Social Anxiety being related to CFS

[forestglip]

I had a thought and wanted to share it.

I have pretty bad social anxiety as well as mild-moderate CFS. When one is worse, so is the other.

So Adderall is like a miracle drug for social anxiety. In the very short term, that is. It pretty much eliminates the anxiety for a couple hours. Tolerance develops very quickly, though, so it's not actually very useful.

This is not just my experience - very many social anxiety sufferers feel profound, immediate, short term relief with Adderall and other stimulants.

It has always felt like my SA is largely due to brain fatigue not allowing me to concentrate on social situations.

What if social anxiety disorder and chronic fatigue syndrome are more closely related than previously thought? Some people's CFS is primarily manifested through deficits in physical energy, some in mental energy. Maybe some people's CFS or similar condition is manifested through social mental energy specifically.

There are, of course, differences in onset age and remission rates, but same goes for other subtypes of CFS.

Could it be that if CFS is shown to be primarily caused by a virus or other toxin, that the same is true for social anxiety disorder?

Maybe not even just social anxiety, but introverted people in general, who say they need to "recharge" after social situations. Reminds me of PEM.

 

[Mouse girl]

Interesting topic! i've known lots of people with social anxiety and with cfs/me as well as fibro and many other illnesses in my 30 years of the cfs/me nightmare.

Don't see the connection, my self. But, i will say that of course a neuro immune illness would amp up any brain related or mental health issues. And this illness does have an anxiety componant as my one amazing doctor told me: "oh course you have anxiety, you have a neurological illness!" He believed that both fibro and cfs/me were neurological based rather than immune.

I was shy as a kid, very much so, as was my father. I did get the genetics for this illness from my Dad's side of the family but, my Dad was the least like a cfs/me patient on the planet. He had energy and vitality like no one else but in a balanced way, not a hyper way. He was dancing all night long and driving home on vacation when he died in his 80's. He was working out at the gym, fixing stuff on the house and making things (brilliant enjineer)driving thousands of miles on vacations, skiing and driving hours on the way to the slopes and back and then going ice skating and then to a dance, then all over again the next day, all in the year of his death. I overcame my shyness after i got sick. The isolation forced me to reach out and chat and talk to strangers just to have interactions and I felt no wierdness about it. But, i do have much more anxiety after getting sick and i see it so related to crashing or being active since getting sick. So, it's really interesting and cool that you noticed these things in yourself. And I could really see that pathogens could cause social anxiety in some for sure. Great topic!

I think it will be interesting to hear others ideas and experiences on this. We are all so different with different personalities, genetic components and backgrounds and life experiences.

 

[hapl808]

I absolutely think it may be connected in ways we don't understand.

Could it be that if CFS is shown to be primarily caused by a virus or other toxin, that the same is true for social anxiety disorder?

I've always been relatively extroverted, but I found as my illness has worsened, introversion is unavoidable. I talk on the phone as much as I can without crashing, but I have to keep myself lower energy or the crash will come faster.

So, like reinforcement learning in computers - over the years I've learned to downregulate my energy and enthusiasm so I don't crash as quickly, be less physically active, etc.

When I was younger, if I was busy 6 days in the week and had nothing to do 1 day, I felt like I was missing out on life. I've always been a FOMO kind of person, but this illness changed who I was in ways I didn't even realize. I'd get so frustrated with myself - why I sometimes didn't 'allow' my enthusiasm for things or people to show. Now I understand more, because I'm so fragile that one enthusiastic (fun - not anxious) phone call will leave me in bed for days.

And along with enthusiasm, my tolerance for stressors is also much lower. Although ironically I think enthusiasm or excitement crashes me much worse than stress (although stress is obviously much more unpleasant).

I don't particularly like the person that this illness ended up sculpting over time. It's very different from who I was.

 

[hapl808]

Also, because I started off as extroverted - people don't think I'm socially anxious or introverted. Since I'm still more extroverted than many of my introverted friends, they think it's normal rather than a defense mechanism. My social anxiety shows up mainly in elevated heart rate and subsequent crashes (back when I was mild enough to have social interactions) - but everything else causes that, too. Cooking a recipe that's complicated, talking on the phone, etc.

