Case Study

Steve, a 54-year-old man, describes himself as suffering from a social anxiety disorder. He says that he was a school phobic as a student, feeling like every day was a “performance” that frightened him. “High school was one of the most painful experiences of my life,” he proclaims, and he is not interested in reunions, which would stir up those memories. He now finds himself clamming up in dining situations when others are close, feeling that others are watching him. There are some clear signs of paranoid ideation in Steve—the hypervigilance and fear of being watched. But his primary fear is that others will see him as ignorant or stupid. He began his academic work as a philosophy student and was a successful teacher but the fear of a dissertation committee’s judgment and his obsessive concern with whether his teaching was acceptable drove him out of the academic arena for his work.

  1. What is the connection between anxiety and paranoia? Does Steve suffer from paranoia or anxiety?
  2. Is Steve’s fear of appearing ignorant or stupid typical of a social phobic? Why would he have such a fear when he appears to be quite professional, composed, and engaging?
  3. Would you advise Steve to try to face up to his fears and continue to pursue his career as a teacher or avoid such difficult situations and find “easier” ways of making a living?

Sample Solution