Understanding Social Anxiety Disorder in Parkinson's Disease

It is natural to have some kind of emotional distress, anxiety, and sadness when diagnosed with Parkinson’s disease. But SAD is not just about being sad, it is being anxious and fearful of participating in social activities. SAD is an abbreviation for social anxiety disorder also known as social phobia. It is quite common in Parkinson’s due to visible tremor and other health problems.

Since 1817, when James Parkinson described Parkinson's disease in detail in “An Essay on the Shaking Palsy” till date, there has been widespread belief that anxiety, depression, social phobias are all result of a reaction to the diagnosis of the disease. But things started to change when research showed that neuropsychiatric disorders were highly prevalent in Parkinson’s disease as compared to other more disabling diseases. Further, it was found that in many people symptoms of emotional distress occur before being diagnosed with Parkinson’s. Thus evolved the understanding that emotional disorders in Parkinson’s are not just secondary to disease.

Today it is widely accepted that neurodegeneration in Parkinson’s disease not only cause the disease of movements, but also neuropsychiatric disorders. SAD is one such situation which is common in people suffering from it. It is important to diagnose SAD on time, as it can be an indicator of other graver neuropsychiatric problems. SAD is commonly associated with memory issues, various mood disorders(1). SAD is one of the difficult to identify medical conditions, due to lack of consensus on how to diagnose it. But various researchers show that its prevalence can be anything between 10-50% in people suffering from Parkinson’s disease (2).

Identifying SAD

SAD is one of the most underdiagnosed problems even in the general population, though it touches a large number of lives in the general population. Its prevalence is especially high in PD because of the stigma attached to the disease. People with defects of movements and tremor avoid socializing with the people. In some cases, a person suffering from Parkinson’s may be stigmatized. But it is not always secondary to the disease. In many SAD may be due to the damage caused by Parkinson’s to various neural structures. A person suffering from SAD will have fear of social performance if exposed to the feared situation they may suffer from severe anxiety, though a person understands very well that his or her fears are baseless. These symptoms have a negative effect on the self-confidence, and interfere with day to day life, causing marked emotional distress(2).

Some of the commonly feared situations are; performing in front of social gathering (even if it is family gathering), person avoids giving tests, person suffering from SAD does not like eating in front of others, have difficulty in using public toilets, and fears situation involving interaction with more than one person (3).

A person suffering from SAD may demonstrate behavioral changes in the feared environment. A person would find it difficult to speak properly, or would try to escape the situation, may start trembling, sweating, and may even complain of dizziness or palpitations. Such a person would often complain that others do not like him or her, would show disinterest and avoid participating in social events(3).

Overpowering SAD

Medical drugs used to treat Parkinson’s and anxiety would surely help a person in getting a grip of fears and phobias. In this article, we will look at some of the non-pharmacological strategies to overpower this enervating problem.

In SAD most fears are perceived rather than real. Thus psychological treatment could be beneficial in most cases. It is important to understand that unlike positive emotions, negative emotions do not leave us on suppression, they rather get stronger and more active. 

• Thus the first step is to recognize all those negative emotions, it is not a bad idea to have a diary and jot down all the negative moments along with all the details. Once you know that most common negative thoughts that come to your mind, you can move on to the second step. Next step involves challenging the negative thoughts and introducing positive thoughts. So if you have fear of bargaining, you must tell yourself that there is no risk or harm in asking once, else you always have an option to agree.

• Another strategy is to refocus your thoughts on the task at hand and avoid thinking too much about it. So if you have to propose a toast, just do it, stop thinking about what others may think or not. Just say what comes to your heart, without thinking overly. You would be amazed at your success in most cases.

• In case of negative emotions, exposure works better rather than avoidance. Thus once you have made the list of your worst fears, get prepared to face them. If you feel worried or ashamed to ask certain questions (e.g. Related to your sexual life) to your doctor, prepare a list and in next visit make sure that you ask each of the questions in a confident manner. After discussing something feared, a person will feel relaxed and slowly fears would sublime.

• Take lessons to improve your social skills. Like lessons in public speaking or dancing would really help.

• Learn relaxation techniques, be it breathing exercises, or meditation. They help in to improve almost every symptom related to neurodegenerative diseases.

• Another simple strategy is to imagine your worst fear. Think about it, and think about the worst consequences. So what if you ask a doctor about your sexual problems related to Parkinson’s, would doctor start laughing at your problem? Would doctor make jokes? Would doctor go and tell everyone in the clinic and your neighborhood about it? You know that answer, isn’t it? None of this will happen. Thus imagining your worst fear may infect help you to overcome it.

• Meeting new people is another way to overcome your social phobias. Try to meet new people at your place of work, or start going to health club which will have the double benefit of physical exercise and social interaction, join group lessons (learning anew language, cooking, dancing).

Finally, remember that practice makes men and women perfect, so whatever strategies you choose, just stick to them over a period of time and see the results. This list is surely not an exhaustive resource for overcoming SAD, so keep learning, participating in social activities and always have a good amount of exercise and sleep. In many situations, just a good sleep can do wonder. If you find to tackle some situation today, don’t worry, just have a sound sleep and start it all over the next day.

Parkinson’s disease is progressive, but with the right kind of planning and efforts, one can delay or even freeze the progress of disease for years if not forever.

References

1. Saldivar C, Moguel-Cobos G. Is There a Relationship Between Social Phobia and Parkinson’s Disease? (P3.078). Neurology. 2014 Apr 8;82(10 Supplement): P3.078.

2. Moriyama TS, Chagas MHN, Silveira-Moriyama L, Tumas V, Lees AJ, Crippa JA, et al. Diagnosing social anxiety in Parkinson’s disease: characteristics and frequencies according to two diagnostic criteria. Arch Clin Psychiatry São Paulo. 2016 Dec;43(6):139–42.

3. Milgrom GD, Burrows J&. Assessing and managing social anxiety disorder. Mod Med. 2007 Aug 1;32(8):28–34.