 

[forestglip]

@Hip on S4ME discussing buspirone inducing higher prolactin in ME/CFS patients:

Just been trawling through PubMed to find studies on other diseases showing exaggerated prolactin responses to buspirone.

It appears that non-ulcer dyspepsia patients and generalized social anxiety patients also have exaggerated prolactin responses.

Whereas patients with major depression or mania are no different to controls.

Schizophrenic patients without tardive dyskinesia had decreased prolactin responses to buspirone, but those with tardive dyskinesia were no different to controls.

I've added these studies to the article.


So exaggerated prolactin responses to buspirone are not unique to ME/CFS.

The study: A preliminary study of buspirone stimulated prolactin release in generalised social phobia: evidence for enhanced serotonergic responsivity?

The prolactin levels of subjects vs controls:

A lot of overlap. It'd be interesting to know what differences there are in the four individuals with very high levels compared to the rest of the patients. A larger study confirming this while controlling for confounders like CFS would be great.

 

[L'engle]

I would think if they were strongly related, people with ME would be fine with doing solitary activities. People I know who are introverted and healthy tend to thrive with solitary physical activity.

There may be more neurodivergent people with ME.

The illness is certainly nerve-wracking.

 

[forestglip]

I would think if they were strongly related, people with ME would be fine with doing solitary activities. People I know who are introverted and healthy tend to thrive with solitary physical activity.

There may be more neurodivergent people with ME.

The illness is certainly nerve-wracking.

So what I'm suggesting is that social anxiety could be a type of chronic fatigue syndrome, or at least a related condition with a similar mechanism causing it, not that they are two parts of the same condition, or even that they are necessarily seen often at the same time in people.

So maybe similarly to how there are people with CFS who are only physically fatigued or only mentally fatigued, maybe social anxiety is where someone is only socially fatigued. At least for the subtype of social anxiety that feels like you don't have the energy to concentrate on conversation instead of your own flaws or the idea of being judged, and which responds very well to stimulants.

 

[FoggyTortoise]

So maybe similarly to how there are people with CFS who are only physically fatigued or only mentally fatigued, maybe social anxiety is where someone is only socially fatigued.

I'm a bit confused here. I thought people with ME/CFS were by definition fatigued after pretty much any form of exertion (hence PEM). Are there really people under the [very wide] CFS umbrella who only experience fatigue after one specific kind of exertion? Perhaps I'm behind the times here and definitions have become even broader than they used to be.

Wearing my old-fashioned hat, I don't think the fact that social anxiety leads to 'social fatigue' means social anxiety should be listed under the CFS umbrella. Parkinson's, cancer, diabetes and many other illnesses also cause chronic fatigue, but since there's a recognised cause, they are listed elsewhere - fatigue in those cases is merely one of many effects of the disease, rather than the central problem. Likewise, social anxiety causes fatigue, but isn't necessarily another form of CFS. It might exist alongside CFS and be yet another stressor that triggers PEM (yep, for me too), but I don't think it's a type of CFS in itself.

Crawling back into my hole now...

 

[Dysfunkion]

Yes you actually hit the nail on the head of which I've been thinking about for a long time. I also need to be careful how much I mentally exert myself because I'll also suffer more socially. The more my PEM is flaring from some kind of over stimulation besides actual stimulants, the worse my anxiety is. I call it fake-xiety because I'm not actually anxious but my nervous system is forcing me to present that way. When this happens socially I'll often draw blanks and forget what I'm going to say or how to string the words together too making me look like a complete idiot. My brain seems to in the neurological chain reaction from over stimulation get overrun with signalling that goes on when it shouldn't long after the things that initially caused it have stopped providing it. It's as if my brain doesn't have the ability to put a break on sensory input chains and they literally need to fizzle out on their own like an electrical circuit losing charge over time.

On introversion, I myself I would say have introverted tendencies but I'm actually pretty social despite needing more space and my actual fake-xiety induced social issues and actual trauma that likes to make a mess of things often (sometimes they even join forces to create the ultimate social embarrassment and completely ruin first impressions). My introverted tendencies themselves seem to stem from me just being a more introspective person who needs more space to integrate what they take in from the world around them. I also like the comfort of personal projects too, in general I value the spaces in between the roar of daily life a lot. What keeps me from being more extroverted is my neurological problem induced social problems and how much more slowly I am forced to be because of PEM that if I simply power through will only become more dysfunctional.

