Borderline Personality Disorder (BPD): Understanding BPD and how to Appropriately Respond to Provocations as a Loved One

Living with Borderline Personality Disorder (BPD) not only affects the individual, but those with whom they have formed a relationship. Relationships are present and strong, but experience more turbulence due to key symptoms of BPD such as: intense reactions, self- doubt, extreme idolization or devaluation, fear of abandonment, mood swings, risky behaviors, etc. There is no one “cause” of a personality disorder like BPD, but studies show that patients with BPD come from families of severe pathology leading to their provocative behavior patterns.

People with BPD engage in provocative behaviors like making wild accusations, over- the- top demands, threatening suicide, etc., all with the intention of being invalidated by their counterparts as they have been their whole life. They feel invalidated (which fuels self- doubts) when they evoke one of three reactions from their counterpart: anxious helplessness, anxious guilt, or overt hostility. If these reactions are displayed, their poor behavior is rewarded and will continue, and feelings of self- doubt are reaffirmed.

When someone with BPD makes a wild accusation, resist invalidating them while disagreeing with the accusation. If they say, for example, “I can tell you hate me,” you can reply with, “I’m sorry you feel that way. I wish there was something I could do that would convince you I love you.” Here, you are disagreeing with the accusation while validating their feelings, and not showing one of the craved reactions. Their poor behaviors are thus not rewarded and feelings of self- doubt are not reaffirmed. Further, simply listen and be attentive. People with BPD most likely grew up being invalidated so they want to feel cared about. When talking to someone with BPD, incorporate the counseling technique “reflection of feelings”. This is defined by interpreting one’s feelings based on their verbal and nonverbal cues. When you’re able to interpret someone’s feelings, it demonstrates that you are paying attention and care, which is of utmost importance to someone with BPD.

If you or someone you know is seeking therapy for a codependent relationship, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://www.nami.org/Personal-Stories/What-Is-BPD

https://www.psycom.net/personality-disorders/bpd-and-relationships/

https://www.psychologytoday.com/us/blog/matter-personality/201401/responding-borderline-provocations-part-iii

https://www.psychologytoday.com/us/blog/matter-personality/201403/responding-borderline-provocations-part-iv

https://www.psychologytoday.com/us/blog/matter-personality/201403/responding-borderline-provocations-part-v

https://www.psychologytoday.com/us/blog/matter-personality/201405/responding-borderline-provocations-part-vi

Physician Burnout during a Global Pandemic

By Eleanor Kim

Physicians and nurses around the world have been at the front lines fighting the coronavirus and saving the lives of those infected. Now more than ever, citizens are coming to realize the importance of those within the medical field and the bravery that comes with entering medicine. That being said, there has been an immense amount of pressure placed upon healthcare workers, often causing stress, anxiety, and depression. At the end of the day, doctors, nurses, and other healthcare workers are humans and can feel the effects of burnout during such a heightened and high stakes moment in medical history.

Burnout is when someone becomes overwhelmed by the demands of their daily life, becoming emotionally and physically exhausted and creating a sense of depersonalization and weakened personal accomplishments. Burnout is a common occurrence among physicians and nurses given the great amount of pressure that comes with saving lives. That being said, these feelings of burnout have skyrocketed given the additionally taxing nature of current frontline medical work such as the stress of isolating from friends and family, the extended hours of work, the tragic lack of medical supplies, and the fear of contracting or spreading the virus, to name a few. Physicians are also left to deal with the other struggles and anxieties that the past year has brought upon the general population regarding economic, political, racial, and other personal effects of the pandemic.

During these elongated periods where healthcare workers are left sleep deprived, improperly fed, and overall anxious about the current status of the pandemic, they are exposed to both mentally and physically long lasting effects. In 2020, there have been a record number of physicians who have reported feelings of burnout and other mental health concerns since the start of the pandemic. Should these issues go untreated, there is an increased risk for depression, self-medication, substance abuse, and suicidal thoughts or attempts. Burnout is more than just stress; it is a mental health crisis and should be treated as such.

If you or someone you know is feeling the effects of physician and healthcare worker burnout, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/.

