Holiday Season May Raise Anxiety For People With Social Phobia

Who’s always missing at your holiday party? Aunt Betty? Your reclusive neighbor? They may have declined your invitation because they are among the millions of Americans living with social phobia. For these people, the holiday season can spark such intense feelings of anxiety and dread that they avoid social gatherings altogether.

"A lot of people have anxiety in social situations, such as when meeting new people at a holiday party, but the fear is not severe and typically passes," said Una McCann, M.D., chief of the Unit on Anxiety Disorders at the National Institute of Mental Health (NIMH). "For people with social phobia, however, the fear of embarrassment in social situations is excessive, extremely intrusive and can have debilitating effects on personal and professional relationships."

People with social phobia have an overwhelming and disabling fear of disapproval in social situations. They recognize that their fear may be excessive or unreasonable, but are unable to overcome it. Symptoms of social phobia include blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness, and other symptoms of anxiety.

To uncover the biological and behavioral causes of social phobia, NIMH is conducting and supporting research on this disorder.

"Without treatment, social phobia can be extremely disabling to a person’s work, social and family relationships. In extreme cases, a person may begin to avoid all social situations and become housebound," said Dr. McCann. "But the good news is that effective treatment for social phobia is available and can be tremendously helpful to people living with this disorder."

Effective treatments include medications, a specific form of psychotherapy called cognitive-behavioral therapy, or a combination. Medications include antidepressants called selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepenes. People with a specific form of social phobia, called performance phobia, can be helped with drugs called beta-blockers. Cognitive-behavioral therapy teaches patients to react differently to the situations and bodily sensations that trigger anxiety symptoms. For example, a type of cognitive-behavioral treatment known as "exposure therapy" involves helping patients become more comfortable with situations that frighten them by gradually increasing exposure to the situation.

At least 7.2 million Americans experience clinically significant phobias in a given year, many of them have social phobia. Phobias are persistent, irrational fears of certain objects or situations; they occur in several forms.

While social phobia is a fear of embarrassment, humiliation, or failure in a public setting, specific phobias involve fear of an object or situation. These include small animals, snakes, closed-in spaces, or flying in an airplane.

Phobias are one of five major anxiety disorders that are being addressed in a national education program conducted by NIMH. In addition to phobias, these disorders include:

Panic Disorder -- Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.

Obsessive-Compulsive Disorder -- Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.

Post-Traumatic Stress Disorder – Persistent symptoms that occur after experiencing a traumatic event such as rape or other criminal assault, war, child abuse, natural disasters or crashes. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, distracted and being easily startled are common.

Generalized Anxiety Disorder -- Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea. Marriage and Family Therapist Continuing Education Ca http://www.aspirace.com
For more information about social phobia and other anxiety disorders, see the NIMH Anxiety Disorders Web site at http://www.nimh.nih.gov /anxiety or call NIMH’s toll-free number, 1-88-88-ANXIETY, for a free packet of information. The National Institute of Mental Health is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services.

Holiday Weight Gain Slight, but May Last a Lifetime

A new study suggests that Americans probably gain only about a pound during the winter holiday season--but this extra weight accumulates through the years and may be a major contributor to obesity later in life.

This finding runs contrary to the popular belief that most people gain from 5 to 10 pounds between Thanksgiving and New Year's Day.

This is the conclusion reached by researchers at the National Institute of Child Health and Human Development (NICHD) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The results of their study appear in the March 23 New England Journal of Medicine.

"These findings suggest that developing ways to avoid holiday weight gain may be extremely important for preventing obesity and the diseases associated with it," said NICHD Director Duane Alexander, M.D.

According to Government statistics, more than half of all adult Americans are overweight, as defined by body mass index, said Jack A. Yanovski, M.D., Ph.D., the study's principal investigator and Head of NICHD's Unit on Growth and Obesity. Body mass index is a mathematical formula used to correct body weight to account for a person's height. According to Dr. Yanovski, the latest national surveys show that 54.9 percent of Americans have a body mass index of 25 or more, and are overweight, while 22.3 percent are considered obese with a body mass index of 30 or more.

