Escaping the Shadow of Shyness

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Escaping the Shadow of Shyness

Social anxiety disorder in teenagers can cause serious phobias that last a lifetime, affecting jobs, relationships

(August 7, 2007) -- It was the start of sophomore year at a different college, but after a few weeks, her high hopes for a fresh beginning and busy new social life evaporated, and she spent day after day studying, sleeping and crying.

Shyness and anxiety at a young age can turn into serious social disorders as the child grows up -- and can lead to the teen or adult locking themselves away from the world or fearful of social interaction.

Indeed, Emily Ford seldom left her dorm room, and with isolation, anxiety and depression mounting, she sometimes scraped her legs with scissors and thought about suicide. Then one evening as she was heading out to eat, she was engulfed by panic, rushed back to her room, locked the door, slid to the floor and huddled there until morning.

Within weeks she had seen a psychiatrist and had a diagnosis: social anxiety disorder. What she was suffering was real. The acute, irrational fears about social interaction and performance had a name. And there were medications and therapy that could make her better.

Ford had taken a step toward recovery. But as she also grappled with depression and an eating disorder, she found her disabling anxiety would get much worse before it got better.

Academics had always been a refuge, and she earned a master's degree in secondary education.

"In school it was easy to force myself to do things because I was on a schedule," Ford says in an interview from Washington,

D.C., where the 27-year-old now lives and works. "After college, I knew I had to get a job, but I just couldn't put myself on the next step. That's when it got really bad."

She tells a moving story of illness and her continuing process of recovery in a new book, What You Must Think of Me: A Firsthand Account of One Teenager's Experience With Social Anxiety Disorder (Oxford University Press, $9.95). Co-authors are psychiatrist Michael Liebowitz and freelance science writer Linda Wasmer Andrews.

Part of the Annenberg Adolescent Mental Health Initiative series, the book has expert information about the disorder and treatment for teens or anyone dealing with social anxiety disorder, or social phobia, as it's also known.

Some people are shy and reserved by nature and suffer stage fright.

Someone with social anxiety disorder may start out a bit shy, but the fear of social interaction and performing, of humiliation and embarrassment, becomes so extreme and disabling that it affects a teen's ability to function in daily life.

Ford is afraid to talk on the phone. In addition, she has battled an eating disorder and won't eat in front of other people or fall asleep in someone's view. She's still afraid to ride in a car, but counts it a major sign of progress that she can work in a cubicle now among co-workers.

Before treatment that was unthinkable. For Ford, growing up in a farming community in upstate New York, the disorder started in fourth grade when she was separated from close friends, who were assigned to other classrooms. She had trouble making new ones. By seventh grade, she felt painfully excluded, not invited to sit with girls at lunch or go to slumber parties or the mall.

In class, she self-consciously worried about every movement she made and was too embarrassed to raise her hand and ask to go to the bathroom.

"By eighth grade," she wrote, "social anxiety was pushing me farther and farther into the background at school. Over the next few years, I gradually disappeared altogether."

The disorder, which experts say is genetic and biological but also linked to stressful life experiences, causes great pain, yet it's trivialized. So, the child is shy. No big deal. The kid will outgrow it. But often they don't. In some cases, social phobia lasts a lifetime, affecting jobs and relationships.

Liebowitz says educators may not notice because children and teens with the disorder usually are compliant and quiet at school and don't cause the kind of disruptions associated with other disorders. Then too, the embarrassment that afflicts a youngster in social interactions keeps her from coming forward for help.

Ford describes a self-perpetuating dynamic. "If you're socially anxious, you probably tend to distance yourself from others. To other people, your behaviour may seem arrogant and aloof. As a result, they may indeed end up rejecting or making fun of you, which just confirms your worst fears and increases your anxiety. It's a vicious cycle."

Ford broke out of that cycle with treatment and got her biggest benefit from cognitive behavioural therapy, which helps people change damaging thoughts and patterns of behaviour. She called five days of outpatient therapy at the Ross Center in Washington, including exposure therapy to stressful situations, life-changing and continues to see a doctor. Treatment results can be dramatic, doctors say. Those include several classes of antidepressants, including selective serotonin reuptake inhibitors, SSRIs, such as Paxil and Zoloft. Anti-anxiety medications can also help. Ford had been taking BuSpar for anxiety, plus an antidepressant, but recently went off them and is starting new medication.

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She is getting out and doing more. "I just want to be over this, but it's little steps at a time. There's a Happy Hour on Friday, and I'm going to make myself go, even if I don't know those people well."

Is she dating?

"Not yet," she says. "I think that's next. I just try to do the best I can. And I laugh at myself all the time."

SIGNS OF SOCIAL ANXIETY DISORDER

In school:

Avoids speaking in class, making presentations and group activities
Sits alone regularly in the school cafeteria or library.
Reluctant to write on the board or read aloud.
Fears performing in plays.
Constantly worries about being judged by the teacher.

Generally:

Excessively concerned about being judged or embarrassed.
Worries for days before a social event, freezing in social situations.
Frequently nervous, blushing, trembling or sweating.
Unwilling to invite friends to get together.
Reluctant to start conversations or make phone calls

Source: Pediatrics, August 2007.

Last updated 08/07

Escaping the Shadow of Shyness

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