Hi - Questions about Tourette Syndrome and Social Anxiety

[Zach]

I'll try to keep this short, but if any more details would be helpful in understanding my problem I feel very comfortable discussing them. The main reason that I decided to join this forum were the comfort that anonymity provided and the kindness and support that I have seen the members show towards others.

I think that on of the main problems may be that I never really developed the social skills that most people have. When I was younger I would prefer to stay at home and spend time with my cousins (who live in the same neighborhood as I do), my family, etc. I usually did not want to go to birthday parties, school events, etc. and often resisted my parents' attempts to get me to socialize more. I spent most of my childhood interacting with my family and little of it with other people(outside of school). I feel very comfortable around them and can be very outgoing at home and with people that I know.

My problem seems to be around large numbers of people or people that I don't know well. I'm not sure if I get any tics when I am in these situations, but I feel extremely self conscious. When I talk, I can't speak as loudly and clearly as I normally would. I sometimes have trouble enunciating words correctly and my voice sometimes cracks. I feel embarrassed very easily like this, and lose all self-confidence that I normally have when around only a few people who I feel comfortable with. I feel intimidated easily, afraid of embarrassing myself, which I often feel that I do. If I do or say something stupid or clumsy, it often pops into my mind and brings back feelings of embarrassment/stupidity. I can usually deal with this by telling myself to forget about it and stop stressing out over it.

Being this self-conscious did have a positive effect too. I feel that I am a fairly stable person, not prone to suicide or eating disorders, have no motivation to use drugs, etc. Being self-conscious about my appearance led me to learning about physical fitness and learning a lot about exercise and eating healthy. I exercise regularly, am in good shape, and eat healthy. I realize that many people who are self-conscious can end up developing eating disorders, turning to steroids, etc. I don't have any of these problems and have not let my self-consciousness take over this aspect of my life and push me to any extreme measures. Another reason that I got into exercise & fitness was because I thought that it would improve my confidence and allow me to overcome my fears of embarrassment. It hasn't and I think that for a while I was relying on this change in my life to magically fix my other problems.

I don't know whether stress is a factor here, but at the moment I am under a lot of stress. I have SATs, an exam for an AP class, and a large project to worry about at school. I have regular school work to do and am starting to feel stressed about getting into college. I could make a huge list of my problems, but I don't see the point in doing so. I'm hoping that after these exams are over I'll have a break and be able to relax. However, while stress could be contributing to my social anxiety/awkwardness, when I don't have much going on I still feel just as self-conscious and awkward.

I think this summarizes everything pretty well. I'm sure there's more that could be included, I have spent a lot of time thinking about and trying to analyze my problem and have a good idea of what contributes to it and how much trouble I'm causing myself by letting this influence me so strongly. What I'm not sure about is the best way to go about overcoming this. So much for keeping it short .

One more thing, I read here somewhere and in several other places about Agoraphobia (can't remember the name/spelling, it was something like that), trying to avoid situations that cause anxiety and therefore causing more anxiety because of the time spent fearing and trying to escape from anxiety. I think that's very relevant here, but I don't know much more about it than that general explanation.

 

[David Baxter PhD]

Definition of Agoraphobia

Agoraphobia: An abnormal and persistent fear of public places or open areas, especially those from which escape could be difficult or help not immediately accessible. Persons with agoraphobia frequently also have panic disorder.

People with agoraphobia characteristically become anxious if they even think about being trapped in a situation where it might be difficult to leave the situation. People with agoraphobia also characteristically avoid the situations which bring them anxiety or panic.

Agoraphobia is highly variable in severity. People with mild agoraphobia often live normal lives by avoiding anxiety-provoking situations. But, in the most severe cases, the victims may be incapacitated and be homebound.

The disorder affects women twice as often as men, tends to start in the mid to late 20's and the onset may appear triggered by a traumatic event.

The treatment for agoraphobia involves behavior and cognitive therapy and/or medications. As might be expected, people with a mild case of agoraphobia do best while those with a severe case may be plagued for many years, if not the remainder of their lives.

