One of the most famous psychiatrist Carl Jung who developed Jungian Analysis. His approach to the human mind deferred from Sigmund Freud who believed it that alll mental illness started from childhood. Carl Jung - How To Be Authentic (Jungian Philosophy) Carl Jung - How To Be Authentic (Jungian Philosophy) The Individuation Process: Finding Your Authentic Self How many of us can say that we live fully authentic lives? Have you ever met someone who has undeniably discovered his authentic self? There is a confidence, a conviction in their passion for whatever path they are on. Psychologist Carl Jung described such flowering as individuation, the process by which personal and collective unconscious are brought into consciousness to reveal one’s whole personality. In short: it is the process of becoming self-actualized. How many of us can say that we live fully authentic lives? In our quest for approval from peers, parents, mentors, and even from strangers, we often set aside what our intuition tells us is right, what is true for us, to fall in line with the rest of the pack. Think of the classic tale of the would-be artist son or daughter who goes to law school or medical school to please their parents. Ironically, the energy that we use to suppress our inner voice is the very creative energy that returns to us, to be used for our own vocation. Fear of failure or low self-esteem may further work to push our passions down to a forgotten place—where, we tell ourselves, they belong. The problem is that by attempting to silence our inner voice, we limit our true potential and our ability to lead full and happy lives. “What is it, in the end, that induces a man to go his own way and to rise out of unconscious identity with the mass as out of a swathing mist?” Jung asked in his collected works, The Development of Personality . “It is what is commonly called vocation: an irrational factor that destines a man to emancipate himself from the herd and from its well-worn paths." Anyone with a vocation hears that voice of his inner man: He is called. The individuation process leads one ever closer to the person he is meant to be, with both a sense of awareness and a sense of wholeness. This journey is not just one of becoming whole but also one of expansion. Through individuation, boundaries of who we are and what we allow ourselves to know and feel extend even further out into the far reaches of what is possible: our potential. As you prepare to embrace possibility, ask yourself: What is your passion—your vocation? By learning to listen and following your inner voice, you will be able to direct your journey toward a unique and self-actualized life. If you don’t follow herd consciousness but rather your own destiny, you will be able to unlock your true potential and discover, at last, a sense of personal wholeness. Only the outcasts can lead, for they stand ahead and above the rest and, from that place, can contribute back to the group and lead. By listening to that inner calling and pursuing your dreams, you can individuate and live a happy, fulfilled, and self-directed life of authenticity and purpose. Source: Psychology Today

A recent film about singer Joan Baez and repressed memory. KEY POINTS Recovered memory therapy, a discredited therapy, claimed to recover repressed memories. Research finds memory can be manipulated, and we are more susceptible to creating false memories. The documentary "Joan Baez: I Am a Noise" is a cautionary tale. One never knows which film will introduce a moment of significant psychological insight, particularly a startlingly unexpected reminder that therapy can sometimes be harmful. Such is the case with Joan Baez: I Am a Noise , a documentary about the world-famous singer and human rights activist. As her history unfolds in her own words and archival footage, we learn of her struggles with depression , substance use, and romantic relationships . Now an octogenarian, she reflects on the diminishing quality of her voice, fears about retirement , and coming to terms with regrets. While this is fascinating to watch (particularly for Baez fans), it does not warrant a posting for Psychology Today . However, approximately 75 minutes into this two-hour film, Baez recounts entering therapy and accessing long-repressed memories of childhood incest . It is then that the film becomes a cautionary tale of therapy. Recovered Memory Therapy: A Fad Recovered memory therapy , defined by the American Psychological Association as “a form of treatment specifically designed to elicit from the client forgotten or repressed memories of traumatic childhood events, such as sexual abuse ,” was introduced in the 1980s and reached its apex in the following decade. It became widely accepted that traumatic incidents in childhood, particularly sexual abuse, could be forgotten as an involuntary psychological defense mechanism yet continue to insidiously influence a person decades later, leading to depression, panic attacks, and eating disorders. The treatment approach was to consciously access repressed trauma through a panoply of techniques such as hypnosis and guided imagery. At its peak, an entire recovered memory industry formed, leading to self-help books, clinical training, and a cadre of well-intentioned and (in retrospect) overenthusiastic mental health providers. A national panic ensued. Patients, friends, and colleagues wondered aloud if they had been sexually abused as children yet had no memory of the incidents. Teachers, daycare workers, and parents were besieged with claims of sexually abusing children in their care; reputations were destroyed, families were ripped apart, and people were imprisoned. There was one problem with this movement: It was not supported by research. Research finds memory can be manipulated, and we are far more susceptible to creating false memories than we realize. In a 1999 position paper (later reaffirmed in 2013), the American Psychiatric Association determined, Some therapeutic approaches attempt specifically to elicit memories of childhood abuse as the central technique for relieving emotional distress. The validity of such therapies has been challenged. Some patients receiving this treatment have later recanted their claims of recovered memories of abuse and accused their therapists of leading or pressuring them into such ideas In their review of the repressed memory movement, Tavris and Aronson (2020) more succinctly state, “The problem for most people who have suffered traumatic experiences is not that they forget them but that they cannot forget them; the memories keep intruding.” Joan Baez's Story: A Cautionary Tale Now, let’s return to Joan Baez. It appears she began recovered memory therapy during the height of its popularity, and this led her to recall sexualized encounters with her father. Baez, a prodigious personal archivist, kept pleading letters and recorded phone messages from her seemingly bewildered parents as to her claims of childhood sexual abuse. We listen to these messages in the film. Baez and her parents became estranged, and her relationship with her once-beloved father never recovered. In the film, Baez reflects she will never know the full truth of what happened with her father. Therapy Can Harm: What We Can Learn from the Recovered Memory Movement Joan Baez: I Am a Noise unexpectedly reminds us of the possible dangers of therapy; it brings back a time in the not-too-distant past when a therapeutic technique once widely embraced fell into disfavor as research, reporting, and lawsuits led to doubts about its claims. Hearing the plaintive voice of Baez’s father as he attempts to reach out to his daughter reminds us that a therapeutic technique hurt an untold number of people, who, possibly like Baez, are forever left to make sense of their past. What happened and what didn’t? ​References American Psychiatric Association. Commission on Psychotherapy by Psychiatrists. (2000). Position statement on therapies focused on memories of childhood physical and sexual abuse. The American Journal of Psychiatry , 157 (10), 1722. American Psychological Association. APA Dictionary of Psychology . Tavris, C., & Aronson, E. (2020). Mistakes were made (but not by me): Why we justify foolish beliefs, bad decisions, and hurtful acts . Harcourt.