 

[forestglip]

I'm a bit confused here. I thought people with ME/CFS were by definition fatigued after pretty much any form of exertion (hence PEM). Are there really people under the [very wide] CFS umbrella who only experience fatigue after one specific kind of exertion? Perhaps I'm behind the times here and definitions have become even broader than they used to be.

I don't have a lot of examples, but I think I've seen multiple people say they only get PEM from mental or only from physical effort. One example:

My first overt ME/CFS symptoms began in 1999 (after stopping a medication called Finasteride due to side effects) and advanced slowly. By 2004, Ι had full-blown ME/CFS.

My symptoms included fatigue after exertion [...]

Still able to do mental work, I turned to advanced data analytics to develop software in order to research my own personal case and ME/CFS in general.

Wearing my old-fashioned hat, I don't think the fact that social anxiety leads to 'social fatigue' means social anxiety should be listed under the CFS umbrella. Parkinson's, cancer, diabetes and many other illnesses also cause chronic fatigue, but since there's a recognised cause, they are listed elsewhere - fatigue in those cases is merely one of many effects of the disease, rather than the central problem. Likewise, social anxiety causes fatigue, but isn't necessarily another form of CFS. It might exist alongside CFS and be yet another stressor that triggers PEM (yep, for me too), but I don't think it's a type of CFS in itself.

So my theory is that social anxiety doesn't cause fatigue, but that the condition is a fatigue disorder localized to socializing, and the symptom is social anxiety.

The reasons I think so:

• Stimulants decrease social anxiety, which I think is unlike the effect for most other types of anxiety. In fact, people with social anxiety report that their general anxiety and wired feeling increases even though their social anxiety decreases with Adderall. Can confirm personally.
• It feels personally like a major lack of mental energy to stay focused on conversation or come up with things to say is one of the primary issues causing my social anxiety.
• Personally, CFS and social anxiety increased to high levels at the same time, and during a PEM crash, the social anxiety is worse. (Then again, so did generalized anxiety.)

Writing this out and the more I think about it, the less confident I am in this idea and the weaker it sounds. I'm going to continue to try to research whether there are common neurological mechanisms in CFS and social anxiety though.

 

[Dysfunkion]

I don't have a lot of examples, but I think I've seen multiple people say they only get PEM from mental or only from physical effort. One example:



So my theory is that social anxiety doesn't cause fatigue, but that the condition is a fatigue disorder localized to socializing, and the symptom is social anxiety.

The reasons I think so:

• Stimulants decrease social anxiety, which I think is unlike the effect for most other types of anxiety. In fact, people with social anxiety report that their general anxiety and wired feeling increases even though their social anxiety decreases with Adderall. Can confirm personally.
• It feels personally like a major lack of mental energy to stay focused on conversation or come up with things to say is one of the primary issues causing my social anxiety.
• Personally, CFS and social anxiety increased to high levels at the same time, and during a PEM crash, the social anxiety is worse. (Then again, so did generalized anxiety.)

Writing this out and the more I think about it, the less confident I am in this idea and the weaker it sounds. I'm going to continue to try to research whether there are common neurological mechanisms in CFS and social anxiety though.

Like you said, it's some kind of energy problem where I lose focus, lose connection to the immediate interaction at hand, and my sensory input blends into everything else going on. I start wandering off into the various rapid subconscious thoughts I have every second technically when having an interaction and I keep getting thrown off by it. There's always when it gets to this point a tension in my jaw muscles, around my cheeks, and forehead. When I start to get that I know things are about to socially go south very quickly but when I'm at work for example I can't just go so I need to try extra hard to appear still normal despite the fact that I'm being overrun with the constant stream of thoughts going on in my subconscious trying to dominate my conscious mind. I think this makes us extremely anxiety ridden because the content of that subconscious stream of though is everything going through your mind in response to the environment completely unfiltered. When you lose enough energy to the point where what is usually in tight control just starts blending with the immediate sensory input then you're going to be an awkward mess no matter what.

