This story is purely fictional and is not intended to represent a real family. Any similarities between this family and a real life family are purely coincidental.
When Nikhil was born, his entire family rejoiced. In a family of 8 granddaughters, he was the only grandson and that made him so special to all of his relatives. He was a very healthy baby, weighing in at 7 pounds 10 ounces at birth and bringing into the world with him a very strong set of lungs. Sahil and Reema were ecstatic when they took Nikhil home for the first time excited about his future. Would he be a doctor like his grandfather or an engineer like his father? Perhaps he’d be an entrepreneur like his mother!
Prior to Nikhil’s birth, Sahil and Reema bought a townhouse in a quiet neighborhood with several other young families. They wanted their children to grow up with other kids in the neighborhood and feel safe when they played outside. Both of them were not outgoing people so they took time to become friends with their neighbors. Once they established a friendship, though, they were very friendly and warm.
Nikhil was a more difficult baby than others. He cried often and was often inconsolable. By the age of 8 months, he had trouble establishing a regular sleeping routine, waking up 2-4 times a night crying and was distressed for no apparent reason. Nikhil began exhibiting fearful behavior of strangers around 4 months, earlier than average and he strongly preferred Reema over Sahil especially if there was an unfamiliar face in the room. Both parents credited Nikhil’s “maturity” for developing the otherwise normal milestone of stranger anxiety so early in his life. What they didn’t realize is that this was a precursor symptom for many more symptoms in his future that would lead to his eventual diagnosis of Social Anxiety Disorder (also known as Social Phobia).
Sahil’s mother came to visit the family around Nikhil’s first birthday. While he was very cautious of his grandmother for the first day, he slowly warmed up to her over her week-long visit. She had been watching and playing with Nikhil for a couple of days when she made a comment to Sahil.
“He really doesn’t seem to like new things does he?” she asked quietly.
“What do you mean?” asked Sahil as he finished his breakfast.
“Well, when he’s at home, around you both, with his toys, he is happy. But if someone comes into the house who he doesn’t know, he just stops what he’s doing and almost freezes. When I gave him a few of the new toys I brought for him, he didn’t touch them right away. He was a little curious but then put them aside for his older ones. He’s slowly becoming adjusted to the new toys but he just doesn’t seem very excited about new things as much as a boy his age should be.” Sahil’s mother was quite concerned and had been grappling with how to express this to her son without sounding too critical.
Sahil just nodded and did not respond.
“I don’t mean to say anything negative. I’m just worried that maybe something else is going on.”
“Well don’t worry,” Sahil responded, slightly defensive. “The doctor said he’s just fine.”
As Nikhil grew, his inhibited behavior remained. While he became more familiar with their close friends, he was always wary of people he did not immediately recognize. Even by the age of 4, he had a clear preference for their neighbors and immediate family over anyone new. He was always the last to join in neighborhood games and many times, he would just refuse play dates preferring to be by himself, playing with his toys. 
Going to school was also a very difficult task for him. Teachers beginning from kindergarten called him very quiet and introverted. They often complained to Sahil and Reema that they try to encourage him to play with other children but he often refuses, preferring to be alone. In 4th grade, Reema received a phone call from his teacher during lunch time.
“I just wanted to let you know that this is the fourth day in a row that Nik did not eat lunch. Is everything ok? I checked him for a fever and he seems fine,” said his teacher.
Reema did not understand. He had no problem eating lunch at home on the weekends and she always made sure to pack his favorite food on school days. That weekend, they went to Nikhil’s classmate’s birthday party after much coaxing from his mother. Reema saw what his teachers had been complaining about for several years. He wasn’t disliked by his peers but he had no friends. He rarely interacted with the other boys and preferred to sit by himself and watch. During lunch, he took a slice of his favorite pizza and walked to a corner to eat by himself. When a classmate approached him, he had the same “deer in headlights” look that her mother-in-law had described when he was a baby. He appeared uncomfortable and stopped eating while the boy was nearby as if he didn’t want his peer to watch him eat.