Agoraphobia comes from the Greek "agora", marketplace + "phobos", fear = fear of the marketplace.

 

[Retired]

Thanks for the additional information, Zach.

The question I would follow with is how important is it to you, at this time to overcome your apprehension about socializing?

Social skills are learned and come with practice, so like any other skill, you would start in a small, controlled environment, perhaps even doing some role playing with a trusted friend or family member, then trying out your skills in public.

You may want to enroll in a group such as Toastmasters or something like the Dale Carnegie courses.

You may even want to try some assertiveness training exercises, which might help speak with more self assurance.

One such easy exercise is to take a dollar bill, and walk into a store and ask for four quarters. Then walk into another store with your four quarters and ask for a dollar bill.

You can make the exercise more complex as you go along, like asking for dimes and nickels and so on. Expect to be refused from time to time, but when you ask for the change, practice looking the person in the eye and speak up..

The fact of the matter is, Zach, that we cannot diagnose whether you are agoraphobic, or if it is social anxiety or just shyness associated with Tourette.

In order to know for sure, you would be advised to ask to be seen by a mental health specialist, preferably someone with knowledge and experience with people with Tourette.

Many physicians know a little about Tourette, but most do not have sufficient clinical experience with the disorder to understand the complexities of the associated psychological conditions that often accompany Tourette Syndrome.

The Tourette Syndrome Association local chapter can be helpful in locating a local practitioner with that kind of expertise.

Being this self-conscious did have a positive effect too

By finding the positive aspects of your makeup will be the key to finding ways to use these attributes for making the right career choice and how you live your life as a successful adult.

Your attitude is inspiring, Zach and the research you are doing will provide you the information to make the right choices in your life.

Do you have easy access to be seen by your family doctor and to be able to ask for a referral to a specialist?

 

[NicNak]

I agree with TSOW. Zach your attitude is inspiring. I am glad you are able to see the silver lining.

 

[Zach]

The question I would follow with is how important is it to you, at this time to overcome your apprehension about socializing?

While I definitely have a good life as I am now, I'm seeing more and more how much trouble this anxiety/shyness has already caused for me and will continue to cause if I don't do something about it. So I think that it's very important for me to overcome this problem soon.

I think the main difficulty for me is that I don't see a way out. I do have hope for resolving it, but I can't see the light at the end of the tunnel yet. It's hard to imagine actually changing my situation and how I would progress from how I am now to how I would like to be.

I would find medication a tempting solution if it were to be offered as an option by my doctor, but I'd prefer not to depend on anything to help me feel comfortable socializing if I don't need to. If I was worse off or the medication was to be a temporary measure to make me calm/comfortable enough to start socializing more and begin making progress, I wouldn't mind so much. But I don't want to be permanently on a medication for a problem if I can fix it and be just as well-off without medication.

Social skills are learned and come with practice, so like any other skill, you would start in a small, controlled environment, perhaps even doing some role playing with a trusted friend or family member, then trying out your skills in public.

You may want to enroll in a group such as Toastmasters or something like the Dale Carnegie courses.

You may even want to try some assertiveness training exercises, which might help speak with more self assurance.

One such easy exercise is to take a dollar bill, and walk into a store and ask for four quarters. Then walk into another store with your four quarters and ask for a dollar bill.

You can make the exercise more complex as you go along, like asking for dimes and nickels and so on. Expect to be refused from time to time, but when you ask for the change, practice looking the person in the eye and speak up..

I have heard similar suggestions before. I haven't done it before because it seems like it would feel more awkward then regular social interaction. I've never heard of Toastmasters or the Dale Carnegie courses. I will look into these.

The fact of the matter is, Zach, that we cannot diagnose whether you are agoraphobic, or if it is social anxiety or just shyness associated with Tourette.

I understand this and was not expecting a diagnosis .

In order to know for sure, you would be advised to ask to be seen by a mental health specialist, preferably someone with knowledge and experience with people with Tourette.

Many physicians know a little about Tourette, but most do not have sufficient clinical experience with the disorder to understand the complexities of the associated psychological conditions that often accompany Tourette Syndrome.

