Overcoming Social Anxiety and OCD: A Path to Confidence and Independence

Social anxiety, fear of riding, obsessive-compulsive disorder (OCD)?

Dear Dr.
Wu,
My son is nearly 30 years old and belongs to a vulnerable group.
He has poor expressive abilities and social difficulties.
At the age of four, his developmental assessment showed that his "environmental understanding" was below that of his peers.
During a certain grade in elementary school, he was bullied by his classmates, which led to social anxiety disorder.
He constantly suspects that his classmates are whispering and criticizing him, fears engaging in conversations, and often stutters.
When faced with verbal bullying, he silently endures it.
His anxiety at school has never eased, and he feels tense all the time.
This has also resulted in sleep disturbances.
Throughout his educational journey, he has not made any friends and is afraid to go out alone, leading to very low self-esteem.
In high school, he developed obsessive-compulsive disorder with a focus on cleanliness.
He spends 2 to 3 hours on personal hygiene routines, such as using the restroom and showering, and disregards family advice, insisting that his cleaning methods are correct.
He does not allow family members to touch most of his personal belongings unless they are disinfected with alcohol.
Although he has a driver's license, he is too afraid to drive on the road and only dares to ride on sparsely populated roads for a few minutes with family on a motorcycle.
His fear stems from the frequent traffic accidents in Taiwan, which make him anxious about the speed of vehicles.
These symptoms have severely impacted his ability to function, yet he has been hesitant to seek help from a psychiatrist due to a previous experience with psychiatric medication that caused turmoil in our household for a while.
Currently, he urgently needs to address his fear of riding a motorcycle.

Could you please advise on a treatment direction, Dr.
Wu?
Thank you for your time and consideration!

Wu Zhu Mama, 30~39 year old female. Ask Date: 2023/09/03

Dr. Wu Enliang reply Psychiatry

Online users may consider pharmacological treatment to reduce anxiety.
If medication is not acceptable, they may also consider seeking psychological therapy or relaxation training at a hospital or mental health clinic.
Dr.
Wu Enliang.

Reply Date: 2023/09/03

More Info

Overcoming social anxiety and obsessive-compulsive disorder (OCD) can be a challenging journey, especially for individuals who have faced significant obstacles throughout their lives. Your son's experiences with social anxiety, bullying, and OCD have understandably impacted his confidence and independence. It’s crucial to approach his situation with empathy and a structured plan for treatment.

Understanding Social Anxiety and OCD
Social anxiety disorder (SAD) is characterized by an intense fear of social situations where one may be judged or scrutinized by others. This fear can lead to avoidance behaviors, such as not engaging in conversations or avoiding social gatherings altogether. In your son's case, the bullying he experienced during his formative years likely exacerbated his anxiety, leading to a cycle of fear and avoidance.

OCD, on the other hand, involves intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions) aimed at reducing anxiety. Your son's compulsive behaviors, such as excessive cleaning and the need for specific routines, are common in OCD and can significantly interfere with daily functioning.

Treatment Options
1. Cognitive Behavioral Therapy (CBT): This is one of the most effective treatments for both social anxiety and OCD. CBT focuses on identifying and challenging negative thought patterns and beliefs. For social anxiety, exposure therapy, a component of CBT, gradually exposes individuals to feared social situations in a controlled manner, helping them build confidence over time. For OCD, CBT can help your son learn to manage his compulsions and reduce the anxiety associated with his obsessions.

2. Medication: While you mentioned past experiences with psychiatric medications that caused family distress, it’s important to note that not all medications have the same side effects. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for both social anxiety and OCD and can be effective in reducing symptoms. A psychiatrist can work with your son to find a medication that minimizes side effects while addressing his symptoms.

3. Support Groups: Connecting with others who have similar experiences can be incredibly beneficial. Support groups provide a safe space for individuals to share their struggles and successes, fostering a sense of community and understanding.

4. Gradual Exposure: Since your son has expressed fear about riding a motorcycle due to traffic accidents, a gradual exposure approach could be beneficial. This might involve starting with short, low-pressure rides in safe environments, gradually increasing the complexity and duration of the rides as he becomes more comfortable.

5. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep-breathing exercises, can help your son manage anxiety in the moment. These techniques can be particularly useful before facing anxiety-provoking situations, such as riding a motorcycle or engaging in social interactions.

6. Family Support: Encouraging family involvement in his treatment can create a supportive environment. Open communication about his feelings and experiences can help him feel less isolated. It’s essential for family members to understand his struggles and provide encouragement without pressure.

Encouraging Professional Help
While your son may be hesitant to seek professional help due to past experiences, it’s important to emphasize that treatment can be tailored to his needs. A compassionate mental health professional can work with him to create a treatment plan that respects his concerns and preferences. It may also be helpful to accompany him to his first appointment for support.

Conclusion
Overcoming social anxiety and OCD is a gradual process that requires patience, understanding, and support. By combining therapy, medication, and gradual exposure techniques, your son can begin to reclaim his confidence and independence. Encouraging him to take the first step toward seeking help is crucial, as it can lead to significant improvements in his quality of life. Remember, recovery is a journey, and every small step counts.

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