Reema and Sahil took Nikhil to the pediatrician and explained all of these symptoms, to which the doctor replied, “He’s just shy. Get him involved in extracurricular activities and he’ll grow out of it.” Relieved to hear it was nothing more than shyness, Reema and Sahil encouraged him to try different sports, activities and pastimes becoming frustrated that he did not enjoy any of them. He often sat quietly during art class or cried in piano class when he had to show his teacher what he had practiced during the week.
Through junior high and high school Nikhil had started regularly complaining of nausea and stomach pains with no apparent physical cause. Since he was a child, he also was prone to profuse sweating; however as a teenager he became much more aware and sensitive about it.
One day, Sahil caught him putting deodorant on his face, neck and elbows. When he asked Nikhil what he was doing, Nikhil began stuttering. His whole body appeared to tremble. He blushed and began to sweat.
“I asked you a simple question. What are you doing?” demanded Sahil. Nikhil could not utter a word and just walked out of the bathroom without saying anything.
During senior year of high school, Reema and Sahil attended Nikhil’s final parent-teacher conference and they were shocked to hear what the teacher had to say.
“Nik is a very bright kid who does very well academically,” she started. “However, I am very concerned about him. He is extremely shy, does not interact with his classmates and he rarely speaks in class. Last week, we had oral presentations. It took him 2 minutes to get out of his seat to stand in front of the class. Once he was up there, he began to shake, sweat and blush. After about a minute of standing there, he ran out of the class. Another boy found him throwing up in the bathroom. I asked him if he was sick and he said no and walked away from me.”
Reema and Sahil, who at first were so proud of the teacher’s comments, sat in disbelief. They knew Nikhil was a shy child but they did not know how bad this had gotten. Since fourth grade, they both demanded that the teachers only speak about Nikhil’s academic achievement, saying that his shyness is something he would grow out of. This was the first time a teacher explained the true nature of the symptoms in the last 8 years.
“All of the students are working on college applications now,” said the teacher, “and I’m strongly advising that Nik consider junior college. I just don’t think he is ready for a large university yet. Let him stay at home for a couple of years and maybe have him speak to a counselor to identify what is going on with him.”
Sahil and Reema both became very angry. They listened to the teacher politely and left the conference curtly, both fuming at the insinuation that their child was not good enough to get into a university.
“I don’t care what you have to do. You are going to a university. Do you understand me?” yelled Sahil at the dinner table. “I’m so sick of this. You have to be a man!”
“How do you expect a girl to marry you if you act like such a little girl?” Reema argued. “It’s time you grow up and snap out of this charade that’s been going on! You’re not a little baby anymore where this is cute!”
“What is wrong with you that you can’t just speak in front of a others?” continued Sahil. “I don’t like it either but when I have to give a presentation at work, I do it because I have to! You have to grow up Nikhil! No excuses. You are going to a university.”
Nikhil had the academic merit to attend most private institutions; however he was not accepted due to his extremely awkward and mostly silent interviews where he trembled and looked down at his hands waiting for the torture to be over. Instead, he attended a public university in his state where he became extremely depressed. He had always been alone and had preferred it that way for his entire life. But this was the first time he realized that his fear of being around others was something abnormal. He saw his fellow dorm mates socializing, making friends and trying new things, none of which he wanted or knew how to do. Instead he took his meals back to his room to eat in isolation so no one could see him.
“It’s just homesickness,” said his roommate who noticed Nikhil feeling down one day. But Nikhil knew otherwise. This seemed more serious than that. He felt depressed, alone and overwhelmed. He knew there was something wrong with him and he could not fix it. His parents would not understand because they thought there was something wrong with him. One night, his roommate came home and found Nikhil on the floor with an empty bottle of Tylenol.
Fortunately, Nikhil survived the suicide attempt and after seeing a university counselor, was officially diagnosed with Social Anxiety Disorder.
“It’s different from just being shy because you can’t just push through it and engage in a task that makes you nervous,” explained the counselor. “It’s much more serious than that and very few people, including doctors, know about it enough to diagnose it early enough.”
Social Anxiety Disorder affects up to 20% of the South Asian population (both men and women) and is associated with serious depression and substance use. Click here for more information and treatment options for Social Anxiety Disorder.
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