Albert Moukheiber

The diagnosis of social anxiety disorder (SAD) has seen substantial changes in the last 35 years from its first appearance in the DSM-III in 1980 up to the most recent ones in the DSM-5. Throughout all these changes, this disorder, previously called social phobia, is still considered one homogenous entity with only one specifier (“performance only”) introduced in the DSM-5 revision with specific fears or associated personality profiles not being considered relevant clinical markers to define… Voir plus

The diagnosis of social anxiety disorder (SAD) has seen substantial changes in the last 35 years from its first appearance in the DSM-III in 1980 up to the most recent ones in the DSM-5. Throughout all these changes, this disorder, previously called social phobia, is still considered one homogenous entity with only one specifier (“performance only”) introduced in the DSM-5 revision with specific fears or associated personality profiles not being considered relevant clinical markers to define SAD subtypes. However, our therapeutic experience suggested substantial particularities associated with the fear of blushing in patients with SAD. Some patients presenting this profile, historically called “erythrophobia”, seem to have a very specific type of social anxiety that does not include shyness and other characteristics of classical SAD. In a study conducted in a sample of 450 new consecutive outpatients seeking treatment for SAD, we compared 142 subjects with fear of blushing without other social fears, 97 subjects with fear of blushing with other associated social fears and 190 SAD subjects without fear of blushing. The group with pure fear of blushing presented a different profile when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, i.e. less shyness, and higher self-esteem. Furthermore, from a therapeutic point of view, some specific strategies such as the Task Concentration Training have shown to be particularly effective in fear of blushing. We will further argue the validity of a possible “fear of blushing” subtype of SAD. Voir moins

Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the… Voir plus

Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the existence of two partially distinct temperamental profiles. We used the Temperament and Character Inventory (TCI-R) and the Positive and Negative Emotionality (PNE) scale to compare two groups of patients with OCD (n=227) or AD (n=827). The latter group included patients with social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. Most temperament, character and emotionality measures showed no significant differences between both groups. In the personality measures results, only the self-directedness score (TCI-R) was significantly lower in OCD patients but this difference was not significant when the comparison was adjusted for the depressive scale score and age. Only lower PNE positive affects scores were obtained in OCD patients in the adjusted comparisons. These findings suggest that OCD and AD are not really distinguishable from the point of view of associated personality traits. Voir moins

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are non-invasive brain stimulation methods that became widely used as therapeutic tools during the past two decades especially in cases of depression and schizophrenia. Low frequency rTMS and cathodal effect of tDCS inhibits cortical functioning while high frequency and anodal effect of tDCS have the opposite effect. Prolonged and repetitive application of either methods leads to changes in… Voir plus

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are non-invasive brain stimulation methods that became widely used as therapeutic tools during the past two decades especially in cases of depression and schizophrenia. Low frequency rTMS and cathodal effect of tDCS inhibits cortical functioning while high frequency and anodal effect of tDCS have the opposite effect. Prolonged and repetitive application of either methods leads to changes in excitability of the human cortex that outlast the period of stimulation. Both rTMS and tDCS induce functional changes in the brain-modulating neural activity at cortical level. This paper reviews rTMS and tDCS effects in clinical trials for obsessive-compulsive disorder (OCD). Low frequency rTMS, particularly targeting the supplementary motor area and the orbital frontal cortex, seems to be the most promising in terms of therapeutic efficacy while older studies targeting the prefrontal dorsal cortex were not as successful. tDCS clearly needs to be investigated in large scale and sufficiently powered randomized control studies. From a general point of view, these non-invasive techniques hold promise as novel therapeutic tools for OCD patients. Voir moins

Fear of blushing (FB) is a form of social anxiety disorder (SAD) characterized by an intense and obsessive threat of blushing in front of other people. No data are available on the specific efficacy of antidepressants on FB. This open-label pilot study investigated whether the selective serotonin reuptake inhibitor escitalopram specifically improves symptoms of FB in SAD patients.

Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria… Voir plus

Fear of blushing (FB) is a form of social anxiety disorder (SAD) characterized by an intense and obsessive threat of blushing in front of other people. No data are available on the specific efficacy of antidepressants on FB. This open-label pilot study investigated whether the selective serotonin reuptake inhibitor escitalopram specifically improves symptoms of FB in SAD patients.

Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SAD and presenting a significant FB according to the Salpêtrière Erythrophobia Questionnaire (SEQ) were administered open-label escitalopram (10–30 mg/d) for 12 weeks. A systematic assessment, at baseline and at week 12, included the SEQ, the Liebowitz Social Anxiety Scale, and the Hospital Anxiety and Depression scale.

From the 39 patients included, 31 attended the week 4 visit, and 28 the week 12 visit. Significant reductions of FB were observed after 4 weeks of treatment and were more pronounced at the end of the 12-week treatment since patients experienced a 60% decrease in their FB symptoms (P < 0.001). Nineteen subjects (67.8%) reported a 50% decrease or more of their SEQ score, and 14 (50%) met criteria for remission of FB (SEQ score <7). The effect sizes of changes on SEQ, Liebowitz Social Anxiety Scale, and Hospital Anxiety and Depression scale scores were high, with η2 ranging between 0.53 and 0.86.

