I am a 35 year old man and I have never been in a serious relationship.  I would like to date and get married, but I become extremely shy when I talk to other people, especially women I find attractive.  I actually turn red and start to shake, which is really embarrassing.  I end up avoiding people because I don’t want to make a total fool of myself.  Will I be alone forever?

Dear Writer,

It sounds like you have social anxiety disorder.  Social anxiety is a fear of being negatively evaluated by other people.  It is very common for people with social anxiety to have a fear of talking with someone that they find attractive.  Other common situations that cause people with this disorder discomfort are:

Eating in front of others
Public speaking
Being observed by others walking in public
Starting a conversation with someone
Attending a party or social gathering
Talking to people you consider are in authority positions
Asking a store clerk a question
Returning items that were purchased
Using a public restroom

The list goes on, but social anxiety has the common theme of worrying that something you say or do will cause embarrassment and possibly rejection.

Social anxiety disorder is actually the most common anxiety disorder, and one of the most common mental health issue in the United States, so you are not alone!   It is often associated with depression.  This makes sense when you think about it, people with social anxiety tend to avoid situations and withdraw, and feel disappointed for doing so, this can easily lead to feelings of depression.

Social anxiety has some common characteristics that maintain the anxiety.  These are:

SOCIAL PERFECTIONISM
This is where you have unrealistically high standards for yourself.  You believe you need to be funny, smart, know what to say, not have pauses in a conversation, and never interrupt someone.  This pressure makes you feel more anxious and self-conscious.

SELF-FOCUSED ATTENTION
This is where it feels that you are in the spotlight.  If you are walking down the street, eating in a restaurant, asking a question, you believe people are looking at you and evaluating you.  When you are talking to someone, you are putting the spotlight on yourself, evaluating how you sound, how you feel, what you look like to the other person.  This again makes you feel more anxious and uncomfortable.

AVOIDANCE
If you don’t down right avoid going to a party, you may still be using avoidance.  At a party you may not initiate conversation, wear a turtleneck so no one can see your neck turn red, not hold a cup because someone will observe you hand shaking.  These are subtle avoidance strategies that actually maintain your anxiety in the long run.  They reinforce ideas that if you make a mistake or show you are anxious, you will be judged and/or rejected.

The good news is that Cognitive-Behavioral Therapy is very effective for social anxiety disorder, no matter how long you have had it.  It helps you to overcome your anxiety and meet life goals that you have for yourself. To learn more about this disorder and other anxiety disorders you can go to adaa.org.

Warm Regards,
Jennifer

My daughter is is seventh grade and she is refusing to go to school.  She feels sick on school mornings.  This started about 6 weeks ago.  She has always been a good student and liked school.  I don’t think anything happened, although she did seem to have a panic attack during PE a few weeks ago.  Could this be anxiety and what should I do?

Dear Writer,

While a diagnosis of any anxiety disorder is impossible without meeting your daughter, the timing of her sickness does suggest it may be anxiety-based.  Stomach aches and headaches are common symptoms people have resulting from anxiety.  If she doesn’t feel sick on weekend mornings, and if when you let her stay home she feels better after an hour or two, that is further evidence of anxiety. If this is anxiety, a couple things pop into my mind.  One is social anxiety which often occurs at this age.  With social anxiety, the individual feels extreme self consciousness, as though people are looking at them and criticizing or judging them.  They fear doing or saying something embarrassing.  It is a type of performance anxiety, but the  performance can be the simple act of walking on campus, eating, or starting a conversation.

Another possibility is the beginning of panic disorder.  You said she had a panic attack in PE.  Panic attacks can be very frightening and sometimes people develop a fear of having another one.  She may be avoiding school because she associates it with panicking.  Her fear of having another panic attack makes her more susceptible to having one.

One other possibility is separation anxiety, although this usually appears in younger children.  Separation anxiety is the fear of being away from one’s parents.  If she has not demonstrated this kind of fear before, it is unlikely separation anxiety.

Cognitive-Behavioral Therapy (CBT) is an effective treatment for social anxiety, panic disorder and separation anxiety.  To read more about these anxiety disorders, you can go to adaa.org and click on Anxiety Disorders.

It is important to get her back into school as soon as possible.  Easier said than done, however, the longer she avoids going, the worse her anxiety will get.  Working with a CBT therapist to help develop a plan to get her back in school would be a good idea .

It is important to rule out any physical cause of her feeling sick, so she should see her pediatrician.  It is also important to explore further if something upsetting happened at school that may need to be addressed.

Warm Regards,

Jennifer