fordCecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for Women’s Voices in many articles over the years. This week, she counsels a 45-year-old woman whose lifelong social anxiety has quenched her appetite for experience.


(Image by rashmi.ravinray via Flickr)

Dear Dr. Ford:
I have always been anxious and shy. I could not date, and I barely survived college. I work as a bookkeeper in a small company owned by a family friend. I am 45 and never worked anywhere else. I am good at my job, and so far have functioned well enough, considering my anxiety level.

The problem is that the company is going to be merged with a larger company in nine months, and I am terrified of both losing this job and terrified of being around new people. I have “habits” that make me feel less anxious: I drive the same route every day, park in the same spot, eat the same lunch, leave at the same time, and take the same route home.  I don’t know if I can function if I have to change anything in my life. 

The Internet has been a good source of information for me, since I rarely go out except for scheduled food shopping, doctor, dentist, and the basics of life. I read that drugs can help people with my condition, but my mother always told me that therapy and drugs were for crazy people. I’m not crazy, but I am in real trouble.  What kind of professional should I see, and what can be done? At least I have nine months to find out if something can help me before the sale of the company is final.



Dr. Ford Responds:

Dear Lorraine:

It sounds as if you have had a very hard time holding yourself together all these years. What you describe goes beyond a picture of “average” shyness; instead, it resembles social anxiety disorder. The good news is that this is treatable. By no means does having this diagnosis mean that you are crazy. On the contrary, you have an identifiable condition that can be treated.

I’m guessing, based on your letter detailing how your have lived your life, that you have been living with most of the following symptoms, which are the signs and symptoms of emotional and behavioral social anxiety disorder:

• Intense fear of interacting with strangers
• Fear of situations in which you may be judged
• Worrying about embarrassing or humiliating yourself
• Fear that others will notice that you look anxious
• Anxiety that disrupts your daily routine, work, school, or other activities
• Avoiding doing things or speaking to people out of fear of embarrassment
• Avoiding situations where you might be the center of attention
• Difficulty making eye contact
• Difficulty talking

You have done a heroic job of “working around” your symptoms and your illness, but now, faced with an inevitable change, you are worried that your “system” may collapse.

Researchers have discovered in recent years, through advances in brain imaging technology, that anxiety disorders may be the result of poor communication between different parts of the brain. In addition, certain images and activities may become linked to strong emotions; once these patterns are established, they are “hardwired”—which is why telling someone that her fears are irrational is so ineffective. There is also evidence that anxiety disorders run in families, so some people are born with a “predisposition” to them. Environmental stressors such as poor parenting, negative childhood events, and trauma can exacerbate these conditions.

What you have been doing is the equivalent of someone who has allergies never going outdoors for fear of encountering plants or grass. Just as an allergic person would take antihistamines so as not to live such a limited life, there are now effective treatments for your condition. Your mother did you a disservice in telling you that therapy and drugs were for crazy people. You have a brain disorder, and both therapy and drugs are available to help.

Your first step is to consult a therapist. Ask about CBT, cognitive behavioral therapy. This kind of treatment aims to help correct your disordered thinking and behavior patterns. Together, you and the therapist can decide if drugs are also indicated, but given how longstanding your problem is, I believe psychopharmacology will be needed. Many new forms of drug therapy, developed to target your symptoms, are not addictive and have minimal side effects. These drugs can act on the chemistry of the brain to help restore “healthier” functioning.

Many people experience considerable relief from these treatments. I think you may want to have a second phase of therapy in which you explore ways to build more things into your life, as well as mourn the years you have lived so painfully because of your condition. This limited, meager way of living has gone on too long—if you use this job change as an opportunity to take action, it will be the opportunity of a lifetime.

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  • Roz Warren September 4, 2014 at 9:09 am

    Forwarding this to a pal who has described herself as having a social anxiety disorder. Untreated as far as I know. Maybe it’ll inspire her to act?