9781585624836.jb05 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.”