300.23 Social Anxiety Disorder/Social Phobia

DSM-IV Diagnostic Criteria for Social Anxiety Disorder:

A. A marked and 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 humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

C. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.

D. The feared social or performance situations are avoided or else are endured with intense anxiety or 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 the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

H. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.

Although technically there may be some aspects of social anxiety disorder that are relevant in my case, it should be noted that there are conditions, and that this is not a primary diagnosis, as disordered eating and body image issues and long-term depression (and eventual loss of ties and status), seem to be the more significant factors, and which have resulted in a lack of social opportunities.

A significant issue is that in my teens I didn't recognize I was anxious. It may sound strange, but I had no conscious perception that I was afraid. I just thought that as a result of being in adolescence, one of the ways in which I was affected was that I was sweating more, maybe due to having something different about my metabolism, which some other teens shared to a similar extent, but which most did not - although most were probably experiencing increased perspiration at least at times.

My attempts at relaxation were instinctual. I found that it helped to daydream about sex, such that the unpleasant symptoms were replaced by more pleasurable ones. I also stopped trying as hard to concentrate while in class.

Looking back now I can see that I probably was nervous about taking PE (it was not compulsory, and I hadn't taken it in Grade 9 due to my ichthyosis, but in Grade 10 I think I took it to face my fear, and also because my father admired athletic accomplishment); that I might have been affected by my father giving me a 'Winning isn't everything it's the only thing' photocopy after I came first in Grade 9 (I was the top advanced level student); that I was experiencing some sibling rivalry because my sister had moved in with us while the previous year I had been an 'only child'; that I had picked up on increased tension in the household because my father's girlfriend was not happy; and because after spending a summer with my mother in which my eating habits had stabilized and were in effect normal, I was once again out of control at the start of the new school year, and was worried about the impact on my appearance, as well as experiencing a lot of guilt and shame about my lack of control.

Later on, I still didn't consciously fear social situations, I didn't have conscious awareness that I had performance anxiety, that I feared judgment or disapproval.

As time went on, and I became an adult, had not attended university or managed to get a job, I experienced social discomfort due to my lack of status. It was unpleasant to converse with new people, it was unpleasant to attend family gatherings in which everyone else had positive news to share. When young, I had looked forward to a certain level of achievement commensurate with my early potential. When the added social stigma of being on welfare and contracting genital herpes was added to this, my choices were either to make up more appealing facts about myself, deal with continual judgment and rejection, or stop having contact with people.

As the years went on, it became a fear of mine that I would run into someone I used to know when I was a promising student, especially after I first accepted welfare - and it should not be underestimated how this contributed to the constant wish to die that was evident by the time I was 23-24. This might have been a form of social anxiety, but for the most part when I went out it was mainly that I tried to get it over with, as a kind of ordeal. I think the issue was that I was not moving forward, I had no future prospects, I was lost and unconnected to life through circumstance, my experiences were not like those of others my age, and I no longer fit anywhere.

My social anxiety was valid. It doesn't help to say I feared negative appraisals - it makes me sound irrational. I had lost status. I had lost connections and I was rapidly losing potential. I had no one asking me to go out, and I had no realistic places to go.

I myself focused my energy such that I would be able to enter Grade 13 on time and hopefully get back on track. I did as much as was within my power to do, or my abilities or resources. It is not easy to get back into the public school system when you have lost the momentum of it, and it is not easy to get back into it when your experiences have left you unlike the other students your age. At this time I began to find it harder to think of friendships as genuine - I had conflicted feelings, felt often embarrassed about my baggage and tried to hide it, and often felt conflicted in the presence of those who tried to be my friends.

Certain 'achievements', like attaining a college diploma through correspondence courses, I saw as having little 'real' value. I burned my diploma. My diploma was in Fitness and Nutrition, and since I did not look fit, and since I knew my eating habits, which included bulimia, were unhealthy, I was too embarrassed to talk about my studies. I could have handled more challenging material, but what was the point if I lacked all ability to connect this knowledge in a practical way in my life?

It is probably accurate that I experience social anxiety, but I don't really relate to the wording or focus of the diagnostic criteria. For me, the issue couldn't be solved with medication or desensitization, because I'd have to have actual concrete social activities to participate in in the first place. If I had those, then we'd see if the other things were an issue.

And if a social activity is something I have not found enjoyable in the past, should the focus be on my social anxiety, or on the idea that certain people and I might not be compatible as friends? Or that unless I have some 'work' that is recognized by the people I know, and unless I am not dismissed as pretending to be more helpless than I am, and unless people are more open to complicated communication, it's not very likely I will find interaction satisfactory.

If everything has hinged on me accepting a kind of responsibility that involves me going against my personal ideas, assessments, and insights just in order to fit in and gain respect, how am I ever going to fit in or be accepted by people who demand that I take that kind of responsibility or they can't respect me?

The diagnosis should not be given if the fear is reasonable given the context of the stimuli.

