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Do I Have Just Social Anxiety Or Other Diagnoses Combined With SA?

Question:

Hello Dr. Schwartz,

I am writing to you from New Zealand to ask your opinion and ideas about what my “condition.” I think it may be Social Anxiety or something in the lines of that. My “Symptoms” vary so,……..here we go.

I get very anxious when I go out of the house. For example, walking down the street in a town I think people in cars may be staring at me and laughing about how I look or act! And when I’m walking down a footpath & People come towards me I either look down at the ground or at a sign or anything but them, especially making eye contact. Even if I’m at my house alone or with someone, but especially alone, I worry a lot about when I have to go back outside. I worry about future events or meetings with people, even family members!

A lot of the time I have this really strange, unexplainable feeling where I feel like I’m kind of in a dream-like state and things are kind of “unreal” and delirious! I have it most of the time but it gets much worse when I’m in an uncomfortable situation & out of my comfort zone. I looked it up on the net and I heard of something called “‘De-personalization, and another called “De-realisation” and I’m pretty sure they are somehow connected to my Social Anxiety. 

A lot of it has to do with worrying about how I look and appear to other people and how I sound and all sorts of other silly things! I live in a very small town, pretty much a village, but I’ve only been here a few years. Because of my Social Anxiety, or whatever, I have acted strange and people here have definitely noticed and have commented to me and payed attention to me. So it’s definitely not my imagination. I even have people driving by the house I live in and slowing right down to have a look at the house.

Some times I am much more sociable and I can go out and I find it easier but there are other times I cant even go out to the mail box or stand by the window in case someone sees me! I know some of it is probably paranoia caused by Social Anxiety and racing thoughts but I’m pretty sure some isn’t.

Like I said before, I live in a tiny town where most people were born and all Know each other. I don’t really know anyone except people I meet when I have to hitchhike daily to get to the slightly bigger town for stuff. I know I have acted pretty damn strange when I get really anxious and get that delirious strange feeling. People here have made comments and most likely think that I’m much worse then I really am.

To tell the truth, Social Anxiety, if I have it, is not that serious in some ways but sometimes the physical things that happen and things I may say make me look much worse then I actually am. Because of that I get even more anxious! Because, to tell the truth, a lot of the time I can hold down a proper conversation and do other stuff without acting “strange.”

The country I live in is a lot different then the U.S. and other places and people here are very ignorant and narrow-minded so it makes it quite a bit worse! Because of this problem, I have never held down a job and have put a stop to my social life and anything else.

So Dr I would be very much appreciated if you answer my rant and raves! I want to get a respected opinion and work things out from there. After you reply I will also go and see a Local counselor/psychologist. Thank you.

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Answer:

It is really impossible to diagnose over the Internet and I agree that you should see a psychologist. However, I will give you some of my impressions and guesses.

It does seem that you may have Social Anxiety Disorder or some type of phobia that fills you with do much fear and tension that it seems to you like you are paranoid. It can feel that way when anxiety is intense without it being paranoia.

In answer to your question, it is possible to come under more than one diagnostic category. In fact, this is not unusual. I have to agree with you that you may experience depersonalization. Depersonalization and derealization are the same thing. It is part of what we call a dissociative disorder. This usually occurs when a person has experienced extreme and ongoing trauma, particularly during childhood. Its interesting because depersonalization and anxiety can certainly go together.

You mention that you live in a very small town or village and only for a few years. In a village setting, new comers are not readily accepted. In fact, it can take years to achieve anything like real friendship. This may explain why you feel as though people are judging or talking about you. Unless you have a psychotic illness, where you are not in touch with reality and experience delusions and hallucinations, it is hard to imagine that you behave in ways that are very strange.

I don’t know if you suffer from a psychotic illness but it is doesn’t seem likely from what you describe.

What I am suggesting is that some of what you feel or sense when you go out into the village has more to do with being a newcomer than anything. You also report that people in the village have told you that your behavior is strange. It’s difficult for me to imagine that anyone would be so outspoken as to say something like that to anyone, even in New Zealand. I am not arguing with you and I know its not your imagination but I have to ask if you may be misunderstanding or misinterpreting what the other person really means. When very anxious or phobic it is very easy to misunderstand.

Please understand that I know what you mean when you tell me that people there can be very narrow minded and ignorant. Because of that I am asking myself if something else might be going on in your village? Are you running into some type of religious or ethnic prejudice? This is something you need to think about. If it is true, it might explain much of your discomfort. If not, then dismiss this idea.

In any case, you are feeling awful and deserve to get yourself help so that you can feel better about your life. Yes, please make an appointment with a psychologist or counselor and learn what type of problem is affecting you and what type of therapy would be best for you.

Good Luck

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