Resources:

https://www.forbes.com/sites/lipiroy/2020/05/17/doctor-heal-thyself-physician-burnout-in-the-wake-of-covid-19/

Image Source:

https://blog.frontiersin.org/2020/04/14/more-than-a-third-of-medical-staff-suffered-insomnia-during-the-covid-19-epidemic-in-china/

Borderline Personality Disorder: Misdiagnosed

Borderline Personality Disorder: Misdiagnosed

By Zoe Alekel

When struggling with your mental health, the last thing you want to hear from a doctor or therapist is that they don’t think anything is wrong. It can leave you confused, lost, hopeless, and alone. Borderline Personality Disorder (BPD) often goes undiagnosed or misdiagnosed because of the disorder’s symptoms and stigma. According to the Mayo Clinic symptoms of borderline personality disorder include:

  • Intense fear of abandonment—including real or imagined separation/ rejection
  • Feelings of depression, anxiety, and hopelessness
  • Unstable relationships—idealizing someone one moment, then suddenly believing they don’t care or that they are cruel
  • Distorted view of self and self-image—including dissociation (feeling as if you don’t exist at all or if the moment in time isn’t real)
  • Impulsive and risky behavior—including rebellion, drug abuse, reckless driving, sudden decision making, unsafe sex and promiscuity, and sabotaging success or personal relationships
  • Suicidal thoughts, threats, or behavior or self-injury, often in response to fear of separation or rejection
  • Mood swings lasting from a few hours to a few days— including intense happiness, irritability, shame or anxiety
  • Inappropriate, intense anger—losing temper easily, acting out, intense irritability

The symptoms for BPD often look like other mental health conditions—contributing to misdiagnosis or lack of diagnosis. Sometimes BPD has similar patterns and symptoms as bipolar disorder, which can also include severe mood swings. One study shows that 40% of people, who only met the criteria for BPD, were still misdiagnosed with Bipolar Type 2; which is likely due to the overlapping and similar symptoms of each disorder.

Another reason why BPD can go undiagnosed or misdiagnosed is because of the myth that teens can’t have BPD. Many of the symptoms of BPD can be seen as “typical teenage behavior” as this is a crucial time in an adolescent’s life when they are developing personality and identity. Diagnosing younger adolescents with BPD is often avoided because of the stigma attached to the diagnosis. Some clinicians may fear that the client’s symptoms may only worsen with a BPD diagnosis. This can be very dangerous and harmful to the client who is not accurately being diagnosed, especially because it limits the resources they can receive for help.

BPD does not only appear in a specific age group or gender, and sometime can mirror other diagnoses or the experience of a typical adolescent. Health professionals and advocates must continue to educate and understand the reality of BPD, and know when to properly diagnose so their client can receive the help they need.

If you or someone you know is struggling with borderline personality disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources: https://nami.org/Blogs/NAMI-Blog/October-2017/Why-Borderline-Personality-Disorder-is-Misdiagnose

https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

Image source: https://wakeup-world.com/wp-content/uploads/2016/01/Genie-in-a-Bottle-The-Spiritual-Gift-of-Borderline-Personality-Disorder-1.jpg

Bipolar Disorder: Loving someone with bipolar disorder, the ups and downs

Bipolar Disorder: Loving someone with bipolar disorder, the ups and downs
By Zoe Alekel

Loving someone with bipolar disorder can be a challenge if you don’t have the right tools and knowledge to help both you and your loved one. The first step in loving someone with bipolar disorder would be to understand what it means to be bipolar. Although you may never know exactly how your loved one feels, it is important to understand and educate yourself about their behaviors and emotions. According to the Mayo Clinic, bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). To understand what your loved one is going through, it is key to remind yourself that your loved one can’t always control these emotional mood swings—and more importantly it is not a reflection of you or how they feel about you.

It is understandable that it can be difficult to understand these seemingly sudden and intense mood swings, and your loved one struggling with bipolar disorder may already know this and feel bad about how it affects you. Make sure you approach them with kindness, and always ask them what you can do to help them. Sometimes space and understanding that the mood swing will pass is enough support for your loved one. No matter how involved or uninvolved they want you to be with their mental health, always respect their wishes.

One thing you can do to help you cope with your loved one’s bipolar disorder is to find others that have loved ones with bipolar disorder as well. Additionally, you can reach out to a therapist to share your feelings and the struggles that you experience as someone who has a loved one diagnosed with bipolar disorder. A way you can further educate yourself on bipolar disorder is to visit the National Alliance on Mental Illness (NAMI) website. NAMI provides credible information for those with loved ones diagnosed with bipolar disorder, and suggests you can try the following to help a family member or friend with bipolar disorder:

  • Recognizing and preventing serious mood episodes/ mood swings
  • Being able to recognize the warning signs of mania and depression
  • Making sure your loved one is taking their medication regularly and consistently (as directed)
  • Communicating and making time to talk to your loved one about their feelings when they feel ready
  • Remaining calm and rational with your loved one
  • Keeping a positive attitude and a clear mind to help your loved one the best you can
  • Reaching out for psychological support for you and your loved one