The Tourette Syndrome Association local chapter can be helpful in locating a local practitioner with that kind of expertise.

Do you have easy access to be seen by your family doctor and to be able to ask for a referral to a specialist?

Yes, I can go to my family's doctor, but I started seeing a psychologist because of my tourettes and shyness, and I still see him occasionally. I was also seeing a doctor who I believe dealt specifically with tourettes, but I don't see him anymore since they aren't much of an issue right now.

 

[Retired]

I started seeing a psychologist because of my tourettes and shyness

Great! Have you asked your psychologist about offering some strategies to deal with your social anxiety?

I would find medication a tempting solution if it were to be offered as an option by my doctor

Medication might be only one option, and would depend on the diagnosis. Your psychologist may decide to work in conjunction with your doctor to develop a joint strategy of therapeutic options.

As I am sure you know, the disorders we are talking about are thought to be caused by chemical imbalances in brain chemistry, and some diagnoses require a stabilization of brain chemistry through the use of appropriate prescription medications.

Sometimes the goal in a joint therapy program is to prescribe a medication to control anxiety, and your psychologist would work on training exercises to develop the skills you need.

At some point, you and your doctor may find that meds are no longer necesssary, but depending on the condition being treated, it might take longer to maintain the correct brain chemistry balance much like diabetes requires long term intervention.

I've never heard of Toastmasters or the Dale Carnegie courses

Dale Carnegie Seminars for Young Adults and Toastmasters International are two that came to mind, but you may wish to investigate other similar public speaking and social interaction seminars.

I know that Dale Carnegie has books based on their seminars that are available in libraries and on Amazon.

The goal of this type of seminar is to develop public speaking skills, to learn skills to meet and create a favorable impression on people and to improve one's self confidence.

 

[Zach]

Great! Have you asked your psychologist about offering some strategies to deal with your social anxiety?

Yes, I have discussed it with him. He has suggested simple strategies, like trying to start conversations with people at school and build up confidence from that. I'm a quiet person at school, but I have done this occasionally.

I know that Dale Carnegie has books based on their seminars that are available in libraries and on Amazon.

The goal of this type of seminar is to develop public speaking skills, to learn skills to meet and create a favorable impression on people and to improve one's self confidence.

I've heard of his book, How to Win Friends and Influence People. I looked at the websites you mentioned and they looked interesting. I'll look into those groups and see what else I can find in my area. Thanks for showing these to me

 

[goldilox]

Hi Zach....im new aswell, youve found a very welcoming site.

 

[Retired]

I have discussed it with him. He has suggested simple strategies, like trying to start conversations with people at school and build up confidence from that. I'm a quiet person at school, but I have done this occasionally

It's the practice that should help over time; as with any new learned skill, there may be occasional setbacks, so don't be discouraged if you happen to goof. In fact at the best of times, when meeting someone new, and trying to make friends, there may be something in the chemistry of the two people that doesn't quite click and you walk away shaking your head, wondering what went wrong....that happens to all of us. But if you analyze your practice experiences, and learn from the goofs, you can then modify your technique the next time.

Based on remarks you made earlier, Zach, I am assuming your tic activity does not appear to be a problem when dealing with people....if it is then correct me.

When building a friendship, remember that 1) people love to hear their names said out loud, and 2) that people love talking about themselves.

Using this information, you can hit the ground running in starting a conversation. When you hear the person's name in the introduction, make an effort to remember it, and use it often during your conversation.

Then ask a lot of questions, in order to elicit responses from your new acquaintance, using the 5 W's: Who, What, Where When and How. That way you are not under pressure to think of something clever to say, but if you are asked a question, you can answer...and then follow up with another question.

Just keep asking questions, such as "Where do you live?" "What is your career plan?" "Where do you plan to go to university?" "How did you learn about that?"

Based on your interaction in this discussion, Zach, I would say you demonstrate intelligence, a warm personality and certainly someone that would be interesting to chat with.

So in working with your psychologist your perceptions that make you feel apprehensive about meeting people should change, and by practicing the skills being suggested, you should do just fine.

BTW, Zach, what are your own plans for further education and eventually a career?