The approach of Jungian therapy for the treatment of anxiety follows a central premise. Our thoughts and beliefs can become our worst enemies, especially if we resist or don’t know how to manage what worries and paralyzes us. However, getting to the root of our problems and accepting them can allow us to free ourselves from them and what they represent to us. If there’s a word that can define Jung’s psychological approach, it’s self-realization. This is something that always differentiated Jung’s premises from Freud ‘s. He believed human beings were always oriented towards one single drive: to be able to fulfill themselves as people. However, everyone suffers from anxiety. The reason for this always seemed clear to Jung. To him, the world doesn’t always seem like a safe place. Our social environment, institutions, authorities, and even the flow of modernity that surrounds us doesn’t shape a favorable scenario in our eyes. Things like dissatisfaction, the feeling of not being free, and that we can’t fulfill ourselves completely are all added to that constant feeling of insecurity. External pressure divides us on the inside and, instead of assuming that internal tension, we resist in a stoic way. Carl Jung once said something worth remembering: what you resist, persists. Treating anxiety according to Jungian therapy Jungian therapy is a specialized form of psychotherapy whose methodology differs from the ones in cognitive-behavioral or humanistic psychotherapy. In fact, universities such as the University of California, Berkeley have been training students in this approach for more than 40 years. This psychotherapy presents some interesting pillars worth considering if you’re wondering if it’s actually effective in treating anxiety. Anxiety is a human characteristic, but it’s important to individualize it In order to evidence an idea, Jungian therapy talks about concepts such as archetypes and the collective unconscious . Human beings share a psychic substrate where common elements that define all of us emanate from. This means there are instincts, shadows, and drives that we all share equally (according to this theory). Anxiety is like a carpet we walk on every day. It’s an emotion filled with suffering, which arises from what we previously discussed: the feeling of living in an environment that’s not always safe. Now, even though all human beings have this dimension in common, there’s a fact that defines this approach which Jung clarified through analytical psychology: we’re obligated to individualize ourselves, emerge from the structure we all share, and become autonomous and independent. The people who live with anxiety every day must be able to define what they feel, what they perceive and, most importantly, what they need. Jungian therapy uses a closed methodology, a dialectical procedure where the therapist must be able to connect with the patient’s personality to favor their comfort and autonomy. They have to be an active agent of their healing process. Recognition of the “shadow” or the deep roots of anxiety Another one of this therapy’s keys to treating anxiety is finding the original cause, the root of the problem that causes psychic suffering. This means recognizing our shadow and letting the darkest side of our personality come to the surface. Likewise, it’s also essential for the therapist to identify the patient’s affective complexes ( needs, obsessions, feelings of admiration ). In order to achieve this, this methodology is based on the following strategies: Conversation therapy. Dream interpretation. Association of ideas. Creative techniques. Analyzing the unconscious , which is often loaded with troubles, voids, and neglected needs, is the key to recovery. That said, an alliance between the therapist and the patient must be established to properly work this complex psychic structure. “Until you make the unconscious conscious, it will direct your life and you will call it fate.” -Carl Jung- No more resistance: Acceptance in order to be free Jungian therapy has only one purpose for treating anxiety: individualization. Favoring that psychic and emotional autonomy demands that we’re able to break resistance and stop that desire to flee towards what worries or frightens us. According to Carl Jung, the harder we work to leave negative and jeopardizing thoughts aside, the more power they will have over us. That’s why denying, opposing, or resisting something will aggravate the symptoms associated with anxiety. This will cause more nerves, more restlessness, and more agitation. Furthermore, Jungian therapy will try to guide us so that we’re able to accept a very important aspect: understanding that anxiety is part of being human. This means we must accept it without resistance. Now, that doesn’t mean we should let it control us. That would make us lose our autonomy. Finding a purpose Jungian therapy is conscious of the fact that we sometimes use all of our energy to treat anxiety. The chronic despair and lack of motivation that a lot of people suffer from almost always have the same beginning: a lack of a purpose and not finding a meaning to life. This type of therapy provides the appropriate means to help the person get a new focus in life. That way, the person will be able to construct their purpose based on their needs. This is a good way to appease anxiety and redirect it towards new personal goals . To conclude, Jungian therapy is always at our disposal if we want to use it to treat our anxiety. It restores our emotional balance from our unconscious, our blockages, our fears, and our shadow. It’s important to note that, as of today, there are many different studies that confirm and support Jungian therapy’s effectiveness. Starting a psychotherapeutic journey that favors self-knowledge and personal freedom is always positive. Carl Jung on Overcoming Anxiety Disorders Source: Exploring your Mind

One year after the launch of 988, the National Suicide & Crisis Lifeline has received millions of combined calls, texts, and chats, a substantial increase from the year before. The easy-to-remember number steers callers to counseling and other resources. Although the federal government helped implement 988, ongoing funding relies heavily on local and state money. Six states have enacted legislation to fund crisis services through telecom fees, including California, Colorado, Minnesota, Nevada, Virginia and Washington state, while others are pursuing such fees. Source: Kaiser Family Foundation

Over the past one year, I have made a major change in my life which has substantially improved my health, which has been focusing on proper nutrition. The first step was purchasing a high quality juicer, which I do not recommend. I think it is an expensive investment, where you lose a lot of fiber from the vegetables and fruits that you juice. I kind of regret that I got a juicer, but it was a stepping stone. My second investment was the Vitamix 7500 which I rely recommend. It could be seen as an expensive investment, however I use it once per day, which has been a great investment for my health. Cleansing for the Mind I recommend the Vitamix because it allows you to consume a substantially quantity of veggies and fruits within each smoothie. Today, I made a banana, mango, avocado, lemon, cucumber smoothie, where I added almond/coconut milk, which I thought was amazing. Each day I try to drink at least one smoothie, trying to make different recipes or experiment. It has forced me to consume many more fruits and vegetables, which are packed with vitamins, minerals, antioxidants, which I feel is very important for my health and well being. I highly recommend getting a device where you can make smoothies on a daily basis. There are many brands that are less expensive, such as Nutribullet. I got the Vitamix because I tend to enjoy cooking as well, so its versatility has been amazing. I do not follow any diet, however noticed that I feel so much better eating more fruits and vegetables on a regular basis. I have noticed that I don't have to work out as much and I am losing weight, which is a great feeling. However, I have started to play basketball