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
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
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
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
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
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