Yipes! How about a fear of everyone?
Imagine a life without friends. A life in which even writing a check at the bank triggers overwhelming anxiety. Ask for a raise at work? Don't be ridiculous. Be grateful someone hired you.
Social phobia, also known as social anxiety disorder, can be devastating. Craig--who asked that his real name not be used--is an attractive and athletic 40-year-old New York executive. He grew up in a family of immigrants with no extended family and few friends. Then Craig's mother became schizophrenic in her early 30s. It was an isolated life.
Craig's natural shyness was exacerbated by his home life, and by the time he was 30 he had no friends, no social life, and a job far below his capabilities. "I have been afraid to do anything," he says. "I have already lost my 20s and 30s. I need to know that I can pull out of this so I don' t lose any more time." Craig was so fearful of standing up for himself that he was repeatedly passed over for promotions. Dating, when he summoned the courage, was a disaster: "All I could imagine was the words Loser, Loser, Loser stamped on my forehead."
Diagnosis. Social phobia is described in the standard psychiatric manual as "a marked and persistent fear of one or more social or performance situations." The disorder has two common patterns: Some people are pathologically shy from infancy, while others--also shy--become pathological when puberty hits. Rarely do social phobics recall a specific humiliating experience or trauma, only the gradual and corrosive inability to function socially.
Most who suffer don't even seek treatment until the disorder has become disabling. Craig first read about this disorder in 1996 but only found the courage to seek treatment seven years later. Although the disorder disproportionately affects women, men are more apt to seek treatment, probably because it affects their ability to earn a living. That was certainly true for Craig. Even with an M.B.A., he was in a job that he was overqualified for. Craig's treatment involved both antidepressant drugs and exposure therapy, in which he acted out all the possible scenarios that had paralyzed him. Says his therapist, Franklin Schneier of Columbia University: "We believe that the problem is sustained by irrational negative thoughts about a social situation." In terms of brain function, the therapy attempts to recruit the rational prefrontal cortex to manage the unruly hippocampus and amygdala.
Craig is not particularly interested in the state of his amygdala. But he has joined a choral group, and his social life has improved. More important, he applied for a new job--a supervisory job--and got it. An achievement for anyone, but for Craig a life-changing experience. He says with a rueful smile, "I just wonder why I haven't been doing this for the last 15 years." -Marianne Szegedy-Maszak
This story appears in the December 6, 2004 print edition of U.S. News & World Report.