 

[forestglip]

Like you said, it's some kind of energy problem where I lose focus, lose connection to the immediate interaction at hand, and my sensory input blends into everything else going on. I start wandering off into the various rapid subconscious thoughts I have every second technically when having an interaction and I keep getting thrown off by it. There's always when it gets to this point a tension in my jaw muscles, around my cheeks, and forehead. When I start to get that I know things are about to socially go south very quickly but when I'm at work for example I can't just go that so I need to try extra hard to appear still normal despite the fact that I'm being overrun with the constant stream of thoughts going on in my subconscious trying to dominate my conscious mind. I think this makes us extremely anxiety ridden because the content of that subconscious stream of though is everything going through your mind in response to the environment completely unfiltered. When you lose enough energy to the point where what is usually in tight control just starts blending with the immediate sensory input then you're going to be an awkward mess no matter what.

Sounds pretty similar to my experience. For me it mainly feels like I can't stay focused on a conversation. Or anything really, but with most other things, you don't have to be 100% zoned in and can go in and out of focus, but to follow a conversation and respond appropriately, you have to pay attention to every word.

It seems very strange that Adderall treats social anxiety, but does not help other anxiety disorders (I don't actually know if this is the case, just an assumption based on never hearing about it, and hearing that it often increases generalized anxiety), unless social anxiety is primarily caused by lack of mental energy, or social anxiety could be unique in some other way.

Maybe social anxiety is a lack of energy required to "choose" to direct your focus away from any social anxiety specific self-judging thoughts, as opposed to just increased focus on conversation. Like maybe Adderall just increases the brain's subconscious/conscious ability to break one's focus away from scary thoughts like "they'll all be looking at me" or "if I mess up in my speech, it'll be a literal disaster". But if it doesn't have the same effect for, say, fear of heights, why not?

 

[Dysfunkion]

Sounds pretty similar to my experience. For me it mainly feels like I can't stay focused on a conversation. Or anything really, but with most other things, you don't have to be 100% zoned in and can go in and out of focus, but to follow a conversation and respond appropriately, you have to pay attention to every word.

It seems very strange that Adderall treats social anxiety, but does not help other anxiety disorders (I don't actually know if this is the case, just an assumption based on never hearing about it, and hearing that it often increases generalized anxiety), unless social anxiety is primarily caused by lack of mental energy, or social anxiety could be unique in some other way.

Maybe social anxiety is a lack of energy required to "choose" to direct your focus away from any social anxiety specific self-judging thoughts, as opposed to just increased focus on conversation. Like maybe Adderall just increases the brain's subconscious/conscious ability to break one's focus away from scary thoughts like "they'll all be looking at me" or "if I mess up in my speech, it'll be a literal disaster". But if it doesn't have the same effect for, say, fear of heights, why not?

When I get to the point where I'm zoned out like that where I don't even register some of what is being said then that's how I know I'm completely brain fried and gotta have some time alone. Other drains on my resources mentally at the time can affect it too so it's not just socially connected BUT socializing is one of the things that cause these crashes to happen the fastest.

I will say that in my case stimulants do treat it but for a very short period of time and then I'm even worse sometimes because then I'm even more jittery with unstable thought patterns. Something in my brain "loses resistance" to the subconscious outflow of mundane observation like "what am I going to have for dinner tonight", "does my hair look weird", "what was that that?", "Wow they're good looking", "I hope that package comes in soon", ect- you get the picture. Imagine nonsense like that coming at a million miles an hour that will rapidly shift between entirely disconnected things and that blending in with my mind working up front is my social anxiety in a nutshell.

From my perspective as I was dissecting it happen live on the job yesterday, yes it's as if my brain can't choose a direct focus but it comes from the lack of energy to sustain the stable process of focused thinking in general. When I was first got there I was completely fine but over time things started to break down and it wasn't due to anything specific besides that my brain started to lose steam and all of a sudden every subconscious though, insecurity, and other random data is now making a mess because my brain can't hold it back. My speech is one of the first things to go, after that then my motor movements start getting slightly confused, and then it's all downhill from there. On the topic of drugs even the most neurotypical people are prone to freaking out, I think these negative thoughts that disturb us are in everyone BUT it's all kept tightly guarded as a subconscious process they're brain has the ability to consistently hold back along with everything else in there.

