Hailey was 26 the first time she felt she was “truly breaking down.” She’d taken leave from her job as a medical records clerk due to an intense episode of clinical depression and anxiety, and although she’d been released by her psychiatrist to return to work, she felt unable to go back. Her symptoms seemed to be escalating rather than diminishing. For the first time, Hailey found herself afraid to answer the phone or even leave her apartment. Driving had even become difficult; she feared the scrutiny of other drivers and became terrified to the point of immobility whenever driving on a two lane highway. She despised social gatherings and felt uncomfortable even in one-on-one conversations with her peers at work. Being spoken to by a supervising doctor or nurse made her especially miserable. Hailey feared she would say something “wrong” and be scoffed at behind her back, or worse, fired for incompetence. Whenever Hailey was forced to go out in public—to buy groceries, for example—she often found herself unable to complete errands. More than once she had stepped out of line at the bank or the drugstore and left in a bundle of nerves. Hailey was particularly self-conscious and believed people often looked at her strangely, as though they could see right through her. This was her worst fear; what would people say if they knew how terrified she felt in situations others found ordinary? She wanted more than anything to be invisible. More than once in the matter of a month, Hailey found herself agitated and sweating profusely. Hailey’s heart would race and couldn’t be calmed. She feared she might be terribly ill, but when she finally brought herself around to seeing her doctor, she was told she was likely experiencing panic attacks. This made her even more fearful; what if she had one of these episodes in public or at work? She didn’t want to look foolish for not being able to tolerate what others could. With the medical leave she had taken coming to an end and still feeling unable to return to work, Hailey found herself quickly losing her independence. She could no longer afford her rent, utilities, or many of the basic necessities, and was forced to move back in with her mother. No matter what she did, she couldn’t seem to catch a break. Her depression and fear of social situations were becoming all too intense. Social Anxiety Disorder Symptoms Social anxiety disorder, or social phobia, is a legitimate problem for many people. Sufferers may experience a strong fear of the judgment or scrutiny of others—fear that may be intense enough to make common experiences feel impossible, such as appearing at a social gathering or even answering the phone. The Social Anxiety Institute lists the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for social anxiety this way: A. A persistent fear of one or more social or 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 embarrassing and humiliating. B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack. C. The person recognizes that this fear is unreasonable or excessive. D. The feared situations are avoided or else are endured with intense anxiety and distress. E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. F. In individuals under age 18 years, the duration is at least 6 months. G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder. Aspects of the Disorder Clinical psychologist and author, Barbara Markway, PhD, explains that social anxiety symptoms fall into three categories: mental anguish, physical distress, and what she calls the “toll of avoidance.” Symptoms of mental anguish include persistent negative self-talk such as: “Is what I’m wearing OK?” “They must think I’m so boring/shy/unintelligent.” “They’ll probably know right away how nervous I am.” Physical distress symptoms may include shortness of breath, racing heartbeat, excessive sweating, nausea, digestive distress, shaking, and tightness or pain in the chest. These anxiety symptoms can be overwhelming for many sufferers. By the “toll of avoidance,” Markway explains that social anxiety sufferers frequently avoid important situations or potentially worthwhile relationships as a result of their anxiety. The buildup of such avoidance can be costly to a sense of well-being, and can leave the sufferer feeling depressed and hopeless. Some social anxiety sufferers use alcohol or chemical substances in order to avoid or dampen their social anxiety symptoms. Markway calls this kind of self-medicating in the social anxiety sufferer “partial avoidance.” Treatment There is effective help for individuals who experience social anxiety disorder, however. Therapies that incorporate cognitive behavioral therapy (CBT) are especially effective when combined with certain pharmaceutical treatments. Hailey was able to begin healing her mental and emotional health challenges with the right doctor, therapist, and social support. She found that progress took time but with new habits in thinking and behavior, and as a result of finding the right medication for her, healing was a real possibility.