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Social Anxiety

What do you do when saying 'hi' is the hardest part?

Oakland Tribune, June 26, 2006
By Monique Beeler, Staff Writer

After shopping for an hour, she finds a flattering pair of jeans, snatches them up and heads toward the checkout counter. Then it happens. Again.

Her palms go cold and moist. Her heart races. Perspiration beads at her forehead.

The petite grandmotherly cashier behind the counter is glowering at her, inspecting her, judging her. The cashier doesn't like her.

The pressure is too much. The customer drops the jeans on the nearest table and flees the store.

It's the kind of scenario psychotherapist Catherine Kvikstad has heard again and again from patients suffering from what once was called social phobia. Today it's known as social anxiety disorder, and it afflicts some 15 million Americans, according to the National Institute of Mental Health.

"It's very common," says Kvikstad, who runs a private practice in Castro Valley. "It's a fear of everyday social situations, not just the social situations that everyone would be worried about. Public speaking is the big one."

Other common situations that evoke extreme fear in those with social anxiety include talking or asking questions in a group, making small talk at a party or interacting with an "important person" or person in authority, such as a store clerk, teacher or boss.

Her clients with social anxiety have included:

  • An A-student who so feared speaking in front of class, she became nauseous and physically ill before assignments. Afraid to be the center of attention, she couldn't attend her own graduation ceremony.
  • A woman who feared being watched by others. Each night she waited until all her co-workers had left the office before walking out to her car.
  • A young man who was so anxious about talking to cashiers, he had to ask a friend to place his orders at Starbucks or McDonald's.

Undiagnosed, social anxiety can last a lifetime with devastating effects on a person's professional and personal life. They are often perceived by others as shy, quiet, aloof, conceited or arrogant.

"That could be a somewhat accurate description, but there's a lot more going on," Kvikstadsays. The exact cause of social anxiety is unknown, although researchers believe it's due to a complex mixture of environmental and genetic factors. Formative experiences, such as extreme teasing, may also contribute to the problem.

Social anxiety disorder usually first appears in the mid-teens, although it can also start in childhood. It rarely develops in adults.

"It's often the case that children who are shy or have difficulty with groups or talking to adults they don't know may be at risk," says Dr. Chris Hayward, associate professor of psychiatry and behavioral sciences at Stanford Medical School.

As children with a predisposition for social anxiety become adults, the number of social demands placed upon them grows, whether at school or in their circle of friends, he adds.

"The importance of peer acceptance is much greater in adolescents than it is for a 6-year-old, so that potentially compounds the problem," Hayward says. "If someone is shy, they might become more preoccupied and self-conscious about their perceived inadequacies."

In addition to intense self-consciousness and chronic fear, sufferers may experience physical symptoms such as an increased heart rate or clammy hands. Social anxiety does not appear suddenly in someone who has been a lifelong extrovert, Hayward says.

"The biggest problem with it is it's frequently unidentified, so those who suffer from it don't know what it is or how they can be helped," he says.

Some who fall into this camp may develop drug or alcohol dependencies as they try to cope with the disorder on their own. Once identified, social anxiety can be successfully treated through psychotherapy, medications such as antidepressants or anti-anxiety drugs, or a combination of therapy and medication.

Most of the social anxiety patients Kvikstad has treated sought her help because they were unhappy or overwhelmed by their fears, not because they knew they had social anxiety disorder.

"There's a barrier to seeking treatment," she says. "Often people (with social anxiety) are embarrassed. They're afraid of being criticized."

Hundreds of Bay Area residents have found help at the Shyness Clinic in Los Altos, part of the Kurt and Barbara Gronowski Clinic at Pacific Graduate School of Psychology. Clinic founder Dr. Lynne Henderson says 94 percent of the people who seek assistance through her 26-week program suffer from social anxiety disorder, an extreme version of shyness.

There's nothing wrong with shyness as a temperament, Henderson tells clinic participants. We simply live in a society that overvalues extroversion. In fact, she avoids using the word disorder, because it contributes to the problem.

"The fact is they're not broken," she says. "This stuff is learned, and it can be unlearned."

Henderson says her clients with social anxiety disorder have plenty of social skills, they just don't use them much.