every other day, which has been a lot of fun. It makes me nostalgic about my childhood where I would play outside for literally 3-4 hours per day. I think this is one major factor that has changed for children these days. I think it is really important that kids exercise for at least 1 hour per day, which could mitigate potential stress and has overall health benefits. Aside from limited exercise among youth, I think that our culture tends to consume foods that are high in calories, however nutritional deficient. I think this is one major problem in America, the consumption of too much processed food. I am slowly trying to reduce my intake of processed foods in the long run, as I am concerned about all the additional chemicals and additives in food we purchase. This is one reason why I try to eat organic food at home, however at times, the price and availability can be restricting factors. I guess it would be optimal to grow my own fruits and vegetables. There are various studies that reflect that a high vegetable meal plan helps fight the toxins that exist in our mind and body. The gut does not process meat, especially in how it is mass produced these days. Natural meat does not really exist as all animals are farm raised include wild fish increasing the level of toxins such as mercury, CBC, etc. Here are a few pictures of how farm raised animals lived their lives. Would you want to live in such conditions? Source: Vilash Reddy, MD

Keypoint: This book can help readers looking to navigate the confusing landscape of mental health advice, and assist them in protecting themselves and their loved ones from exploitative tactics. In Mind the Science: Saving Your Mental Health from the Wellness Industry, clinical psychologist Jonathan N. Stea, PhD, presents a no-holds-barred critique of the wellness industry’s pervasive and pernicious influence on mental health care. Stea’s extensive experience in clinical psychology and his dedication to debunking mental health misinformation converge in this sharp, informative, and timely book. His work serves as both a guide and a shield for general readers navigating the murky waters of mental health advice in today's advertisement-saturated world. The book is divided into 3 sections, each addressing a critical aspect of mental health misinformation. The first section equips readers with the knowledge of various red flags that help discern pseudoscience from legitimate science. Stea explores the historical roots of mental health misinformation, tracing its evolution from early misconceptions to contemporary antipsychiatry movement and the wellness industry. This initial groundwork is essential for readers to understand the pervasive nature of misinformation and prepare them for the more detailed analysis in subsequent sections. The second section is essentially a training course in identifying misinformation and propaganda. Stea shines a light on various pseudoscientific practices, illustrating how they prey on those seeking mental health support. He offers psychological insights into why individuals are susceptible to these misleading practices, emphasizing the tactics and tropes used by purveyors of pseudoscience. Pseudoscientific ideas seduce vulnerable individuals, often by exploiting emotional and psychological triggers. This section enables readers to recognize common red flags, tropes, and dubious mental health interventions (there is also a wonderful tabulated summary of these at the end of the book). The final section offers solutions grounded in mainstream science and medicine. Stea guides readers on what to look for in credible mental health treatments and professionals. He emphasizes the importance of evidence-based practices and provides practical advice for finding effective professional help. Mind the Science seeks to inculcate a scientific sensibility in its readers, especially in those without a formal scientific background. Stea’s writing style is engaging, marked by empathy and humor, and he makes complex concepts digestible. The book provides practical, relatable scenarios that illustrate the dangers of pseudoscience. In Stea’s hands, the material is transformed into a practical guide for everyday life. He is plain-spoken and empathetic. Throughout the book, Stea presents technical material in an accessible manner. As an example, in the chapter “Crash Course in Psychopathology,” he goes over the neo-Kraepelinian revolution in psychiatry; discusses the limitations of the DSM (“the sobering reality that the DSM is like a terrible map. Clinicians and researchers rightfully complain that it fails to accurately carve nature at its joints, so to speak… in the remarkably imperfect and difficult science of psychopathology, that’s better than no map at all.”); explains ideas such as “concept creep” and developmental principles such as equifinality and multifinality; and introduces categorical, dimensional, and network approaches to mental illness. I like the simple, catchy way in which he summarizes the network approach: “the relationship between various signs and symptoms is the disorder itself.” The end result is that when Stea criticizes common tropes around “chemical imbalance,” “root causes,” and “symptom checklists,” the readers can see for themselves how these tropes fall short of the actual complexity of psychopathology and the rigor of clinical practice. At the same time, I should acknowledge what the book does not do. The discussion is aimed at general readers and would not be satisfactory to those seeking a philosophically rigorous account of misinformation and pseudoscience. Stea is careful to acknowledge the fuzzy nature of the boundary between science and pseudoscience and he disavows the existence of variables that reliably identify misinformation in any and all contexts, but his goal is not to settle conceptual controversies in this area nor to solve difficult boundary cases. Similarly, Stea’s treatment of antipsychiatry is superficial—correct in broad strokes but does not go into thorny philosophical and scientific details of psychiatric critiques that inevitably come up in this area. Academic scholars of misinformation, pseudoscience, or antipsychiatry will finish this book with various legitimate grievances, but this book is not really aimed at them; the intended audience is the lay person who will encounter and will likely be susceptible to health care misinformation from their peers on social media or from sources such as Goop, Joe Rogan, or the Church of Scientology. In an endearing portion of the book, Stea shares his mother’s story, and how spinal surgery gone wrong left her with complex regional pain syndrome and mainstream medical treatments proved inadequate. Driven by pain and desperation, the family sought help in alternative medicine, “acupuncture, herbal remedies, reflexology, chiropractic, detox foot baths, Reiki, therapeutic touch, meditation, past life regression therapy, Rolfing, ear candling, healing crystals, cleansing bells, incense cleanses, psychics, and more,” practices that were either unhelpful or harmful. Stea reflects, “To this day, we remain at the mercy of the limits of science and a chronic health condition with no known cure… it’s hard not to feel the stirs of resentment toward mainstream health care. Science can send us to the moon, but my mother was forced into a decades-long trek through a fog of health uncertainty that felt unguided because the offerings of scientific knowledge and effective treatments for what ailed her fell short. I too will get sick one day. Will I reach for the healing crystals?” Mind the Science approaches alternative medicine and wellness industries with this human understanding of its seductive powers, especially for those suffering for whom standard medical treatments are often inaccessible or unhelpful. For general readers looking to navigate the confusing landscape of mental health advice, protect themselves and their loved ones from the exploitative tactics, and recognize the snake oil salesmen of our age, they cannot go wrong with Mind the Science. Note: This article originally appeared on Psychiatric Times .

