, but most have more than one social phobia. People with generalized social phobia fear most social situation.10 Social anxiety disorder differs from shyness and performance anxiety in its greater severity, pervasiveness, and resultant distress and impairment. Persons with social anxiety disorder may avoid important activities, such as attending classes and meetings, or attend but avoid active participation. They achieve less in school and work and are less likely to marry than people who do not have the disorder. In primary care settings, social anxiety disorder contributes to poor functioning and missed work, yet most cases go untreated.11
Case – A female patient aged 28 years visited on 1/7/24 in OPD with complaint of Intense trembling and fear in group settings, particularly in situations where she may have to speak or present in front of others.
Present Complaint – Trembling and cold hand before or during public events or meetings where she might have to speak. Excessive sweating, particularly under the arms and palms which is often noticeable to others. Fear of public speaking she avoids social situations where she might be the center of attention or have to speak. Anxiety in situations where she has to interact in groups or speak in front of others. She experiences a rapid heartbeat and palpitations when faced with the possibility of public speaking or group discussions. The patient often experiences dryness in her mouth, which makes it hard for her to speak, and she finds herself struggling to form coherent sentences when the focus of attention is on her. She feels nauseous both before and during social events, which further exacerbates her anxiety. As a result of these symptoms, she avoids situations where she might have to speak or be the center of attention and tends to retreat from social gatherings where public speaking might be required.
History of Present Illness:
The patient recalls a traumatic event from her early adolescence that significantly impacted her social behaviour and anxiety. At the age of 12, she was asked by her teacher to answer a question in front of her class. She was not confident in her answer and, unfortunately, gave the wrong response. Her teacher publicly embarrassed her in front of the entire class, which made her feel humiliated and ridiculed. This public humiliation left a lasting psychological scar, and the patient developed an intense fear of being judged or making mistakes in front of others. Since this incident, she has been highly self-conscious and afraid of being in social situations where she could be ridiculed again. This fear has persisted into adulthood, especially when she finds herself in situations that involve speaking or presenting in front of groups. The anxiety she experiences has grown progressively over time, manifesting physically and emotionally in situations that involve public speaking or attention. Despite the ongoing struggle, the patient has not sought medical treatment for these symptoms and has instead been avoiding situations where her anxiety might be triggered.
Personal History-
Thermal Reaction: Chilly
Desire: Warm food
Disagrees: Sweet
Thirst: 4-5 lit /day
Perspiration: Profuse (palms and under arms)
Diet: Vegetarian
Sleep: Normal (but disturbed before event)
Dream: Accident
Mind & Disposition -The patient is shy and tends to remain reserved in social interactions. She often feels uncomfortable and out of place when surrounded by unfamiliar people or when the focus is on her. This leads to low self-confidence in social situations, where she tends to feel inadequate or unsure of herself. Her fear of being judged or criticized by others creates a significant level of social anxiety. She is extremely sensitive to the opinions of others and tends to be greatly affected by even mild or perceived criticism. This makes her vulnerable to emotional discomfort in social contexts, as she feels any negative feedback could confirm her fears of inadequacy. As a result, her self-esteem is fragile, and her social interactions are overshadowed by the constant worry of being evaluated negatively. She is highly sensitive to even mild criticism and it deeply affects her emotionally. If she cannot physically avoid a social situation, she withdraws mentally, becoming quiet or withdrawn. Her fear of embarrassment leads her to avoid situations where she might be the centre of attention. Even the thought of engaging in social situations causes anticipatory anxiety, making her want to escape. She prefers to remain unnoticed and stay in the background rather than drawing attention to herself. Her fear of speaking or interacting with others often leads her to avoid situations where public speaking or social engagement is necessary.
Gynecological History:
- Menarche: at the age of 13 year
- Menstrual Cycle: 30 days cycle, 5 days blood flow
- Leucorrhea – before the menses, slightly and thin Totality of symptoms:
- Significant anxiety in social settings, when the focus is on her.
- Escape attempts, she avoids situations where she might be in the spotlight.
- Profuse sweating, especially under arms and palms.
- Trembling and cold limbs before and during the event.
- Racing heartbeat and palpitation when facing public speaking.
- Dryness in the mouth
- Nausea before and during events
- Emotional trauma from a specific public humiliation.
- Persistent lack of confidence.
- Intense fear of being criticized or judged.
- Dreams of accident.
- Patient is thirsty and chilly.
- She is extremely sensitive to opinions of others.
Selection of remedy with potency-
After analyzing the reportorial totality, it was observed that ARSENICUM ALBUM was covering the maximum number of rubrics with the highest mark. And it also covers the prominent symptoms of the patient. On consulting Materia medica and according to maism , the remedy arsenic album is matched very well to the patient.it was prescribed in 200th potency, single dose, one dose means 4-5 globules of 40 sized.
Result– After taking the prescribed homeopathic medicine, the patient’s LSAS score decreased from 78 to 38, showing a significant reduction in social anxiety. The patient reports feeling more comfortable in social situations with less avoidance.
Discussion– This case highlights a classic presentation of social anxiety disorder (SAD) with both psychological and physical symptoms. The patient’s intense fear of public speaking, avoidance of social situations, and physiological responses were traced to an early traumatic experience of public humiliation. Based on Kent’s method, Arsenicum Album 200 was selected for its effectiveness in treating anxiety, restlessness, fear of humiliation, and anticipatory fear. The single-dose treatment resulted in a significant improvement. This case demonstrates the efficacy of individualized homeopathic treatment in managing social anxiety, addressing both emotional and physical symptoms.
Conclusion– Homeopathy is based on a holistic approach. It has a great scope in management of mental disease which present themselves with one sided nature with masking of symptoms. Hahnemann conveyed through organon of medicine “it’s the patient and not the disease which is only to be cured”12. This case study illustrates the significant impact of homeopathic intervention in the management of social anxiety disorder. The hallmark of social anxiety disorder is extreme and persistent fear of embarrassment and humiliation.13 The successful reduction in symptoms following treatment with Arsenicum Album 200 underscores the importance of an individualized approach in homeopathy. By addressing both the psychological and physiological manifestations of anxiety, the remedy contributed to improved confidence and social engagement in the patient.
References –
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About Author:
Dr. Shivangi parihar, MD scholar
Guide – Dr. Rakesh Sonkusare
