Q. I have a major problem. I'm afraid of everything, and I do mean everything. I'm 16 and everyone else has their driver’s license but me because I am absolutely terrified of cars. I can't eat in the lunchroom at school because I fear people more than anything else. I can't help it. I want to move far away after college but I'm afraid of planes and the place I want to live is across the country. I also have separation anxiety, so I might not be able to move at all. I can't enjoy being a teenager because I'm too scared to do anything. I can't give a speech in class because I feel like I'm having a heart attack while up there in front of everyone. I can't go swimming at a lake because I'm afraid of fish. I have a huge fear of gaining weight, so I'll just not eat for a day. I have so many more fears not mentioned. Please tell me what to do to get over these fears so I can live my life.
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A. It’s tough to read your letter because it sounds like you are suffering so much from several possible anxiety disorders. These disorders often run in groups and first appear in the teenage years. They are more common in women than men, so you certainly fit the profile of a typical sufferer. Some people are more biologically predisposed to anxiety in general and, in fact, anxiety disorders do run in families.
The degree to which you describe your fears of speaking to people, both in general and in public, indicates a social phobia, which is one of the most common phobias. As you know, this can be extremely debilitating, to the point of really impeding your ability to develop a career or relationships. But the good news is that phobias and anxiety are highly treatable with the help of a trained psychiatrist or psychologist. The first line of treatment is often psychodynamic or cognitive behavioral therapy, with or without medication, depending on the severity.
You describe other fears, too — of driving, of flying, of fish. These specific phobias are also treatable and may even be resolved when you treat your more generalized anxiety. If you had just one specific phobia, treatment would be fairly straightforward. For example, fear of flying can be treated with a virtual-reality therapy where you are in a simulated flight situation while a therapist talks you through the treatment to diminish your fear.
Fear of speaking to others can be helped if you think ahead about what you will say, preparing yourself with a list of topics you feel comfortable and knowledgeable about. It helps to smile, so that you get a positive response from those you are addressing. For speaking to large groups, you can rehearse in front of a mirror or with friends, which will boost your comfort level. Focus on the back wall instead of on the faces watching you. In other words, there are ways to reorient your negative and anxious thoughts.
I often like to recommend things people can do on their own, such as my suggestions above. Your case, though, sounds fairly serious, and I don't think it’s possible for you to handle it successfully without professional help.
It’s very concerning, too, that you try not to eat due to a fear of gaining weight. You could have the beginnings of an eating disorder, and in severe cases these can be fatal.
Unfortunately, you seem so riddled with anxiety that your world has really shrunk. So it is really important that you see an adolescent psychiatrist who can evaluate your symptoms in depth and treat you appropriately. You need to — and you can — change your symptoms and your life.
Dr. Gail’s Bottom Line: Some kinds of specific fears respond well to a do-it-yourself approach, but professional help is warranted for people who have multiple anxieties or whose anxiety is severe.
Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to TODAY. Her latest book is “Anatomy of a Secret Life: The Psychology of Living a Lie.” She is also the author of “Amazing You! Getting Smart About Your Private Parts,” which helps parents deal with preschoolers’ questions about sex and reproduction. Her first book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” was published in 2004 by Riverhead Books. It is now available in a paperback version. For more information, you can visit her Web site, www.drgailsaltz.com.
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