Results of this open-label study suggest that escitalopram can be a useful treatment for FB associated with SAD, even if large controlled trials are now needed to further evaluate this result. Voir moins

Fear of blushing (FB) is a form of social anxiety disorder (SAD) characterized by an intense and obsessive threat of blushing in front of other people. No data are available on the specific efficacy of antidepressants on FB. This open-label pilot study investigated whether the selective serotonin reuptake inhibitor escitalopram specifically improves symptoms of FB in SAD patients.

Thirty-nine patients meeting DSM-IV criteria for SAD and presenting a significant FB according to the… Voir plus

Fear of blushing (FB) is a form of social anxiety disorder (SAD) characterized by an intense and obsessive threat of blushing in front of other people. No data are available on the specific efficacy of antidepressants on FB. This open-label pilot study investigated whether the selective serotonin reuptake inhibitor escitalopram specifically improves symptoms of FB in SAD patients.

Thirty-nine patients meeting DSM-IV criteria for SAD and presenting a significant FB according to the Salpêtrière Erythrophobia Questionnaire (SEQ) were administered open-label escitalopram (10-30 mg/day) for 12 weeks. A systematic assessment, at baseline and at week 12, included the SEQ, the Liebowitz Social Anxiety Scale (LSAS) and the Hospital Anxiety and Depression (HAD) scale.

From the 39 patients included, 31 attended the week 4 visit, and 28 the week 12 visit. Significant reductions of fear of blushing were observed after 4 weeks of treatment, and were more pronounced at the end of the 12-week treatment since patients experienced a 60% decrease of their FB symptoms (p< 0.001). Nineteen (67.8%) subjects reported a 50% decrease or more of their SEQ score, and 14 (50%) met criteria for remission of fear of blushing (SEQ score < 7). The effect sizes of changes on SEQ, LSAS and HAD scales scores were high, with eta2 ranging between 0.53 and 0.86.

Results of this open study suggest that escitalopram can be a useful treatment for fear of blushing associated with SAD, even if large controlled trials are now needed to further evaluate this result. Voir moins

Gaze aversion could be a central component of social phobia. Fear of blushing is a symptom of social anxiety disorder (SAD) but is not yet described as a specific diagnosis in psychiatric classifications. Our research consists of comparing gaze aversion in SAD participants with or without fear of blushing in front of pictures of different emotional faces using an eye tracker. Twenty-six participants with DSM-IV SAD and expressed fear of blushing (SAD+FB) were recruited in addition to… Voir plus

Gaze aversion could be a central component of social phobia. Fear of blushing is a symptom of social anxiety disorder (SAD) but is not yet described as a specific diagnosis in psychiatric classifications. Our research consists of comparing gaze aversion in SAD participants with or without fear of blushing in front of pictures of different emotional faces using an eye tracker. Twenty-six participants with DSM-IV SAD and expressed fear of blushing (SAD+FB) were recruited in addition to twenty-five participants with social phobia and no fear of blushing (SAD-FB). Twenty-four healthy participants aged and sex matched constituted the control group. We studied the number of fixations and the dwell time in the eyes area on the pictures. The results showed gaze avoidance in the SAD-FB group when compared to controls and when compared to the SAD+FB group. However we found no significant difference between SAD+FB and controls. We also observed a correlation between the severity of the phobia and the degree of gaze avoidance across groups. These findings seem to support the claim that social phobia is a heterogeneous disorder. Further research is advised to decide whether fear of blushing can constitute a subtype with specific behavioral characteristics. Voir moins

Abstract

Background

Fear of blushing (FB) in front of other people is a frequent and potentially incapacitating problem, but is not yet described as a specific diagnosis in psychiatric classifications. This can be explained by a lack of comparative studies with other forms of social anxiety disorder (SAD). Our aim was thus to explore the specificity of FB in patients with SAD.
Methods

SAD patients with FB but without other social threat (n = 142), the majority of whom… Voir plus

Abstract

Background

Fear of blushing (FB) in front of other people is a frequent and potentially incapacitating problem, but is not yet described as a specific diagnosis in psychiatric classifications. This can be explained by a lack of comparative studies with other forms of social anxiety disorder (SAD). Our aim was thus to explore the specificity of FB in patients with SAD.
Methods

SAD patients with FB but without other social threat (n = 142), the majority of whom were referred by a department of surgery after an initial request of sympathetic block for facial blushing, were compared to SAD patients with FB and other associated social fears (n = 97), and to SAD patients without FB (n = 190). They were assessed and compared with a structured diagnostic interview for DSM-IV and various scales measuring social anxiety, other anxiety and depressive symptoms, impairment and personality traits.
Results

The group with pure FB showed specific profiles when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, and higher self-esteem. However, their levels of social anxiety and impairment were high. No important differences appeared between the two other groups.
Conclusion

The specificity of FB should be considered in the social anxiety spectrum, and could be viewed either as a SAD subtype or as SAD form secondary to facial blushing. Further epidemiological and therapeutic studies on this disorder are necessary. Voir moins

Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the… Voir plus

Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder. Voir moins