"The prevalence of obesity in the US has increased dramatically in the US over the past decade," Dr. Yanovski said. "Weight gain during adulthood may contribute to heart disease, diabetes, and other serious health problems."

"Because losing weight is so difficult, it is important to learn when and why people gain weight so that effective strategies to prevent obesity can be developed," said study co-author Susan Z. Yanovski, M.D., Executive Director of NIDDK's National Task Force on the Treatment and Prevention of Obesity.

Previous studies suggested that Americans gain an average of 0.4 pounds to 1.8 pounds each year during their adult lives, Dr. Yanovski said. It was unknown, however, if people gained weight at a steady rate throughout the year, or just at certain times, such as during the winter holiday season. To find out just how much of this weight increase occurred over the holidays, Dr. Yanovski and his colleagues measured weight and other health information in 195 volunteers. These volunteers worked at, or lived near, the NIH campus in Bethesda, MD. The group was racially, ethnically, and socioeconomically diverse. The study's participants ranged in age from 19 to 82 years, and in weight from 95 to 306 pounds. Fifty one percent were women, and 49 percent were men. The percentage who were at a healthy weight, were overweight, or were obese was similar to the US adult population. All 195 were weighed at six-week intervals before, during, and after the winter holiday season, and 165 returned for additional measurements in June and the following September, one year after the study began.

Compared to their weight in late September or early October, the volunteers gained slightly over a pound (1.05 lb) by late February or early March, with most of that weight gain (0.8 lb) occurring during the six-week interval between Thanksgiving and New Year's Day. The researchers asked the volunteers about several factors that might influence weight change, such as stress, hunger, activity level, changes in smoking habits, or number of holiday parties they attended. The researchers found that only two factors influence weight gain: level of hunger and level of activity. Volunteers who said they were much more active or much less hungry since their last clinic visit were the least likely to gain weight over the holidays, and some even lost weight. Conversely, those who reported being less active or more hungry had the greatest holiday weight gain.

"The finding that study volunteers reporting more physical activity had less holiday weight gain suggests that increasing physical activity may be an effective method for preventing weight gain during this high-risk time," Dr. Yanovski said.

The researchers also found that study volunteers believed that they had gained much more weight than they actually did over the holidays, overestimating their weight gain by slightly more than 3 pounds . Fewer than ten percent of subjects gained more than five pounds over the holiday season. However, Dr. Yanovski added, overweight and obese volunteers were more likely to gain five pounds than were those who were not overweight, suggesting that the holiday season may present special risks for those who are already overweight.

"Although an average holiday weight gain of less than a pound may seem unimportant, that weight was not lost over the remainder of the year," Dr. Yanovski said. When 165 of the study volunteers were weighed a year after the study began, they had not lost the extra weight gained during the holidays, and ended the year a pound and a half heavier (1.4 lb) than they were the year before.

"This is a 'good news/bad news' story," said Dr. Yanovski. "The good news is that people don't gain as much weight as we thought during the holidays. The bad news is that weight gained over the winter holidays isn't lost during the rest of the year."

The knowledge that that people actually accumulate a large proportion of their yearly weight gain over the winder holiday season, the researchers added, may prove useful in treating overweight and obesity.

"...the cumulative effects of yearly weight gain during the fall and winter are likely to contribute to the substantial increase in body weight that frequently occurs during adulthood," the researchers wrote. "Promotion of weight stability during the fall and winter months may prove useful as a strategy to prevent age-related weight gain in the United States." MFT COntinuing Education http://www.aspirace.com
The NICHD and NIDDK are two of the Institutes comprising the National Institutes of Health, the Federal government's premier biomedical research agency. NICHD supports and conducts research on the reproductive, neurobiological, developmental, and behavioral processes that determine and maintain the health of children, adults, families, and populations. The NICHD website, http://www.nichd.nih.gov, contains additional information about the Institute and its mission.

The National Institute of Diabetes and Digestive and Kidney Disease supports and conducts research on many of the most serios diseases affecting public health, such as diabetes and other endocrine disorders, inborn errors of metabolism, digestive diseases, obesity, nutrition, urology and renal disease, and hematology. For additional information, see http://www.niddk.nih.gov.