Panic is not the issue. My assessment is usually that I will not find social occasions enjoyable. This is partly because I do not have a recognizable status - occupationally or intellectually. In order to express my ideas well, I have to break through many layers of others' conditioning, and this is something that takes time and usually individual or one-on-one communication. I think it is natural for me to feel self-conscious about inflicting this on others. I don't fear symptoms of anxiety, although sometimes I have experienced them in such situations. It is not the symptoms that bother me: my conscious assessment is that I am willing to face anxiety, to try to deal with it, if there is at least the potential for meaningful interaction with other people. The relationships which have added the most to my life have been those in which detailed exchanges occurred, those in which communication was not superficial, in which we went as far together intellectually and psychologically as it was possible for us to go.

What I fear now is the natural inclination that people have to keep communication light, to keep certain people at arm's length, the need to save face, the need to tell 'kind' lies or avoid saying what you really think. If your life is not just in your head, many of your daily actions, nonverbal communication and relationships represent aspects of essential communication, but if your life is mainly in your head, your requirements in communication may involve a higher degree of analysis and verbalization.

Family get-togethers, which I began to avoid, with great guilt, and many changes of mind after I had decided not to attend, probably had social anxiety issues for me: it was not pleasant to have to admit that I was not in school or progressing normally in my development, especially when in the past I had seemed to be doing well, and since my siblings were still progressing normally. In addition to that, I was the only one who didn't photograph well, and was beginning to gain weight, and so the records of the times would always show me as the one who looked diminished, the one most likely to be weak or ill, from appearance alone. My upbringing was that I had to 'suck it up' and accept that I wasn't doing as well because I wasn't trying as hard, and that my appearance issues were related to weak character, laziness, greediness and sloth. On the surface, everyone accepted everyone in the family, there was no preferential treatment, no judgment, and a kind of unconditional love. But the familial circumstances were definitely stressful for me - I do recognize that now. At the time, I could only see it as a copout, and completely unjustifiable, but at present I don't think that my discomfort was unreasonable for the circumstances. My non-attendance now looks something like an accusation: I am not receiving family support (so in a sense I was beginning to withdraw my support.)

I think my social anxiety had more to do with family than strangers: and in fact when it comes to strangers it might be that I have less to 'live up to'.

I have heard of childhood generalized anxiety disorder, in which a person had experienced a feeling of being shy or nervous all his or her life. I can relate to that, but in my case, it seems like some of my shyness or nervousness might have been related to constantly moving and having to meet new kids when I had ichthyosis, and also related to all the tension in the family home, first because of my parents' verbal and physical violence toward each other while still together, and then all the resentment and games after they separated.

Public humiliation

More than two years ago (I am not sure exactly when, but it was before my 2008 world trip), I learned that the comedian Jay Leno had made fun of part of my website on his program. I didn't see the actual program, but through seeing where my site is linked, I found a place where one of my old tarot cards (the devil) was made fun of. I don't know the actual comments. When I put up my site in the first place, I knew that those cards were 'bad', and I had even offered an explanation of what they meant to me in spite of that. What was said publicly was probably only a general opinion that many people who came to my site over the years might have had.

When people have social phobia, they worry about negative perceptions of themselves - well, what if that worry becomes a reality, in front of potentially millions of TV viewers? Surely it says something about me that I was able to travel around the world regardless, and that what's more, I didn't feel the need to remove my website completely from the web to insure that I would never again have to face public ridicule?

I think there is a lot on xesce.net that could be ridiculed. To me, it is important that it be seen as a whole, because otherwise, the bits and pieces don't make as much sense.

I did feel intense anxiety when I saw the words 'Jay Leno', 'mockery' and then a picture of my tarot card. But I dealt with it. I realized that on a show like his, he needs a lot of material. There is always something new to laugh at. People need to laugh. It gives them a release from the stresses of their lives. And in a way the experience might have made me stronger. We are all ridiculous in some ways. People had laughed at me, but I realized that in a way I was connected to life, that I had my part to play. When people laugh at something or other, they don't get to know the issues involved - that's part of the point. We can't get to know every single person on the planet and all their extenuating factors.

I don't remember exactly when I found out, but it was definitely before I travelled around the world, and the public humiliation did not cause me either to not travel around the world, to pull my website or refrain from putting up anything new, or to kill myself. I am stronger than people think.

As for how I think I come across to others in person:

While visiting cities in which I do not live, I have often been asked for directions. I don't think this necessarily means that I look like a local, but it may mean that if I look like a fellow tourist, I look like an approachable one, and I probably don't look lost. The non- threatening aspect of my demeanour may be the significant factor, but if I looked like a nervous wreck or someone panicking, I doubt I would be approached for directions. Men don't ask for directions. Sometimes they ask the time, occasionally they have asked me out for coffee, lunch, a drink, or to see an exhibit of some kind. Homeless males and females have approached me for money, and I seem to be very frequently approached for particular causes - AIDS/HIV donations are probably the most frequent.

If you are always in the same surroundings, it is possible to get stuck in how you see yourself, and in how the people around you see you. If you identify with this image, it can be a source of stability, but if you don't, it can feel like a crushing burden. Travel is a possible way of opening or widening your perception. People in different parts of the world don't all see things exactly the same. The light in different parts of the world actually is different.