If you or someone you know is struggling with bipolar disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources: https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder/Support#:~:text=NAMI%20and%20NAMI%20Affiliates%20are%20there%20to%20provide,about%20bipolar%20disorder%20or%20finding%20support%20and%20resources.

https://www.psychologytoday.com/us/blog/insight-is-2020/201206/bipolar-disorder-loving-someone-who-is-manic-depressive

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955#:~:text=Both%20a%20manic%20and%20a%20hypomanic%20episode%20include,sprees%2C%20taking%20sexual%20risks%20or%20making%20foolish%20investments

Image Source: https://www.bing.com/images/search?view=detailV2&ccid=Yu1OAouO&id=1B4D516A8A17EF4EE248CCCBAD2EC46DA7E6585F&thid=OIP.Yu1OAouOT_6cQM6Ql4oDYQHaLW&mediaurl=https%3a%2f%2fi.pinimg.com%2foriginals%2f13%2fbb%2f82%2f13bb82bf3d3c1b28a560d610c2d17fad.jpg&exph=1128&expw=736&q=loving+someone+with+bipolar+disorder&simid=608040637685434558&ck=DC1BFB40548A0FA375883D67352A1C1F&selectedIndex=21&FORM=IRPRST&ajaxhist=0

Anxiety, Depression, Eating Disorders, ADHD, Et al: How to Support a Friend with Mental Illness

By: Sarah Cohen

When helping a friend with a mental illness, the first step should be assessment of their symptoms. Sometimes they just might be going through a difficult time, but if certain common symptoms associated with mental health issues persist it is imperative to respond sensitively. Majority of the time, friends will just want to know they have your support and that you care about them. A good way to show your support is by talking to them. If you provide a non-judgmental space for them to speak about their issues it will help encourage them to be open with their problems. Let them lead the conversation and don’t pressure them to reveal information. It can be incredibly difficult and painful to speak about these issues and they might not be ready to share everything. If you aren’t their therapist do not diagnose them or make assumptions about how they are feeling, just listen and show you understand. If someone doesn’t want to speak with you, don’t take it personally, just continue to show them you care about their wellbeing and want to help as much as possible. Just knowing they have support can give them the strength they need to contact someone who can help them.

If a friend is having a crisis, such as a panic attack or suicidal thoughts, you must stay calm. Try not to overwhelm them by asking a lot of questions and confronting them in a public setting. Ask them gently what would be helpful to them right now or reassure them. If they hurt themselves, get first aid as soon as possible. If someone is suicidal, contact the suicide hotline at 800-237-8255 immediately.

The best way to help someone is by connecting them to professional help. By expressing your concern and support you can show them that they can get help and their mental health problems can be treated.

If you or someone you know needs support with their mental illness, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem

https://www.mentalhealth.gov/talk/friends-family-members

Anxiety and Bullying

Image result for anxiety and bullying

 

Anxiety and Bullying

By: Vanessa Munera

Being bullied is not an easy thing to handle. It can be a traumatic experience for teens that are being targeted. Those who are bullied experience impacts in their lives such as feeling lonely, anxious, isolated, and vulnerable. Unfortunately, when a bully moves on to the next target, these consequences of bullying linger longer for the victim. After prolonged exposure, victims of bullying can develop adverse effects. These victims will experience depression, eating disorders, and thoughts of suicide. In addition, victims of bullying can develop some sort of anxiety disorder. The top four major anxiety disorders victims of bullying can experience are Post-Traumatic Stress Disorder (PTSD), generalized anxiety disorder (GAD), panic attacks and social anxiety disorder.

  1. Post-Traumatic Stress Disorder (PTSD): this occurs after a traumatic or life-threatening event. PTSD can develop due to events such as a car accidents or losing a close relative. This disorder can also show up after repeated abuse or even bullying. Children who are bullied may experience nightmares, flashbacks, withdraw from others, or are easily startled. Kids, who undergo long term and abusive bullying, have increased chances of developing PTSD.

2. Generalized Anxiety Disorder (GAD): Kids with GAD are often tormented with worries and fear that distract them for their daily life activities. Those with generalized anxiety have a constant feeling that something bad is going to happen. This is not uncommon with victims of bullying. With GAD, physical symptoms may appear such as insomnia, stomachaches, fatigue, and restlessness.

3. Panic Attacks: Those who suffer from panic disorders must deal with unpredictable and repeated attacks. When suffering from a panic attack, the attack is usually with no warning and can cause physically symptoms. These symptoms include sweating, chest pain, and rapid or irregular heartbeats. In fact, a part of the brain called the amygdala plays a pivotal role in panic attacks. When left untreated, the sufferer will begin to avoid going out or things they once enjoyed, in order to prevent another panic attack.