(notice the question technique, in order to hopefully keep the conversation going?)...

 

[Zach]

Based on remarks you made earlier, Zach, I am assuming your tic activity does not appear to be a problem when dealing with people....if it is then correct me.

I don't think it is. However, when I get very nervous movements such as turning my head can feel awkward and jerky, I'm not exactly sure how to describe it. That could be related to TS, but I have no idea whether or not it is, it just seems like a possible nervous tic.

It's the practice that should help over time; as with any new learned skill, there may be occasional setbacks, so don't be discouraged if you happen to goof. In fact at the best of times, when meeting someone new, and trying to make friends, there may be something in the chemistry of the two people that doesn't quite click and you walk away shaking your head, wondering what went wrong....that happens to all of us. But if you analyze your practice experiences, and learn from the goofs, you can then modify your technique the next time.

When building a friendship, remember that 1) people love to hear their names said out loud, and 2) that people love talking about themselves.

Using this information, you can hit the ground running in starting a conversation. When you hear the person's name in the introduction, make an effort to remember it, and use it often during your conversation.

Then ask a lot of questions, in order to elicit responses from your new acquaintance, using the 5 W's: Who, What, Where When and How. That way you are not under pressure to think of something clever to say, but if you are asked a question, you can answer...and then follow up with another question.

Just keep asking questions, such as "Where do you live?" "What is your career plan?" "Where do you plan to go to university?" "How did you learn about that?"

Based on your interaction in this discussion, Zach, I would say you demonstrate intelligence, a warm personality and certainly someone that would be interesting to chat with.

So in working with your psychologist your perceptions that make you feel apprehensive about meeting people should change, and by practicing the skills being suggested, you should do just fine.

Thank you for this advice, this probably is the best way to approach it. It often seems like I never make any progress, but if I look back a year or two and compare myself back then to how I am now, I am very happy with the progress that I've made. Looking at it this way, the solution may be to simply build up a foundation of positive experiences and learn the skills that I haven't developed. It's still very difficult for me to convince myself to try anything that has any risk of embarrassment. I feel embarrassed very easily and hate the feeling, which, along with the embarrassment caused by my behavior meant to prevent that, probably contributes a lot to my problem.

BTW, Zach, what are your own plans for further education and eventually a career?

(notice the question technique, in order to hopefully keep the conversation going?)...

I'm currently torn between two career paths, although I think I've made up my mind. I am very interested in making computer games, and have been learning about this for a while. This is probably the career that I will pursue, which means I'll be going for a degree in computer science when I go to college.
However, ever since I became interested in physical fitness, a career as a personal trainer has been very appealing. I enjoy exercise and like training others. My father used to be a power lifter and amateur boxer when he was younger, and taught me a lot about exercise and nutrition when I became interested in it. So I'm probably going to learn more about this in college and maybe train friends or family members, but probably not pursue it as a career.
On the other hand, I could probably support myself as a personal trainer and work on the computer games as more of a hobby. It's still hard to decide which one I want to do

 

[SoSo]

:welcome2:
SoSoeek:

 

[Retired]

On the other hand, I could probably support myself as a personal trainer and work on the computer games as more of a hobby. It's still hard to decide which one I want to do

Take it one step at a time, and keep all options open. Maintaining both interests can certainly work for you, and in the meantime you can do research on the future business prospects of each career.

when I get very nervous movements such as turning my head can feel awkward and jerky,.........it just seems like a possible nervous tic.

Zach, As you probably know, Tourette tics are involuntary, and one's tic repertoire can vary over time, waxing and waning over weeks and months and even years.

Not every tic emerges in every situation, and some tics seem to emerge specifically under specific situations or conditions.

Furthermore, anxiety in people with Tourette will usually exacerbate (makes more severe) tic activity. Our baseline anxiety level is often higher than the general population, so added stress increases our anxiety level and thus increases tic activity.

If you have been diagnosed with Tourette, Zach, then whatever tics you may present are attributable to your Tourette, and should not be thought of as merely "nervous tics"

By modifying this little misconception, you immediately lift the pressure and perhaps guilt from yourself, and the erroneous thinking that "if I would only control my nerves, I would not be doing this"

Tourette tics are involuntary and need to be expressed, because tic suppression can create added stress, added anxiety and worsening of tic activity.