TOPLINE: A smartphone app that delivers acceptance and commitment therapy (ACT), a type of cognitive behavioral therapy, improves overall well-being and reduces the severity of pain, fatigue, sleep issues, and depression to a greater extent than daily symptom tracking in patients with fibromyalgia. METHODOLOGY: Researchers conducted the phase 3 PROSPER-FM trial at 25 community sites in the United States to assess the efficacy and safety of digital ACT for patients with fibromyalgia. A total of 275 adult patients aged 22-75 years with fibromyalgia were randomly assigned to either the digital ACT group (n = 140) or the active control group (n = 135) for 12 weeks. Patients in the digital ACT group received a self-guided, smartphone-delivered program in which they learned and practiced the core ACT skills of acceptance, values, mindfulness, defusion, self as context, and willingness and committed action to build psychologic flexibility, while the control group underwent daily symptom tracking and received educational materials. The primary endpoint was the response rate on the Patient Global Impression of Change (PGIC) at week 12, which is an indicator of patient well-being. The secondary endpoints included changes in the Revised Fibromyalgia Impact Questionnaire (FIQ-R) total score and pain intensity, pain interference, and sleep interference scores. TAKEAWAY: At week 12, 71% of the patients in the digital ACT group responded with a minimally improved or better change in the PGIC response compared with only 22% of the patients in the control group (P < .0001). The digital ACT group showed a significant reduction in the impact of fibromyalgia, with a between-group effect size of d = 0.65 (P < .0001) at week 12. The FIQ-R total score significantly improved within 3 weeks of using the self-guided digital ACT app. The use of digital ACT also demonstrated positive effects on the levels of weekly pain intensity (P = .001) and depression (P < .0001), compared with the control group. No serious adverse effects related to the app were reported, and both groups demonstrated high rates of adherence, with most (72%) participants in the digital ACT group completing at least 42 sessions. IN PRACTICE: "The results found in the study are essential for professionals who care for patients with fibromyalgia as they present a new viable treatment alternative," Guilherme Torres Vilarino, PhD, Santa Catarina State University, Florianópolis, Brazil, wrote in an accompanying editorial. LIMITATIONS: The study population predominantly consisted of women and White individuals, which may limit the generalizability of the findings to more diverse populations. Additionally, the study was conducted in the United States, and the results may thus not be applicable to other countries with different racial, ethnic, educational, and economic characteristics. The study duration was 12 weeks, and the long-term benefits of digital ACT have not yet been shown. Note: This article originally appeared on Medscape .

COMMENTARY In Saving Normal, Allen Frances, MD, astutely reminded us of problems with overdiagnosis. Within that trend, it is my opinion that posttraumatic stress disorder (PTSD) is an example. This diagnosis has been a prime example of desire by some to obtain medical validation of their suffering and perhaps, more problematically, justification for crimes committed. In modern society, victimization has gained undue prominence with a diagnosis such as PTSD being an emblematic trophy. This shift comes with significant risks including substandard treatment, worsening symptoms, and misallocated resources. In this article, I focus specifically on the misuse of the PTSD diagnosis in legal contexts where the diagnosis is being increasingly employed as a means to secure more lenient sentencing and even acquittal of crimes. My intent is in part motivated by my deep compassion for individuals with PTSD whose experiences are minimized and spoiled by the misuse of the diagnosis. Based on the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESAC-III), which surveyed more than 35,000 Americans, 6% were considered to have PTSD. I have no reason to believe this number is inflated or incorrect; my critique is based on specific cases I have encountered in my practices, best highlighted by forensic cases. As an example of the ever-increasing use of PTSD to justify behavior and ultimately crime, one may point to the highly mediatized trial of US Senator Bob Menendez. As publicized in the media, US Senator Bob Menendez used the diagnosis of PTSD as part of his defense in his corruption trial. It was explained that somehow his Cuban heritage involving poverty may in part explain his acceptance of gold bars, cash, and a luxury car by foreign governments. Trauma is extremely common. PTSD does not prove or endorse past trauma. A 1996 survey of over 2000 individuals from Detroit noted a prevalence of 89.6% of trauma as defined by the more stringent DSM-IV criteria for PTSD, and a mean number of distinct traumatic events of 4.8 in individuals who endorsed any trauma. It is erroneous and inaccurate to interpret trauma as consistently resulting in PTSD. If about 90% of Americans have had trauma, but only 6% have PTSD, 84% of Americans have had trauma which did not result in PTSD. Conversely, it is not the practice of psychiatrists, especially clinical psychiatrists, to conduct fact finding endeavors to verify the veracity of the reported trauma. PTSD is a particularly subjective diagnosis, diminishing the validity of the diagnosis. Despite the a priori expectation that PTSD would be the 1 diagnosis based on actual evidence of trauma, in practice, PTSD is especially subjective. As noted, the vast majority of Americans meet criteria A for trauma. The rest of the diagnostic criteria are often endorsed without objective evidence. In addition to past trauma, PTSD requires the presence of (1) intrusive, (2) avoidance, (3) negative, and (4) altered arousal symptoms. It is common to see evaluations to note such symptoms without any attempt at obtaining objective evidence or worse, the obvious presence of contrary evidence. Intrusive symptoms: Do you get sad thoughts about your trauma? While individuals may often endorse flashbacks, intense reminders, and distressing memories, those are rarely noted by others. In my experience, individuals with PTSD are often noted to have severe episodes of distress memories that require them to take time out of their personal lives in their jobs, relationships, etc. Avoidance of traumatic stimuli: Do you avoid reminders of trauma? The recent proliferation of trigger warnings gives context to the prevalence of the report of this symptom. In my experience, evidence of full participation in social, occupational, and romantic activities is inconsistent with my understanding of avoidance in PTSD. While PTSD does not require the complete avoidance of all settings, regular attendance to restaurants, concerts, sporting events, vacations does not support this diagnosis. Negative alteration: Do you get sad thinking about past trauma? In my experience, many individuals conflate general discontent for the negative alteration of PTSD. While many victims of sexual abuse may find themselves experiencing significant difficulty conceptualizing a future relationship, this is quite different than individuals who blame their past for all of life’s disappointments. Alteration in arousal: Are you ever jumpy? Impulsivity is an especially problematic trait as it is so cross-cutting and can apply to so many disorders. When the DSM-5 task force considered creating a trait dimensional system to diagnose personality disorder, impulsivity was 1 of the 5 traits. This is of significant importance, as impulsivity is also a diagnostic feature of antisocial personality disorder and common in substance use disorders, both particularly frequent in the forensic setting. Ultimately, other than trauma, which is pervasive in modern society, the other symptoms of PTSD are particularly subjective. Hence, in a forensic psychiatry textbook it is noted that “PTSD is based almost entirely on the claimant’s self-report of subjective symptoms.” The textbook astutely recommends for providers to “look for actual evidence.” Symptoms of PTSD can easily be faked. In 2001, Burges and McMillian published a study looking at the ability of college students—without prior knowledge of psychology, medicine, or PTSD—to report symptoms of PTSD when asked to complete self-reported surveys.6 The findings were that “94% of participants fulfilled diagnostic criteria,” indicating that most individuals can endorse