By Jan Jarvis, Fort Worth Star-Telegram
ARLINGTON, Texas -- The only time Larry Putteet went to the
movies was on Tuesday afternoons when no one else was there.
He'd wait until 3 a.m. to slip into a 24-hour grocery store or
dart into a 7-Eleven. He avoided malls, did not work and stopped
eating at restaurants when someone tried to make small talk. If an
acquaintance walked his way, he would head in the opposite
direction.
``I was just a lost person,'' he said. ``I didn't want people to
know me.''
Now after a lifetime of hiding, Putteet, 43, is discovering the
satisfaction of everyday social activities. Medication and therapy
are helping him cope with the devastating effects of a disorder
that until recently he didn't know had a name.
Social anxiety disorder affects an estimated 10 million
Americans and is the third most common psychiatric illness after
depression and alcoholism, according to the American Psychiatric
Association. But because of the embarrassment of those afflicted,
few seek treatment.
Most do as Putteet: They avoid people and small talk at all
costs. Unlike agoraphobics, who fear being in crowds, people with
social anxiety disorder have an intense fear of being scrutinized
by others.
Putteet agreed to be interviewed -- something so difficult that
he would have never considered it before treatment -- to encourage
others to seek help. Others with the disorder contacted for this
story were unable to even talk over the phone.
The disorder can appear suddenly, as it did for the vice
president of a large company who almost quit his job when he could
no longer speak at sales meetings. Or it can permeate every moment
of every day, preventing sufferers from dating, working or talking
to anyone.
``This is not about being a little shy,'' said Jim Wilson,
director of the Phobia and Anxiety Center of the Southwest in
Dallas. ``It's about being immobilized.''
To heighten awareness of this disorder, the American Psychiatric
Association, Anxiety Disorders Association of America and Freedom
from Fear have launched a campaign called ``Imagine Being Allergic
to People.''
In its most severe form, the disorder causes sufferers to
experience intense anxiety about everyday activities such as eating
out, using a public restroom or talking on the phone.
``These people have a constant, steady fear of being scrutinized
by others,'' said Nishendu Vasavada, a Dallas psychiatrist.
Society tends to amplify this fear.
``Our society is very ridicule-oriented,'' said Clark Vinson, a
therapist in Arlington, midway between Dallas and Fort Worth.
``Turn on any sitcom, and you'll see tons of jokes and people
making fun of other people,'' he said. ``Social phobics understand
that people make judgments, and they put a lot of judgmental
thoughts in everyone's head.''
For Putteet, the fear that others were making fun of him made
for a most difficult life.
``I haven't worked in 20 years,'' he said. ``I have no
interests, no hobbies.''
The disorder can be generalized, as it is with Putteet, but it
can also show up in seemingly bizarre, isolated ways.
Some people won't write checks because their hand shakes
uncontrollably when attention is focused on them. They believe the
clerk thinks they're crazy, lying or stealing.
Others stop attending church because receiving communion causes
so much anxiety or the fear of being asked to lead a prayer is
unbearable.
At the movies, they're often the ones in the aisle seats because
they feel trapped otherwise. The attention that they believe will
be focused on them if they have to go to the restroom is unbearable
for them.
Symptoms include trembling, sweating, upset stomach, tense
muscles and lightheadedness. Often the person's mind goes blank,
and panic sweeps over them.
``At that point, they feel like a big spotlight is on them,
saying `loser,' '' Wilson said.
In Putteet's case, he would often get so nervous that he
hyperventilated.
Although the disorder is widespread, only 5 percent of those
with it are treated.
One of the biggest barriers to getting treatment is the person
feels so humiliated that they won't tell anyone about it.
``A social phobic is not going to do anything that calls
attention to themselves,'' Wilson said.
Sufferers wait an average of eight years before confiding in a
friend about the problem, Vasavada said. They wait 13 years to seek
professional help. Often it is chest pains or headaches and not
anxiety that finally takes them to a doctor.
Putteet received treatment only after his wife, one of the few
people he has ever been able to talk with, mentioned his symptoms
to a doctor.
Cognitive therapy and medication are usually used to treat the
disorder. Paxil, the first medication the FDA has approved for
treatment, changed Putteet's life.
``It was like a miracle drug,'' he said. ``I still have this
anxiety, and I have to push myself to do stuff, but now I can; then
I couldn't.''
When the fear occurs only in certain situations, such as when
speaking to a group, some people can take medication to lower their
blood pressure before the event, Vinson said.
The phobia is truly one of the most difficult to treat because a
phobia is an irrational fear, he said.
``This is not an unreal threat,'' he said. ``You truly can
become a complete idiot in front of an audience.''
Helping the sufferers achieve a more realistic understanding of
events can help desensitize them to situations, Vinson said. After
a while they realize they do not look nearly as nervous as they
think they look, he said.
The problem in seeking treatment is that so often, social
phobics see medication as a crutch and a sure sign that they are
inferior, Wilson said.
Although the exact cause is unknown, studies show that
biological and psychological factors play a role. Women develop it
more often than men.
There might be a genetic link. Some research shows that children
of shy people may experience the disorder more than the average
child.
Research also suggests that people with the disorder grow up in
an environment that focuses more on their mistakes than their
successes, Vinson said.
But that does not mean the child has hypercritical parents. Any
embarrassing experiences during childhood can trigger a lifetime of
fear, Vinson said.
``A lot of people have had bad experiences in elementary school
where they were embarrassed in front of their classmates,'' he
said. ``A number have thrown up in their cafeterias or classroom,
and it stuck with them forever.''
As a child, Putteet stayed in his room or sat in the back of the
classroom to avoid contact. His fear of appearing stupid made every
day difficult, but, he said, he finished high school with the help
of a loving and supportive family.
Now Putteet is thinking about his future and all the things he's
able to do. Recently he went to the movies for the first time on a
Saturday night, and he's thinking about college.
``Little things are big miracles to me,'' he said. ``I feel like
a different person inside.''
