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Shyness can deepen into disability for some teens
For those with social anxiety disorder, relating with others can leave them frozen with fear.

Marina Pisano | San Antonio Express-News
November 13, 2007

It was the start of sophomore year at a different college, but after a few weeks, her high hopes for a fresh beginning and busy new social life evaporated, and she spent day after day studying, sleeping and crying.

Indeed, Emily Ford seldom left her dorm room, and with isolation, anxiety and depression mounting, she sometimes scraped her legs with scissors and thought about suicide. Then one evening as she was heading out to eat, she was engulfed by panic. She rushed back to her room, locked the door, slid to the floor and huddled there until morning.

Within weeks she had seen a psychiatrist and had a diagnosis: social anxiety disorder. What she was suffering was real. There were medications and therapy that could make her better.

Emily had taken a step toward recovery. But as she also grappled with depression and an eating disorder, she found her disabling anxiety would get much worse before it got better.

Academics had always been a refuge, and she earned a master's degree in secondary education.

"In school it was easy to force myself to do things because I was on a schedule," Emily says in an interview from Washington, D.C., where the 27-year-old now lives and works. "After college, I knew I had to get a job, but I just couldn't put myself on the next step. That's when it got really bad."

Emily tells a moving story of illness and her continuing process of recovery in a new book, What You Must Think of Me: A Firsthand Account of One Teenager's Experience With Social Anxiety Disorder (Oxford University Press, $9.95). Co-authors are psychiatrist Michael Liebowitz and freelance science writer Linda Wasmer Andrews.

Part of the Annenberg Adolescent Mental Health Initiative series, the book has expert information about the disorder and treatment for teens or anyone dealing with social anxiety disorder, or social phobia, as it's also known.

Some people are shy and reserved by nature and melt with stage fright.

Someone with social anxiety disorder might start out a bit shy, but the fear of social interaction and performing, of humiliation and embarrassment, becomes so extreme and disabling that it affects a teen's ability to function in daily life.

Emily is afraid to talk on the phone. In addition, Emily has battled an eating disorder and won't eat in front of other people or fall asleep in someone's view. She's still afraid to ride in a car, but she counts it a major sign of progress that she can work in a cubicle now among co-workers.

Before treatment that was unthinkable.

For Emily, growing up in a farming community in Upstate New York, the disorder started in fourth grade when she was separated from close friends, who were assigned to other classrooms. She had trouble making new ones. By seventh grade, she felt painfully excluded, not invited to sit with girls at lunch or go to slumber parties or the mall.

In class, she self-consciously worried about every movement she made and was too embarrassed to raise her hand and ask to go to the bathroom.

"By eighth grade," she wrote, "social anxiety was pushing me farther and farther into the background at school. Over the next few years, I gradually disappeared altogether."

The disorder, which experts say is genetic and biological but also linked to stressful life experiences, causes great pain, yet it's trivialized. So, the child is shy. No big deal. The kid will outgrow it. But often they don't. In some cases, social phobia lasts a lifetime, affecting jobs and relationships.

Emily describes a self-perpetuating dynamic. "If you're socially anxious, you probably tend to distance yourself from others. To other people, your behavior may seem arrogant and aloof. As a result, they may indeed end up rejecting or making fun of you, which just confirms your worst fears and increases your anxiety. It's a vicious cycle."

Since she sought help, Emily is getting out and doing more. "I just want to be like over this, but it's little steps at a time. There's a Happy Hour on Friday, and I'm going to make myself go, even if I don't know those people well."

Is she dating?

"Not yet," she says. "I think that's next. I just try to do the best I can. And I laugh at myself all the time."
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