symptoms of PTSD without any training or coaching. Furthermore, most participants (62%) were savvy enough to not also endorse bogus symptoms of other psychiatric disorders . This suggests that many individuals may be capable of testing positive for PTSD while simultaneously being able to avoid a less deserving label or being assessed as a malingerer. It is unclear if PTSD is about trauma rather than psychology. In 2024, Baldwin et al authored a meta-analysis encompassing over 15,000 individuals. They found that PTSD was more correlative with retrospective measures (memories of traumas) than prospective measures of childhood maltreatment (trauma). The authors concluded that “interpretation of events, conscious remembering, and the associated thought patterns are more strongly linked with psychopathology than the mere events themselves.” As has been postulated by providers for many decades, PTSD is often more about the psychology of the individual than the trauma itself. The gold standard for the diagnosis of PTSD does not solve those problems. One may hope that, considering the problems raised previously, methods have been developed to address them. In research and forensic settings, the CAPS-5 (Clinician-Administered PTSD scale for the DSM-5) is often touted as the gold-standard for the evaluation and diagnosis of PTSD . The CAPS-5 follows the DSM guidelines for the diagnosis of PTSD closely and asks about each criterion. Its strength lies in its request for additional details and examples for most criteria; however, the measure does not require the evaluator to pursue or obtain corroborating or contradicting evidence. Instead, to assess validity, the measure asks the evaluator to “estimate the overall validity of responses” based on compliance, the mental status exam, and evidence of exaggerated symptoms. It is thus without surprise that its accuracy “in detecting exaggerated or invalid symptom endorsement has not been demonstrated.” While PTSD is a legitimate and serious mental health condition, the increasing tendency to overdiagnose and misuse the label raises significant concerns. The subjective nature of PTSD symptoms , coupled with the pervasive presence of trauma in modern society, makes it challenging to distinguish between genuine cases and those where the diagnosis is sought for secondary gain. This misuse not only undermines the validity of the diagnosis but also detracts from the suffering of individuals who truly experience debilitating PTSD. As clinicians and forensic practitioners, it is imperative to approach each case with a critical eye, ensuring that diagnoses are based on comprehensive assessments and objective evidence wherever possible. Ultimately, the goal should be to maintain the integrity of PTSD as a diagnosis while providing appropriate support and treatment to those in need. This necessitates a balanced approach that recognizes the real impact of trauma without falling into the trap of misdiagnosis. By adhering to rigorous diagnostic standards and remaining vigilant against potential misuse, we can better serve my patients and uphold the credibility of mental health diagnoses. It is through such diligence and compassion that we can ensure those with genuine PTSD receive the care and validation they deserve, while safeguarding the mental health community from the pitfalls of diagnostic inflation. Note: This article originally appeared on Psychiatric Times .

Keypoint: SSRI and SNRI antidepressants were deemed the safest classes of antidepressants in the event of excess dosing in an assessment of 14 antidepressants prescribed in the United States on 3 safety indices. Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants were deemed the safest classes of antidepressants in the event of excess dosing in an assessment of 14 antidepressants prescribed in the United States on 3 safety indices.1 In addition to a fatal toxicity index (FTI) for overdoses, Zach Poliacoff, MD, of the Department of Psychiatry at the University of South Florida in Tampa, applied an index for serious morbidity (SMI) and a health care utilization index (HUI) for health care facility treatment required for adverse events. “There have been only limited attempts to compare agents on nonlethal but significant adverse effects resulting from toxic exposure, which is a necessary consideration in risk assessments,” Poliacoff observed. “There have been no attempts to quantify the burden on the health care system of each agent in overdose.” Poliacoff used the total number of prescriptions for the respective antidepressants in the study period for the denominator of each index. He notes that this approach particularly diverges from traditional fatality indices, for which the denominator is total exposures, commonly drawn from the National Poison Data System (NPDS). “However, this method does not properly adjust for each agent’s prevalence in the population,” Poliacoff explained. “Using a measure of total prescriptions as the denominator would provide a more accurate picture of risk associated with each drug in the real world at the time of prescribing.… Per-prescription risk rather than per-exposure risk is used here because the goal of the study is to determine the relative safety of these agents when prescribing, rather than when treating an exposure.” Poliacoff extracted data on antidepressant-related deaths, major adverse events, required treatment in health care facilities, and prescription quantity for the period between 2013 and 2020 from the NPDS and the Agency for Healthcare Research and Quality’s Medical Expenditure Survey. In total, the sample comprised 364,526 single-agent exposures and more than 1,844,877,361 prescriptions. An adverse event was classified as a serious morbidity if it corresponded to NPDS criteria for “major,” when “the patient exhibited signs or symptoms that were life-threatening or resulted in significant residual disability or disfigurement.” Agents were excluded from analysis if prescribed for fewer than 200,000 individuals in a year. Other agents not in the analysis included lithium, as it is primarily indicated for bipolar disorder rather than unipolar depression, and trazadone, as it is more commonly prescribed as a sleep aid than as an antidepressant. Selection Diverges From Safety Among the findings, bupropion was associated with comparable rates of mortality but higher morbidity and more use of health care facilities for adverse events than the tricyclic antidepressants (TCAs) nortriptyline and imipramine. The FTI of bupropion was approximately twice as large and its SMI about 5 times as large as venlafaxine, which is characterized as the next-highest modern agent. Poliacoff reflected on the finding that bupropion appeared significantly more likely to lead to death, major adverse outcomes, or treatment in a health care facility than all other first-line agents. “It is therefore an open question whether its status as the second-most-prescribed antidepressant in this study is justified by its relative risks vs benefits,” he posed. In the 4 TCAs included in the analysis, doxepin and amitriptyline had higher FTI, SMI, and HUI than those of imipramine and nortriptyline. For the 5 included SSRIs, escitalopram and paroxetine had the lowest FTI; however, the difference in FTIs among all 5 was not statistically significant. Among the SNRIs, duloxetine had a statistically significantly lower FTI, SMI, and HUI; although its FTI and SMI were comparable to those of the SSRIs, the HUI was significantly lower. “It is not surprising that when comparing classes, SSRIs and SNRIs are overall safer than the alternatives,” Poliacoff remarked. “Within the SSRI class, the relative safety of paroxetine and escitalopram are notable, though the clinical significance of the absolute differences in FTI and SMI are questionable.” Poliacoff also commented on amitriptyline having the second-highest FTI, SMI, and HUI while being prescribed “far more frequently” than other TCAs. “Its metabolite, nortriptyline, is significantly safer on all measures,” Poliacoff pointed out, “and, because of their structural similarity, may have similar benefit.” In contrast, the TCA imipramine was determined to be both the safest of the TCAs as well as the least prescribed. “Imipramine was associated with no deaths in the NPDS data set during the study period,” Poliacoff pointed out. “Overall,” Poliacoff concluded, “these results suggest that prescribing practices for antidepressants may not necessarily reflect the reality of their relative risk vs benefit profiles in several respects.” Note: This article originally appeared on Psychiatric Times .

