Adolescent Shyness Case Study

Case 5.3 Adolescent Shyness

Barbara L. Milrod, M.D.

Nadine was a 15-year-old girl whose mother brought her for a psychiatric evaluation to help with

her long-standing shyness.

Although Nadine was initially reluctant to say much about herself, she said she felt constantly

tense. She added that the anxiety had been “really bad” for several years and was often

accompanied by episodes of dizziness and crying. She was generally unable to speak in any

situation outside of her home or school classes. She refused to leave her house alone for fear of

being forced to interact with someone. She was especially anxious around other teenagers, but

she had also become “too nervous” to speak to adult neighbors she had known for years. She said

it felt impossible to walk into a restaurant and order from “a stranger at the counter” for fear of

being humiliated. She also felt constantly on her guard, needing to avoid the possibility of getting

attacked, a strategy that really only worked when she was alone in her home.

Nadine tried to conceal her crippling anxiety from her parents, typically telling them that she

“just didn’t feel like” going out. Feeling trapped and incompetent, Nadine said she contemplated

suicide “all the time.”

Nadine had always been “shy” and had been teased at recess since she started kindergarten. The

teasing had escalated to outright bullying by the time she was in seventh grade. For 2 years, day

after difficult day, Nadine’s peers turned on her “like a snarling wolf pack,” calling her “stupid,”

“ugly,” and “crazy.” Not infrequently, one of them would stare at her and tell her she would be

better off committing suicide. One girl (the ringleader, as well as a former elementary school

chum) hit Nadine on one occasion, giving her a black eye. Nadine did not fight back. This event

was witnessed by an adult neighbor, who told Nadine’s mother. When Nadine’s mother asked

her about the incident, Nadine denied it, saying she had “fallen” on the street. She did, however,

mention to her mother “in passing” that she wanted to switch schools, but her delivery was so

offhand that at the time, her mother casually advised against the switch. Nadine suffered on,

sobbing herself to sleep most nights.

Full of hope, Nadine transferred to a specialty arts high school for ninth grade. Although the

bullying ceased, her anxiety symptoms worsened. She felt even more unable to venture into

public spaces and felt increasingly embarrassed by her inability to develop the sort of

independence typical of a 15-year-old. She said she had begun to spend whole weekends

“trapped” in her home and had become scared to even read by herself in the local park. She had

nightly nightmares about the bullies in her old school.