4. Social Anxiety Disorder: People who suffer from social anxiety fear being humiliated or seen negatively by others. Those with this disorder often worry that the way they look or act cause others to mock them. This can cause sufferers to avoid social gatherings to avoid being humiliated. In fact victims of bullying often develop social anxiety due to the repeated shame and public humiliation they experienced.

If you or a loved one appears to be suffering from an Anxiety Disorder, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

 

References:

https://www.verywellfamily.com/bullying-and-anxiety-connection-460631

https://www.stopbullying.gov/blog

 

 

Caregiver Depression

Caregiver Depression

By: Maryellen Van Atter

Caring for another individual is no easy feat; just as parenting requires preparation, so does caring for a family member with an illness or disability. A seldom discussed topic is ‘caregiver syndrome’, also known as caregiver depression or caregiver burnout. It is estimated that 20% of family caregivers suffer with depression – in the general population, it is reported that 7.1% of all individuals suffer from depression. This means that caregivers experience depression at a rate more than double the average person. Despite the prevalence of this condition, it is rarely talked about and sometimes viewed as something shameful. This should not be: caregiving is a difficult job and the first step to feeling better is acknowledging that it’s okay to feel the way you do. Just as there is no ‘perfect’ way to parent, there is no ‘perfect’ or ‘right’ way to be a caregiver.

Everyone experiences depression differently, but a few common signs are a loss of interest in things that you once found enjoyable, a change in sleeping patterns, and feeling irritable, hopeless, or helpless. These symptoms can persist even if you have placed a loved one in a care facility. Psychotherapy has been shown to be effective at managing caregiver depression and helping caregivers to feel more satisfied with their lives. Additionally, antidepressant medications can provide symptom relief; combined with psychotherapy, this can allow caregivers to explore their feelings and manage their caregiving responsibilities.

        If you or someone you know is struggling with caregiving responsibilities, Arista Counseling and Psychotherapy can help. Please contact us in Paramus, NJ at 201-368-3700 or in Manhattan, NY at 212-996-3939 to arrange an appointment. For more information about our services, please visit http://www.counselingpsychotherapynjny.com/

 

Sources:

https://www.nimh.nih.gov/health/statistics/major-depression.shtml

https://www.caregiver.org/caregiver-depression-silent-health-crisis

 

Seasonal Affective Disorder

Seasonal Affective Disorder (S.A.D)

By Tatyana A. Reed

As the weather seems to slow down and we shift from bright sunny days to cold winter nights, some of us may notice a sudden change of mood that comes with this weather shift. This change of mood is called Seasonal Affective Disorder (S.A.D). According to National Institute of Mental Health (NIMH), “S.A.D is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.”

Signs & Symptoms

  • Feeling depressed most of the day, nearly every day
  • Feeling hopeless or worthless
  • Having low energy
  • Losing interest in activities you once enjoyed
  • Having problems with sleep
  • Experiencing changes in your appetite or weight
  • Feeling sluggish or agitated
  • Having difficulty concentrating
  • Having frequent thoughts of death or suicide.

Causes

  • People with SAD may have trouble regulating seratonin, which is one of the key neurotransmitters involved in mood.
  • People with SAD may overproduce the hormone melatonin.
  • People with SAD also may produce less Vitamin D.

 

Getting Treated

  • Medication: if someone suffers from S.A.D they can be helped by taking Selective Serotonin Reuptake Inhibitors (SSRIs). However, like all medication there are side effects, make sure to speak with your doctor about this first.
  • Light therapy: the feelings of S.A.D can be lessoned by sitting in front of a light box that emits 10,000 lux of cool- white- fluorescent light for 20-60 minutes. The light is said to replace the loss of light from daylight savings
  • Therapy: it is best to talk with a psychologist, counselor, or someone in the mental health field when feeling different types of emotions that may be negative such as sadness or anger. Seeking help is the first step to eliminating S.A.D.

If you or a person you know is struggling with S.A.D, it may be beneficial to contact a mental health professional and receive therapy. The psychologists, psychiatrists, and therapists at Arista Counseling and Psychiatric Services can help.  Contact the Bergen County, NJ or Manhattan offices at (201) 368-3700 or (212) 722-1920.  Visit http://www.acenterfortherapy.com for more information.

References:

Koblenz, Jessica. “11 Things About Seasonal Affective Disorder That Psychologists Wish You Knew.” Reader’s Digest, www.readersdigest.ca/health/conditions/seasonal-affective-disorder-facts/. (PHOTO)

National Mental Health Institute. “Seasonal Affective Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services, http://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml.

