Peter (not his real name) was a smart, savvy businessman with a PhD and a bright future. He had quickly climbed the corporate ladder, but when he was offered another promotion -- one that would put him at the top of his division -- he turned it down, jeopardizing his career. Why? The thought of being the center of attention in a major meeting, required in the new position, threw Peter into a blind, desperate panic, complete with physical symptoms like flushing, sweating, and heart palpitations.
The first step is to rule out the possibility that your symptoms are being caused by a medical condition that is not psychiatric. Among the conditions that produce symptoms similar to those of anxiety are hyperthyroidism or other endocrine problems, too much or too little calcium, low blood sugar, and certain heart problems. A thorough evaluation by your health care provider will determine if any of these conditions are the cause of your symptoms.
If no other medical culprit can be found and the...
Peter had what psychiatrists call circumscribed social anxiety disorder (SAD) -- an intense, irrational, and persistent fear of being scrutinized or negatively evaluated by other people. People with SAD, also known as social phobia, tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. Social anxiety disorder can be "circumscribed," like Peter's (he only feared being scrutinized at work), or "generalized" -- a much more debilitating condition that can make everything from walking to a table at a restaurant to attending your best friend's wedding a cause for sheer terror.
In February, two antidepressant drugs, Effexor and Zoloft, were added to a list of about a dozen approved medications for social anxiety disorder, sparking renewed interest in this little-known condition. Is social anxiety disorder just another name for being really shy?
Putting the Brakes on Life
Not at all, say many leading psychiatrists. "Many people are a little bit shy. If you're shy, you might be somewhat uncomfortable in situations such as going to a party where you don't know anyone, but you do it. You give yourself a push, you go to the party, after a while you relax and talk to people," says Rudolf Hoehn-Saric, MD, who heads the Anxiety Disorders Clinic at Johns Hopkins University School of Medicine. "The social phobic person, at the prospect of the same party, would be overwhelmed by such anxiety that [he or she] would have a physical reaction -- perhaps nausea, sweating, heart racing, dizziness -- and would avoid it if at all possible. It's a matter of degree."
In other words, being shy can complicate your life. Having social phobia can stop it in its tracks. "The hallmark of social anxiety disorder is that it causes impairment in your function," explains Sy Atezaz Saeed, MD, chair of the department of psychiatry and behavioral medicine at the University of Illinois College of Medicine at Peoria and co-director of the University's Anxiety and Mood Disorders Clinic. A high school student -- many adolescents have social anxiety disorder -- might be so overwhelmed by the fear of standing up to give a report that he can't complete assignments and fails classes. For Peter, the businessman, social anxiety disorder endangered his career advancement.
"I've treated patients who are very competent, but have jobs well below their capacity because they're afraid of asking for a promotion or going out and looking for a better job," says Hoehn-Saric. This might explain why some 70% of people with SAD are on the lower end of the socioeconomic scale and nearly 50% fail to complete high school.