In a bid to reduce stigma and improve treatment rates, a small group of clinicians, as well as military personnel, is lobbying the American Psychiatric Association (APA) to change the name of posttraumatic stress disorder (PTSD) to posttraumatic stress injury (PTSI) for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The APA's policy is that a rolling name change is available if the current term is determined to be harmful. Currently led by anesthesiologist Eugene Lipov, MD, clinical assistant professor, University of Illinois Chicago, and chief medical officer of Stella Center, Chicago, the formal request for the proposed name change to the APA's DSM-5-TR Steering Committee in August 2023. The APA Steering Committee rejected the proposed name change in November 2023, citing a "lack of convincing evidence." However, Lipov and his colleagues remain undeterred and continue to advocate for the change. "The word 'disorder' is both imprecise and stigmatizing," Lipov told Medscape Medical News . "Because of stigma, many people with PTSD — especially those in the military — don't get help, which my research has demonstrated." Patients are more likely to seek help if their symptoms are framed as manifestations of an injury that is diagnosable and treatable, like a broken leg, Lipov said. "Stigma can kill in very real ways, since delayed care or lack of care can directly lead to suicides, thus satisfying the reduce harm requirement for the name change." Neurobiology of Trauma Lipov grew up with a veteran father affected by PTSD and a mother with debilitating depression who eventually took her life. "I understand the impact of trauma very well," he said. Although not a psychiatrist, Lipov pioneered a highly successful treatment for PTSD by adapting an anesthetic technique — the stellate ganglion block (SGB) — to reverse many trauma symptoms through the process of "rebooting." This involves reversing the activity of the sympathetic nervous system — the fight-or-flight response — to the pretrauma state by anesthetizing the sympathetic ganglion in the neck. Investigating how SGB can help ameliorate the symptoms of PTSD led him to investigate and describe the neurobiology of PTSD and the mechanism of action of SGD. The impact of SGD on PTSD was supported by a small neuroimaging study demonstrating that the right amygdala — the area of the brain associated with the fear response — was overactivated in patients with PTSD but that this region was deactivated after the administration of SGB, Lipov said. "I believe that psychiatric conditions are actually physiologic brain changes that can be measured by advanced neuroimaging technologies and then physiologically treated," he stated. He noted that a growing body of literature suggests that use of the SGB for PTSD can be effective "because PTSD has a neurobiological basis and is essentially caused by an actual injury to the brain." A Natural Response, Not a Disorder Lipov's clinical work treating PTSD as a brain injury led him to connect with Frank Ochberg, MD, a founding board member of the International Society for Traumatic Stress Studies, former associate director of the National Institute of Mental Health, and former director of the Michigan Department of Mental Health. In 2012, Ochberg teamed up with retired Army General Peter Chiarelli and Jonathan Shay, MD, PhD, author of Achilles in Vietnam: Combat Trauma and the Undoing of Character, to petition the DSM-5 Steering Committee to change the name of PTSD to PTSI in the upcoming DSM-5. Ochberg explained that Chiarelli believed the term "disorder" suggests a preexisting issue prior to enlistment, potentially making an individual appear "weak." He noted that this stigma is particularly troubling for military personnel, who often avoid seeking so they are not perceived as vulnerable, which can lead to potentially dire consequences, including suicide. "We received endorsements from many quarters, not only advocates for service members or veterans," Ochberg told Medscape Medical News. This included feminists like Gloria Steinem, who championed the rights of women who had survived rape, incest, and domestic violence. As one advocate put it, "The natural human reaction to a life-threatening event should not be labeled a disorder." The DSM-5 Steering Committee declined to change the name. "Their feeling was that if we change the word 'disorder' to something else, we'd have to change every condition in the DSM that's called a 'disorder'. And they felt there really was nothing wrong with the word," said Ochberg. However, Lipov noted that other diagnoses have undergone name changes in the DSM for the sake of accuracy or stigma reduction. For example, the term mental retardation (DSM-IV) was changed to intellectual disability in DSM-5, and gender identity disorder was changed to gender dysphoria. A decade later, Lipov decided to try again. To bolster his contention, he conducted a telephone survey of 1025 individuals. Of these, about 50% had a PTSD diagnosis. Approximately two thirds of respondents agreed that a name change to PTSI would reduce the stigma associated with the term "PTSD." Over half said it would increase the likelihood they would seek medical help. Those diagnosed with PTSD were most likely to endorse the name change. Lipov conducts an ongoing survey of psychiatrists to ascertain their views on the potential name change and hopes to include findings in future research and communication with the DSM-5 Steering Committee. In addition, he has developed a new survey that expands upon his original survey, which specifically looked at individuals with PTSD. "The new survey includes a wide range of people, many of whom have never been diagnosed. One of the questions we ask is whether they've ever heard of PTSD, and then we ask them about their reaction to the term." A Barrier to Care Psychiatrist Marcel Green, MD, director of Hudson Mind in New York City, refers to himself as an "interventional psychiatrist," as he employs a comprehensive approach that includes not only medication and psychotherapy but also specialized techniques like SBG for severe anxiety-related physical symptoms and certain pain conditions. Green, who is not involved in the name change initiative, agrees that the term "disorder" carries more stigma than "injury" for many groups, including those who have experienced childhood trauma, those struggling with substance abuse, or who are from backgrounds or peer groups where seeking mental healthcare is stigmatized. Patients like these "are looking to me to give them a language to frame what they're going through, and I tell them their symptoms are consistent with PTSD," he told Medscape Medical News. "But they tell me don't see themselves as having a disorder, which hinders their pursuit of care." Framing the condition as an "injury" also aligns with the approach of using biologic interventions to address the injury. Green has found SGB helpful in treating substance abuse disorder too, "which is a form of escape from the hyperactivation that accompanies PTSD." And after the procedure, "they're more receptive to therapy." Unfortunately, said Lipov, the DSM Steering Committee rejected his proposed name change, stating that the "concept of disorder as a dividing line from, eg, normal reactions to stress, is a core concept in the DSM, and the term has only rarely been removed." Moreover, the committee "did not see sufficient evidence…that the name PTSD is stigmatizing and actually deters people with the disorder from seeking treatment who would not be deterred from doing so by PTSI." 