 

[L'engle]

Writing this out and the more I think about it, the less confident I am in this idea and the weaker it sounds. I'm going to continue to try to research whether there are common neurological mechanisms in CFS and social anxiety though.

It's not a bad idea. This is a forum for sharing thoughts including theories of illness. Be interesting to see what you come up with.

 

[L'engle]

Some of us are kind of jaded and cynical, from years of hearing theories. Don't let that stop you from sharing your ideas!

 

[Murph]

I was naturally pretty extroverted as a young person. Loved parties. too much maybe. But yep, post mecfs I started hating parties and getting uncomfortable sometimes at them and even beforehand.

I have a dexamfetamine prescription and it certainly helps return me to a more extroverted state. I've opted against taking it daily but it's not bad to take before a social event. I think dex works on dopamine and I have read somewhere that dopamine pathways may be dysregulated in mecfs.

 

[hapl808]

I have a dexamfetamine prescription and it certainly helps return me to a more extroverted state. I've opted against taking it daily but it's not bad to take before a social event. I think dex works on dopamine and I have read somewhere that dopamine pathways may be dysregulated in mecfs.

I wish stimulants worked on me without crashing. I tried a 1/4 dose of Modafinil and crashed pretty badly. Recently discontinued caffeine to see how it is without it. But I may try some others like Ritalin just because they work on different receptors. Not expecting much besides a crash, though.

 

[Dysfunkion]

I was naturally pretty extroverted as a young person. Loved parties. too much maybe. But yep, post mecfs I started hating parties and getting uncomfortable sometimes at them and even beforehand.

I have a dexamfetamine prescription and it certainly helps return me to a more extroverted state. I've opted against taking it daily but it's not bad to take before a social event. I think dex works on dopamine and I have read somewhere that dopamine pathways may be dysregulated in mecfs.

An interesting thing on parties and loud social environments is that on what I'd call a normal day for me there is no major issues is that I will if there is enough things to immediately do that start that dopamine rush I spring to life. Things like concerts, going to a loud casino, a day where I'm planning a lot to do and the possibilities feel endless, or even a combination of all these things. It's pretty short lived though and lasts no more than a day at most before after I crash and hard. Like completely antisocial, just want to isolate, everything makes me irritated, going outside makes me want to jump out of my skin. So my mind routinely chases these states of "dopamine chaining" because it appears to be the only way I can feel very close to what I imagine in many ways having a "normal" brain feels like socially. My brain can't seem to achieve it though without reaching a near manic state. But if this dopamine inducing activity goes on too long it will also lead to a crash but even more severe of one. So something can't seem to retain balance in there no matter what and I'm just left riding the waves as they come. If I'm in a bad crash state like right now for example energetically then those dopamine inducing activities won't even work save for a very brief window of functioning as I'm having my morning coffee with some music as I see what's going on in the usual spaces online. As much as I try my brain just can't seem to "connect to itself" entirely so I just give up and sit in silence doing more minimal things around the house I can get done in this state verrrryyyy slllooowwwllly.

On a different note on this topic, I had a bunch of chicken last night as I was having a lot of seafood (laregely because I been on lyme herbals and wanted to give my guts good bacteria more to feed on as I was bombing them with herbal antibiotics) lately in between 2 day dinner fasts that seem to have been working out for me. I don't have as much of a reaction to chicken or land meat as I used to but it's still there and the same but lessened. That reaction also leads to almost the exact same energy crash state. Seafood I may get a little more tired after I eat and the next day but nothing major at all but only that as it doesn't psychologically do what meat does to me. Meat turns me into an irritated, depressed, lifeless, driveless (in all areas, even my sex drive tanks), recluse in one meal. Of course with all of this all those social anxiety linked issues amplify themselves to the max, I just can't deal with people at all. Even messaging friends on Discord becomes way too energy consuming. There is nothing I can do about it either but wait it out and shelter myself to avoid more stress. So like I'm stuck in this look where I need to eat a very specific way, live a specific way, and organize my life in a way that feeds that stupid dopamine chain thing I need to retain social normality. If I don't I get completely thrown off the rails and my life falls apart quite rapidly.