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David Baxter

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No longer a prisoner of panic
09/26/06
by Shawn Rhea, Asbury Park Press

Kristen Silary was at a restaurant with her mother and grandmother the first time she became uncontrollably nervous about what other people might be thinking of her.

"When we got to the restaurant my stomach started hurting and I had to leave and go to the bathroom," Silary said.

Only 12 at the time, Silary, now 19, didn't realize she was having a panic attack.

"I had the whole racing heartbeat and I couldn't breathe and I was clinching my fists," said Silary, of Voorhees.

Even when the attack began to subside, Silary couldn't bring herself to leave the restroom. "I was fearful of what people were thinking about me and that everybody was looking at me," she said.

When Silary's mother learned of the episode, she wanted to take her daughter to the doctor. But she convinced her mom that it was a fluke occurrence.

However, the attacks worsened over the next four years and they were most intense when Silary found herself in social situations. "It got to the point where I couldn't leave the house," she said.

At her worst point, Silary found herself experiencing the attacks as often as twice daily. At school, she'd avoid being called on in class and had to sit next to the door in case she felt an attack coming on.

Finally, during her junior year of high school, Silary's mother insisted her daughter see a doctor. After running several tests that came back normal, Silary's pediatrician diagnosed the then 16-year-old with social anxiety disorder, a condition where individuals fear interacting with people due to an overwhelming feeling that they will be negatively scrutinized.

"They're terrified," said Rhona Brown, a Cherry Hill-based psychologist specializing in child and adolescent care. "In social situations they can experience heart palpitations, shakiness, blushing, nausea, headache and stomach-ache."

There are no definitive statistics on how many children and adolescents are living with social anxiety, but about 13 of every 100 youngsters ages 9 to 17 experience some type of anxiety disorder, according to the U.S. National Mental Health Information Center.

And, recent national surveys found about 5 percent of American children and teens have social anxiety disorder, according to the University of California, San Diego, Web site veryshy.org.

Young people with social anxiety are living with a real and debilitating condition that can be the root of a long list of problems, including poor school performance, isolation and depression, say experts.

For example, about 75 percent of children with social anxiety disorder have no or few friends, according to a paper written by Canadian pediatric psychiatrist Dr. Jim Chandler. Half of socially phobic children aren't involved in any after-school activities, half say they don't like school and 10 percent refuse to attend school, he reports.

"Social anxiety isn't shyness," explained Brown. "A shy kid is the one that's slow to warm up to a crowd, but once they get started, they may be the life of the party.

"Social anxiety is a marked condition. If you've got a kid who gets sick every time there's a birthday party or it's time for school and there's no (logical) reason for it, then that may be the child with social anxiety."

One of the baffling aspects of social anxiety is that it can appear to strike suddenly, say mental health experts. Kids who are perfectly comfortable and talkative around family and close friends may suddenly freeze and experience a host of physical ailments when placed in unfamiliar situations, such as eating at a restaurant or working on a group school project.

That's exactly what happened with Silary, who, before her first attack, hadn't experienced any direct fear associated with social situations. "I've always had the same group of friends from the neighborhood," she explained.

But, as her circle began to widen, so, too, did her anxiety about meeting new people or being put into the spotlight. "When friends would call and ask me to go out, I'd make excuses," she says.

When she turned 16, Silary finally began to get a grip on her fear with the help of medication. Her doctor prescribed a low dose of the anti-anxiety medication Lexapro (escitalopram, known as Cipralex in Canada and the UK), which Silary takes once daily. "I haven't experienced any side effects, which is lucky, because my doctor told me it usually takes people a long time to find a medication for something like this," she said.

The treatment has helped Silary take on a public job working as a waitress and assistant manager at an area International House of Pancakes. She also attends Camden County College and gives talks to teens about social anxiety.

"The funny thing with it, is I'm very much a people person," said Silary. "So, my mom and I were, like, how could I have social anxiety? But what I really focus on now is how I've changed, and that someone with a mental illness can have a successful life."
 

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