'An Avenue for Dignity' Ken Duckworth, MD, chief medical officer of the National Alliance on Mental Illness (NAMI), noted that the organization does not have an official position on this issue. However, he shared his own personal perspective. There may be merit in the proposed name change, said Duckworth, but more evidence is needed. "If it's clear, after rigorous studies have been performed and there's compelling data, that calling it a 'disorder' rather than an 'injury' is actually preventing people from getting the care they need, then it merits serious attention." If so, Duckworth would be "interested in having a conversation with the policy team at NAMI to start to see if we could activate the DSM Committee." Roger McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto, Toronto, Ontario, Canada, and head of the Mood Disorders Psychopharmacology Unit, said the name change initiative is a "really interesting proposal." McIntyre, chairman and executive director of the Brain and Cognition Discovery Foundation, Toronto, who is not involved in the initiative, has also heard "many people say that the term 'disorder' is stigmatizing and might even come across as pejorative in some ways." By contrast, "the word 'injury' parallels physical injury, and what we currently call 'PTSD' is a psychological or emotional injury no less devastating than torn tissue or broken bones," added McIntyre, who is also the chairman of the board of the Depression and Bipolar Support Alliance. Ochberg agreed. "In the military, 'injury' opens up an avenue for dignity, for a medal. Being injured and learning how to deal with an injury is part of having yet another honorable task that comes from being an honorable person who did an honorable thing." While disappointed, Lipov does not plan to give up on his vision. "I will continue to amass evidence that the word 'PTSD' is stigmatizing and indeed does prevent people from seeking care and will resubmit the proposal to the DSM Steering Committee when I have gathered a larger body of compelling evidence." Currently, Lipov is in active discussions with the special operations force of the US Army to obtain more evidence. "This will be the follow-up to bolster the opinion of Peter Chiarelli," he said. "It is known that suicide and PTSD are highly related. This is especially urgent and relevant because recent data suggest suicide rate of military personnel in the VA may be as high as 44 per day," Lipov said. Lipov is the chief medical officer and an investor in the Stella Center. Green performs SGBs as part of his psychiatric practice. Ochberg, McIntyre, and Duckworth reported no relevant financial relationships. Note: This article originally appeared on Medscape .

Hi. I'm Art Caplan, at the Division of Medical Ethics at the NYU Grossman School of Medicine. I had an interesting case presented to me recently by a member of an ethics committee, not at NYU, but at another hospital in another state. That committee, of which this woman was a member, had been consulted about a case involving a very sick, almost terminally ill young woman. The doctors who were caring for her thought they were going to reach a point where interventions to try to help her would become futile and where her suffering was going to be extreme. Maybe they could control it with drugs and medication, but they'd almost have to knock her out completely in order to handle the pain and suffering she had from a widespread cancer that was ravaging her. The doctors involved in the care sought a consult with the ethics committee at this hospital. They basically asked their opinion. Did they think it was legitimate to stop care, even if the family did not agree, because it looked to them like it was going to become in the best interests of this patient to do so? What sort of disclosures should they make? How should they manage a situation in which they had reason to believe that the family might not be cooperative in any conversation or any plan to terminate treatment and let the young woman die? The question that the ethics committee member had for me was, because they requested the consult, did the ethics committee or anybody at the hospital have a duty to disclose to the family or the patient that a consult had been sought? I actually didn't know the answer to this question. Do people who consult with ethics committees have an obligation, legal or moral, to let others know that a consult has been requested by doctors or nurses? Do they have to tell family? Do they have to tell patients? Is there anybody else they have to tell? It turns out that the answer to this question — if you were to consult an ethics committee or call for an ethics consultation — is no, you don't have to disclose the request if you ask for ethics advice. If you're doing what is sometimes called a curbside consult — where you're just saying, give me your opinion, I'll weigh it, and it's something I'm going to take into consideration in caring for a patient or our team will take into consideration — you don't actually have to tell the patient or anybody else that you're seeking outside advice. There's no legal obligation. There are no laws I could find. Morally, you're just asking for an opinion, which ultimately you're going to weigh, accept, or not take into account. The only difference is, if the ethics committee is asked to do a formal mediation with a family or a patient, then obviously, they have to know that a mediation is going to happen. The committee will listen to various accounts of what is being disputed and may render an opinion. A formal dispute resolution, yes. If you're going to put a note that an ethics committee opinion was sought into a chart, then that could become known to the patient and family because they have the right to see their medical records. If there's no note and no formal dispute resolution invoked, it turns out that you can ask for ethics advice without having to notify anyone except the people who, if you will, are waiting to get the advice back from the committee. There is no obligation and no duty to disclose that I can see to the patient or family. That may bring you more comfort and may make it a little bit easier to consider getting an opinion from an ethics consult or an ethics committee because you don't have to worry so much about who else is going to know. I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thank you for watching. Note: This article originally appeared on Medscape .