BTW in some instances, some people with Tourette can actually temporarily suppress their tic activity through practice, but the fact is for these people they need to allow for a time to eventually release the built up tic activity. If you want to know more about this, let me know and I can elaborate.

As you gain more insights into Tourette, you will find that there are many people with the disorder who have avoided a correct diagnosis, just because they were convinced their tic activity was due to "nerves".

I say this because as you go through life, by understanding the complexities and related effects of Tourette, you will be much better equipped to deal with situations that arise.

In my own case, my personal comfort level with myself and my body, my perception of myself and my ability to understand why I behave the way I do improved exponentially after I received an official diagnosis and later learned more about the disorder.

 

[Zach]

Take it one step at a time, and keep all options open. Maintaining both interests can certainly work for you, and in the meantime you can do research on the future business prospects of each career.

I intend to.

Zach, As you probably know, Tourette tics are involuntary, and one's tic repertoire can vary over time, waxing and waning over weeks and months and even years.

Not every tic emerges in every situation, and some tics seem to emerge specifically under specific situations or conditions.

Furthermore, anxiety in people with Tourette will usually exacerbate (makes more severe) tic activity. Our baseline anxiety level is often higher than the general population, so added stress increases our anxiety level and thus increases tic activity.

If you have been diagnosed with Tourette, Zach, then whatever tics you may present are attributable to your Tourette, and should not be thought of as merely "nervous tics"

I understand this, and I guess what I said wasn't worded well. I was wondering if what I described might be a ts related tic brought out by nervousness, or just a reaction to the anxiety and unrelated to ts.

By modifying this little misconception, you immediately lift the pressure and perhaps guilt from yourself, and the erroneous thinking that "if I would only control my nerves, I would not be doing this"

I think I end up making my nervousness worse that way very often.

Tourette tics are involuntary and need to be expressed, because tic suppression can create added stress, added anxiety and worsening of tic activity.

BTW in some instances, some people with Tourette can actually temporarily suppress their tic activity through practice, but the fact is for these people they need to allow for a time to eventually release the built up tic activity. If you want to know more about this, let me know and I can elaborate.

I didn't know this, I always thought of the tics as habits or urges, almost like the urge to scratch yourself if you feel itchy. I didn't know that they could build up, like stress or frustration. Would you please explain more about this?

As you gain more insights into Tourette, you will find that there are many people with the disorder who have avoided a correct diagnosis, just because they were convinced their tic activity was due to "nerves".

I say this because as you go through life, by understanding the complexities and related effects of Tourette, you will be much better equipped to deal with situations that arise.

In my own case, my personal comfort level with myself and my body, my perception of myself and my ability to understand why I behave the way I do improved exponentially after I received an official diagnosis and later learned more about the disorder.

I feel comfortable about about the fact that I have tourettes, but I'm sure that would be different if I still had serious tics to deal with. I see there is a lot more to it than what I already knew, I was never very concerned with it after my tic activity died down.

 

[Retired]

I always thought of the tics as habits or urges, almost like the urge to scratch yourself if you feel itchy. I didn't know that they could build up, like stress or frustration. Would you please explain more about this?

I would describe Tourette tics more like urges, than habits. Habits imply a behavioural component, which can be modified thereby giving the false hope of reducing or eliminating tic activity.

As for tic suppression, most people with Tourette with whom I have spoken, who can temporarily suppress their tics, will usually say the tics can be held back only a limited time. After that, it's like that itch that needs to be scratched, or the eye that needs to be blinked.

So for those who suppress tics, they need a way and a time to be able to relieve the stored up need to tic. They might excuse themselves from whatever they might be doing, go into a stairwell, a quiet room, into a car and express their tics, if that's what they need to do.

Others develop ways of redirecting tics while in social situations, by flexing muscles that are not obvious to others, curling toes inside their shoes, or performing movements that appear socially innocuous, in order to camouflage their tics.

