Nadine was a 15-year-old girl whose mother brought her for a psychiatric evaluation to help her with long standing shyness.Although Nadine was initially reluctant to say much about herself, she said she felt constantly tense. 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 also became “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.Nadine also felt she constantly was on her guard, needing to avoid the possibility of getting attacked. She was the most confident when she was alone in her room. From seventh grade to ninth grade, Nadine’s peers turned on her. The bullying was daily and included intense name-calling (for example – “stupid,” “ugly,” “crazy”) and physical threats. One girl (the ringleader) had been Nadine’s good friend in elementary school, but hit her and gave her a black eye. Nadine did not fight back. She refused to tell her parents what happened, but cried herself to sleep at night.Nadine transferred to a specialty arts high school for ninth grade. Even though the bullying ended, she could not make friends. Nadine felt even more unable to venture into new places. She felt increasingly self-conscious that she could not do as much on her own.Nadine was even scared to read a book by herself in a local, public park. She had nightmares about the bullies in her old school. She spent whole weekends “trapped” in her home.
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