Social Anxiety
For millions of Americans, every day is a struggle with debilitating shyness
Much worse--and, for drug companies, far more lucrative: Recently, SmithKline Beecham won FDA approval to market the anti depressant Paxil for social phobia, leading to a raft of "public education campaigns"--on top of those already put out by the National Institute of Mental Health and the Anxiety Disorders Association of America. This media blitz has raised concerns that normally shy people will conclude they're social phobics and seek medications for what is a complex, emotional problem, or opt for such drugs merely as "lifestyle" aids to win friends and influence people (story, Page 54).
Hard-hitting. Social phobia hit Steve Fox so hard in high school that girls made a sport of saying "hello" just to watch him turn beet red. He refused to speak in class and never dated; even walking in front of other people left him with sweaty palms and gasping for air. By the time Fox was 19, his father was concerned enough to find a doctor, and a combination of medication and therapy has helped him recover. Fox, now 23, recently gave a speech in front of 1,700 people, and he is married to one of the cheerleaders who used to tease him.
Normal shyness and serious social phobia are clearly different, but they are related. Emanuel Maidenberg, associate director of UCLA's Social Phobia and Performance Anxiety Clinic, says that shy ness is to social phobia what a fair complexion is to skin cancer. "It's a predisposing factor but will only translate into disease under certain circumstances," he says. "For pale people, that might be 10,000 hours in the sun. For shy people, it might be a string of embarrassing events."
Even though some people are born with a tendency toward extreme shyness, biology is by no means destiny. Harvard researcher Jerome Kagan has shown that by 8 weeks of age, babies display innate shyness or boldness. Roughly 1 in 5 will consistently be frightened of and avoid anything or anyone new, while the others welcome the unknown, reaching out to touch strangers or to grab new objects. Yet, many shy babies become gregarious 10-year-olds, and some outgoing babies become shy, even socially phobic, adults.
Life experiences can mold the brain to become more or less shy over time. Through a process psychologists call "contextual conditioning," the brain attaches a fear "marker" to the details of a situation that causes trauma (place, time of day, back ground music). So when a child gets a disparaging tongue-lashing from a teacher, the student will feel at least a bit nervous the next few times he or she steps into that classroom. But sometimes the brain is too good at making those associations, says Maidenberg, and the anxiety grows like a cancer, attaching itself to the act of entering any classroom or talking to any teacher.
The classic behavior of a child who does not know how to handle these "daggers to the heart," says University of Pennsylvania psychiatrist Moira Rynn, is to avoid any attention at all. In fact, social phobia used to be known as avoidant personality disorder. First, avoidant kids may stop inviting friends over. Some will only speak to certain people, usually their parents, a condition known as "selective mutism" (box). Others develop "school refusal." By avoiding the very situations they need to learn the social skills of adulthood, these children end up diminishing their ability to cope. Not only can a parent who is highly critical train a child to cower, but even the gentlest parent can raise a fearful child. "If parents avoid social situations or worry excessively about what the neighbors think of them," says Richard Heimberg, director of the Adult Anxiety Clinic at Temple University in Philadelphia, "the message to a child is that the world is full of danger, humiliation, and embarrassment."
advertisement