Keypoint: Social anxiety disorder: increased screening and recognition are essential for proper diagnosis, and psychotropic and psychotherapeutic options can be effective. TALES FROM THE CLINIC In this installment of Tales From the Clinic: The Art of Psychiatry, we examine a case of social anxiety disorder (SAD), an underappreciated entity that is often confused with shyness and temperamental disposition. SAD is common and thought to rank third among psychiatric conditions, after depressive and addictive disorders, worldwide; however, it is often challenging to diagnose because social interactions are heavily modulated by cultural and gender considerations as well as setting-specific considerations including work and school expectations. Case Vignette “Damien” is a 27-year-old medical trainee who presents to the clinic with the complaint of anxiety exacerbated by social situations. He outlines anxiety that he noted as early as age 10 years: “We have a big family, lots of uncles, aunts, cousins. Going into those gatherings was always so hard even though everyone there cared—and I have known them all since birth.” In high school, he had excellent grades but struggled when he tried taking a communications elective and recalls panic symptoms before a group presentation: “I had sweaty palms and my heart was skipping. I could not collect my thoughts; I must have looked like an idiot.” The solution Damien devised for this type of situation was to be the notetaker for the group, who prepared PowerPoints and did background work. That way, he felt he was still participating and his work was appreciated, but he did not have to be in the spotlight. He did experience further challenges when he tried to ask someone out on a date, and when he had trouble placing his food order in front of others in a restaurant. He jokingly adds that being a medical student helps as he can always pretend he is busy, instead of saying he feels uncomfortable in social gatherings. He answers by text rather than calling when he has the chance. Other specific situations included difficulty calling to schedule his own medical appointments and going through mock examinations. He finds introducing himself to patients to be challenging and feels his voice is shaky when he presents in rounds. Damien is presenting to care because he feels his symptoms have brought about significant impairment in his social life and career, preventing him from meeting new friends and from expanding his scholarly activities as he cannot present his research findings for fear of getting panicky. Defining Social Anxiety Social anxiety refers to the anxiety occurring directly in conjunction with social situations and the fear of being scrutinized in those situations. The gamut of situations that could trigger social anxiety ranges from meeting or talking to unfamiliar individuals, to presenting or performing in front of others, to acts that are seemingly mundane such as eating with others present (Figure 1). Some anxiety in social situations may be situation-congruent (eg, major presentation that could determine a promotion), but the core of SAD is the underlying layer of negative cognition suggesting to the beholder that they will be judged, ridiculed, or otherwise negatively perceived. A traumatic experience in social settings is not needed as antecedent of SAD, and the disorder is far-reaching, causing impairment in multiple life functional areas. A duration of 6 months is needed for an SAD diagnosis as per the DSM-5. As with other anxiety disorders, clinical manifestations must be considered within developmental stage parameters. For instance, in a child, SAD may manifest as refusal to go to school, thereby raising the possibility of a separation anxiety disorder. In a teenager or young adult, SAD may interfere with asking others out or engaging with new friends (eg, when starting a new sport or moving to middle/high school or college). In individuals with medical conditions with noticeable movement abnormalities or postaccident/postsurgery disfigurement, some anxiety about interacting with others is common, and the diagnosis of SAD can only be applied in those situations where the anxiety is excessive or unrelated. SAD also includes paruresis, the fear of urinating in a public bathroom. The prevalence of SAD in the US is about 7%, with higher prevalence in women than men. SAD has a global prevalence ranging from 5% to 10% and a lifetime prevalence of 8.4% to 15% (Figure 2). The prevalence rose slowly from the 1960s to the early 2000s with a preponderance in married, more educated populations. The relationship between SAD and problematic internet use is not well understood but a small study in medical students has shown an association between anxiety and excessive internet usage. Using alcohol or substances before or during events to mitigate distress is common, as is blushing, a hallmark physiological response of SAD. According to the DSM-5, SAD can have a subtype of performance-only anxiety, which is given when the fear is restricted to speaking or performing in public. This fear could be particularly impairing if/when school or work requires performance in front of others, such as in public speaking class or a musical performance. Avoidance of the feared situation is a common feature of SAD. In history taking for the patient, it is essential to ask about what situations were missed because of fear, and what the costs of those avoidant behaviors have been, professionally and personally, for the individual. Less severe manifestations include a high level of anticipatory anxiety, overpreparation, or only joining the event with a companion or some assistance. Screening for comorbid conditions is essential, and clinicians should inquire about other anxiety disorders, alcohol or other substance use, and mood disorders, especially depression. Diagnosis of SAD is facilitated by the Social Phobia Inventory and the Liebowitz Social Anxiety Scale. Management Management strategies for SAD involve a combination of 2 primary treatment approaches, namely psychotherapy and focused pharmacologic intervention. Treatment also varies between adults and children/adolescents. Details outlining each treatment strategy are delineated here and in Figure 3. Psychotherapeutic Intervention Cognitive behavior therapy (CBT) remains the recommended first-line psychotherapeutic intervention for SAD in both adults and younger patients. There are also mindfulness and acceptance-based therapies, which include acceptance and commitment therapy, mindfulness-based stress reduction, and in vivo exposure—all of which aim to provide disconfirming evidence for cognitive distortions related to social expectations. The focus in adults is on guided interactive sessions between the psychiatrist and the patient, but in younger patients, parents are included in the physician-patient interaction. Typically, 15 to 20 CBT sessions are administered ranging from 1 to 1.5 hours in length focusing on a multitude of practices: gradual exposure to social situations that incite fear after preparation of a rank-ordered list of such scenarios, with the least terror-inducing situation being the point of initiation in order to achieve habituation and extinction that lead to reductions in fear7; exercises emphasizing cognitive restructuring before and after said exposures, which have been demonstrated to reduce social phobia and promote positive cognition8; alteration of strongly held core beliefs that have been shown to improve quality of life in patients with social phobias9; and the prevention of relapse to following avoidant behaviors. In young individuals, additional focus on parental education about the disorder is applied and parents are taught how to reinforce acceptable ways of addressing anxiety-inducing situations. Variations of CBT with social skill training are also included in the management plan. Pharmacologic Interventions First-line pharmacotherapies that have clearly demonstrated efficacy in reducing social anxiety and improving quality of life include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors such as paroxetine, sertraline, fluvoxamine, and venlafaxine. Citalopram, escitalopram, and vilazodone have also shown promise, and seem to be more effective than fluoxetine. Minimum treatment durations of 4 to 6 weeks are needed for notable benefit. Paroxetine and sertraline are the most impactful drugs in the treatment of SAD owing to their exceptional relapse prevention rates, and a 10- to 50-mg/d dose of paroxetine is considered the gold standard in producing the best response rates (> 50%) if overall adverse effects are taken into account. Although some clinical studies have shown monoamine oxidase inhibitors like phenelzine to possess astounding response rates (> 80%), the diverse host of adverse effects attributed to them prevents them from being recommended as a first-line option. Combination Finally, although psychotherapy and pharmacologic intervention are rarely combined for the treatment of SAD, evidence demonstrating the benefit of combination CBT and paroxetine is beginning to accumulate and it would not be surprising to see future guidelines reflect these changes. A major change in the treatment of SAD could be brought about by the recent positive results of nasal antianxiolytics such as PH94B/fasedienol: antidepressant and antianxiolytic effects of pherine molecules can provide a short-acting, as needed, treatment tool to be used before anxiety-provoking situations. Pherine molecules (neuroactive steroids), when sprayed intranasally, interface with the olfactory bulb which then feedback into γ-aminobutyric acid and corticotropin-releasing hormone neurons in the limbic amygdala. Concluding Thoughts SAD is a common and significant disorder that carries silent suffering, and contributes to depression, underemployment, and overall lack of ability of achieving one’s socioeducational potential. Increased screening and recognition are essential for proper diagnosis, and psychotropic and psychotherapeutic options can be effective.