Many people are consumed by the obsessive need to be perceived as perfect. For these individuals the thought of being seen as noticeably nervous can create high anxiety and panic. This anxiety often leads to a phobia, as toxic thinking goes something like “it’s better to avoid something than to let people know I’m not really good at it”.

One of my patients was an attractive intelligent 31 year old who worked in bank marketing. She quit her $200,000 year job because of her concern that people would detect her nervousness in front of groups and conference calls. Another patient, a 33 year-old lawyer drove an expensive sports car and maintained an expensive condo on the beach despite the fact that he was almost bankrupt. He also had a number of hair transplants and a nose job. He became extremely depressed after going on the web site “hot or not”.

A number of my patients have at one time considered going from operation to sever their nerves because of their fear of blushing and sweating. In these cases the fear of being seen as noticeably nervous (because a blush cannot be hidden) created depression and desperation.

Many socially anxious adults (men and women) avoid intimacy at all costs. “Involuntary virginity”, the avoidance of sex due to anxiety and performance concerns is quite common. High levels of shame, embarrassment, and humiliation around the issue of not being experienced and skilled sexually leads to a phobia. The need to be “perfect” in this scenario can be thought of as a “James Bond syndrome”.