 

Changes to the Brain

 By: Katie Connell

                For a long time, scientists believed that changes to brain structure only occurred during infancy and childhood. By the time one became an adult, it was thought that brain structure would remain largely permanent and that no more changes could occur. However, in the 1960’s, scientists discovered that changes to the adult brain were indeed possible. One thing that verified this were brain changes that occurred to patient’s brains that were damaged in injuries and accidents. Damage that occurred in certain parts of one’s brain resulted in healthier parts taking over. With this discovery came insight into other ways that the brain could be changed, specifically in the realm of psychotherapy. Cognitive Behavioral Therapy (CBT) is a great example of a type of psychotherapy that can lead to long lasting changes to the brain. During a process called synaptic pruning, extra neurons (which transmit information) and synaptic connections (which permit neurons to transmit info) are eliminated to increase the efficiency of neural transmissions. One way this happens is by neurons being used more frequently. Those that aren’t used as much get eliminated, which improves the transmission of information. By repeated exposure and engagement in CBT (including thought shifting techniques and cognitive restructuring), neurons become strengthened, meaning less synapses and better transmission of neurons. Through the use of routine CBT, critical neural networks are able to change how we think and feel.

If you or a person you know is seeking CBT or other forms of therapy, the psychologists, psychiatrists, and therapists at Arista Counseling and Psychiatric Services can help. Please contact the Bergen County, NJ or Manhattan offices at (201) 368-3700 or (212) 722-1920. 

Source:

https://www.verywellmind.com/what-is-brain-plasticity-2794886

 

 

Social Anxiety Disorder

Social Anxiety Disorder

Social Anxiety Disorder

By: Julia Keys

It is typical to feel a bit nervous before public speaking or maybe a little anxious before a performance, however, for those with Social Anxiety Disorder, or SAD, even the smallest interactions with others can provoke feelings of extreme anxiety. Social Anxiety Disorder is characterized by a strong and persistent fear of humiliation and embarrassment that could be caused by social situations. People with Social Anxiety Disorder struggle with feelings of self-consciousness that are produced by the possibility of judgement in social interactions. Oftentimes the distress caused by social situations can become so overwhelming for those with SAD that they begin to avoid everyday activities and responsibilities such as going to work, going to school, or picking up the phone.

Signs of Social Anxiety Disorder:

  • Anxiety about being with other people
  • Difficult time interacting with others, stuttering, trailing off, and reserved behavior are common
  • Self-consciousness in front of other people and feelings of embarrassment
  • Fear of being judged
  • Difficulty making and keeping friends
  • Blushing, sweating or trembling around other people
  • Other physical symptoms such as disorientation, shallow breath, diarrhea, muscle tension and upset stomach

Social Anxiety Disorder can be treated with psychotherapy, medication, or both. A common affliction for those with SAD is the rumination that follows social interactions. New types of therapy are being developed to help those with SAD deal with this common symptom: post-event processing or PEP Mindfulness based therapies are aiming to target the feelings of shame, worry, and embarrassment that are caused by overanalyzing personal performance in social situations. Cognitive-Behavioral therapy helps people with SAD change unhealthy thought patterns that may be contributing to their anxiety. Medications such as antidepressants and anti-anxiety meds are often used in conjunction with psychotherapy. Social Anxiety Disorder affects over 19 million people across the US; however 35% of those suffering with social anxiety waited over ten years to seek treatment. Don’t hesitate to reach out and get the help you need.

If you or a loved one is struggling with social anxiety, do not hesitate to seek help by contacting Arista Counseling & Psychotherapy, located in New York and New Jersey to speak to licensed professional psychologists, psychiatrists, psychiatric nurse practitioners or psychotherapists. To contact the office in Paramus NJ, call (201) 368-3700. To contact the office in Manhattan, call (212) 722-1920. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.anxiety.org/social-anxiety-disorder-sad

https://www.psychologytoday.com/us/blog/fulfillment-any-age/201904/the-one-dose-approach-help-social-anxiety-disorder

Source for Picture:

https://www.bing.com/images/search?view=detailV2&id=1DCB8A68F1C1E13F5FC8DB9E2A8A155D5018D398&thid=OIP.S96UZQjJADokE5fdhVCocAHaHa&mediaurl=https%3A%2F%2Fsocialanxietyinstitute.org%2Fsites%2Fdefault%2Ffiles%2FFemale3_0.jpg&exph=360&expw=360&q=social+anxiety&selectedindex=414&ajaxhist=0&vt=0&eim=1,2,6