Tourette tics cannot be stopped voluntarily, and if suppressed, usually require expression sooner or later. However, in some people with Tourette, tic activity subsides at a later age, while in some the tic activity waxes and wains throughout their lives, with an ever changing repertoire of tics.

Zach, this Psychlinks post gives an overview on the complexities of Tourette tics.

 

[David Baxter PhD]

Just added: See http://forum.psychlinks.ca/tourette-syndrome/17152-stress-and-tourette-syndrome.html

 

[liannalee]

Hi, I'm Zach. I'm hoping that I can find some helpful advice on this forum and be of some help to the other people here as well. I have Tourette's Syndrome and social anxiety. I'm very self-conscious and probably a bit of a perfectionist too. I'm not what else to put here and I need to get some sleep, so I'll leave it at that for now

Hi there!

My eldest has TS. It has been a struggle for him, but don't despair. There is help out there. Did you know there are doctors with TS? (I had one of them come to TO and speak with us - he is a surgeon) There are also a slew of famous people who have TS.

My son is 29 now, but when he was first diagnosed at age 7, I sat on the Board of Directors TSFC and learned so much. Armed with information is the way to tackle this condition.

Nice to meet you and hope to see you around.

liannalee

 

[Retired]

Welcome to Psychlinks, Liannalee and thank you for joining the discussion. Your experience will certainly be valuable in providing further insights into Tourette Syndrome.

doctors with TS? (I had one of them come to TO and speak with us - he is a surgeon

You are no doubt referring to Mort Doran, my personal hero. It was one of Mort's early interviews on the CBC that alerted me to the fact that I might have Tourette. I found his willingness to share his personal experiences inspirational, which motivated me to become an advocate for Tourette.

Would you care to share your son's challenges and successes in dealing with Tourette, which might provide further insights for Zach?

How did your son deal with his schoolmates and did he face challenges in building friendships and relationships in early adulthood?

 

[Zach]

Thanks for all the information you've been providing, I'm going to read through some of the stickies on tourettes, shyness, and anxiety.

---------- Post added later and automatically merged ----------

I met with my psychologist recently, and I have decided to take his advice and start on a very low dosage of Zoloft to help with my social anxiety. From what he told me it can be very effective, so I'm hoping that it will help me deal with my anxiety and feel more at ease around other people.

 

[Retired]

Progress begins with the first step.
:cool2:

Do keep us posted, Zach.

 

[liannalee]

Welcome to Psychlinks, Liannalee and thank you for joining the discussion. Your experience will certainly be valuable in providing further insights into Tourette Syndrome.



You are no doubt referring to Mort Doran, my personal hero. It was one of Mort's early interviews on the CBC that alerted me to the fact that I might have Tourette. I found his willingness to share his personal experiences inspirational, which motivated me to become an advocate for Tourette.

Would you care to share your son's challenges and successes in dealing with Tourette, which might provide further insights for Zach?

How did your son deal with his schoolmates and did he face challenges in building friendships and relationships in early adulthood?

Yes, I was speaking about Mort Doran. Like you, I am awe of all of his accomplishments. I suppose you know he flies a plane too? He had terrible trouble with authority figures (read - police - and it's a tic) and was always getting in trouble at airports. He would poke people's backs and they would get very angry and call for help. Welp, more than once he ended up missing the flight. (hence the pilot's license) lol

Watching him speak and talking to him was amazing. He fidgets with his watch but cannot do that while operating. To "replace" the tic, he fidgets with his gloves while in the OR. Very few patients opted out of having an operation, in spite of some fairly complex tics.

I wish I could share good news about my son, but alas not all TS stories are happy endings. One of the reasons I stepped down from the board of directors was because of the severity of his symptoms.

But don't despair, I know more success stories than the other way around.

I believe the key to everything comes with a sense of humour. One lovely lady who had TS was a joy to watch speak. She peppered her angst with the most wonderfully amusing stories. This blond bombshell had trouble with winking one of her eyes and had many interested suitors looking her way. It was a good thing her hubby had a good sense of humour too.

Alas, I have rambled on.


liannalee