Hello Dr. Robert!
First off, I would like to thank you for the great work you have been doing through your website.
I am 18 years old on my way to med school in Stockholm.
However there is one issue that has been slightly bothering me for quite a while now. I have always noticed that I tend to get very nervous in specific types of circumstances. For example I get very nervous when I am in public areas where there is a large amount of people. I have also realized that I think too much about what other people may or may not think about me to the point where I get nervous and anxious. This is specially irritating when for example I make a mistake in front of the class room and feel tormented and nervous later on. Most of the time I feel like everything revolves around me that I am the centre of attention when as a matter of fact I am a simple person just the same as everyone else. I know that I should not feel like I am better or more special than everybody else but I just can't help it. As a child my parents used to praise me which boosted my self confidence a lot. I am not really sure if that has a direct correlation with my current situation.
Your thoughts on this would be extremely helpful
Thanks for your kind comment about the website.
Social anxiety (which sometimes is called social phobia) is a common problem—in fact, it is one of the most frequent complaints which bring people into psychotherapy. According to Richards (2003), the prevalence of social anxiety which has reached a level serious enough to be considered an emotional disorder--what used to be called a neurosis—is somewhere between two and seven percent of the adult population of the U.S.
Now feeling nervous in certain social situations such as having to make a public presentation, or going out on a first date is normal, but when everyday situations produce a level of anxiety or ill-ease which interferes with normal functioning, then such anxiety has risen to the point of demanding diagnosis and treatment. The Diagnostic and Statistical Manual (DSM), which is a handbook of diagnostic categories used widely by psychiatrists and psychologists, has defined a set of diagnostic criteria for Social Anxiety Disorder (SAD) which include the following:
1. A marked and persistent fear of one or more social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
2. Exposure to the social or performance situation almost invariably provokes an immediate anxiety response. This response may take the form of a situationally bound or situationally people predisposed Panic Attack.
3. The person recognizes that their fear is excessive or unreasonable.
4. The avoidance, anxious anticipation of, or distress in, the feared social or performance situation interferes significantly with the person's normal routine, occupational (academic) functioning, social life, or if the person is markedly distressed about having the phobia.
I cannot judge from your brief letter if you meet these criteria or not. However, the teenage years are the usual time for the onset of social anxiety disorder, so you should consider them carefully to see if they apply. If they do seem descriptive of your experience, I would suggest getting some counseling help as soon as possible since anxiety disorders have a tendency to worsen with time if untreated.
Social Anxiety Disorder has both cognitive aspects and behavioral aspects as well, meaning that the sufferer is troubled by his or her own thoughts (such as believing, incorrectly, that you are always a center of attention), and also manifests behaviors which are abnormal and counterproductive, interfering with the freedom to function satisfactorily in ordinary life. One common behavioral aspect of SAD might occur in your case if your nervousness in crowded public areas caused you to avoid such places. This, you see, would hamper your ability to move freely through the world. If this avoidance went too far, you might then have to struggle not only with social anxiety, but also with agoraphobia, which is a fear and avoidance of public areas that sometimes becomes severe enough so that the sufferer cannot bear to leave home at all. I understand that your social anxiety has not developed into this kind of problem yet, but this is another reason why I suggest a professional evaluation and possible treatment. It is much easier to treat these kinds of problems before they become incapacitating.
mentioned having been praised lavishly by your parents. Sometimes too
much praise can lead to narcissistic problems which might be one
basis for the development of social anxiety—particularly the
feature of feeling always the center of attention, or of being judged
Another possible factor in the development of SAD is genetic
background. Studies of identical twins raised in different families
show that, if one twin developed social anxiety disorder, then the
other was between thirty and fifty percent more likely than average
to develop the disorder too. This suggests that a factor other than the parental environment and other early experiences must be influential in the development of social anxiety. Other studies have followed people who
as infants showed marked introversion or a fearful nature (probably present from birth), and these studies have
shown that such infants are more likely than average to
develop SAD later in life. Other possible factors may be having
experienced a particularly embarrassing event—such as, for example,
a total meltdown when called upon to speak in public—or having
learned social avoidance from parents by imitation of their unease in social situations.
As I said, you should think about getting some personalized psychotherapeutic help with this problem. In the meantime, I would suggest avoiding drugs and alcohol if you use any of those substances, since the period of withdrawal from them may exacerbate any symptoms of SAD.
Thanks for writing.