NIMH

Hi Irene,

It's almost funny that I found your site and am now writing to you---as I don't have ANY female friends. I can't keep a friend to save my life. If I hit it off with someone, I end up sabotaging the friendship. I say "yes' to plans and then start panicking about what to do, say, wear, and ultimately end up thinking of an excuse so that I won't have to go.

I don't like the phone so I don't call people back. I suffer from severe anxiety and it really cripples my ability to trust. I don't trust girls because I've always been disappointed with them. I should probably also mention that I am in a very happy and fulfilling relationship and am getting married in September...My energy is always focused on my fiancé and I know that in doing so, I relinquish the ability to "give" myself to potential friends. I don't think that is wrong, but then why do I get sad when I don't have a Girls' Night Out to go to?

Finally, one other key piece - I have a twin sister who, while we email/speak every day, I am too much for her. She constantly pushes me away and always holds me at arms length. It's really sad, and I do wish for more. This email seems too disjointed to even send, but I might as well put it out there anyway.

All the best,
Fran

ANSWER:

Hi Fran:

It sounds like as much as you would like to have female friends---you just don't feel comfortable making friendships or being around people you don't know very well.

One possible explanation is that you are suffering from a condition called social anxiety (also called social phobia). People with social anxiety feel like they are constantly being evaluated by other people and even may become viscerally uncomfortable in the presence of others. Given these uncomfortable feelings, it's understandable that the person would try to avoid or escape from social situations, even ones they would really to participate in, like parties or other social events.

The National Institute of Mental Health has an excellent online publication that describes some of the hallmark symptoms of social anxiety. People with social anxiety:

• are very anxious about being with other people
• are very self-conscious in front of other people; that is, they are very worried about how they themselves will act
• are very afraid of being embarrassed in front of other people.
• are very afraid that other people will judge them
• worry for days or weeks before an event where other people will be
• stay away from places where there are other people
• have a hard time making friends and keeping friends
• may have body symptoms when they are with other people, such as blushing, heavy sweating, trembling, nausea, and having a hard time talking

You seem to have remarkable insight into your predicament so it would definitely be worthwhile for you to discuss this problem with a mental health professional. There are a range of medications and behavioral approaches that make social anxiety eminently treatable. While you may never be the life of the party, when treated, you may find that you have no problem making friends and enjoying their company.

It's great that you have a good relationship with your fiancé but you are missing out on other relationships that may also be rewarding. I'm not sure what the problem is between you and your twin sister---she may not understand how you're feeling or acting. Alternatively, it may be totally unrelated to this problem.

It was very brave of you to write. Interestingly, people with social anxiety often feel more comfortable with virtual friends than face-to-face ones.

I have every confidence that you will change---because you want to! Congratulations on your upcoming marriage. If you are planning a wedding, it would be great to get this problem in check before then.

My best,
Irene

It’s depressing to be with a friend who is truly depressed. You may even get weepy yourself. The black cloud of depression spreads over you too, making you feel like you want to escape and be with anyone else but her. But read this first!

I’ve blogged here repeatedly about the importance of female friendships to women’s emotional and physical well-being---and about the perils of toxic ones as well. I’ve talked about friends who are too needy, too self-centered, too angry, too demanding, or too unreliable and have pointed out that some friendships reach a tipping point when it’s time to call it quits. I still believe that relationships that are consistently draining should be ended or at least, placed on hold.

Then I received a post from a reader entitled, Toxic Friends May Be Crying Out for Help, which reminded me that there are exceptions to every rule---and that it is important to distinguish between a toxic friendship (which is pathological relationship) and depression (which is a mental disorder). Here's the post:

Dear Irene:

Thanks for pointing out that there are bad friends out there, However I want to play devil's advocate here and say that in 2006 when ALL and I do mean ALL 5 of my close friends bailed on me like a chain of dominoes I nearly died from the depression it caused. In the wake of that nightmare I found out I had a mental problem and needed HELP. Your call to DUMP Toxic Friendships would be better served by advocating INTERVENTION for people who may possibly be in serious trouble rather than leaving them behind like trash on the street corner.

Signed,

Anonymous

Yes, there are some cases when close friends need to cut a little slack. Could it be that your friendship feels burdensome and painful because your friend is depressed?

Recognizing depression

Clinical depression is extremely common, affecting nearly one out of ten people in a given year, and it’s is twice as prevalent in women as it is in men. It’s more than a case of the blues or a bad mood that passes. Depression profoundly affects a person’s ability to function. And as hard as someone tries to shake it, it recurs nearly every day, all day, for at least two weeks or longer.

According to the National Institute of Mental Health (NIMH), the symptoms of depression may include:

• Persistent sad, anxious or “empty” feelings
• Feelings of hopelessness and/or pessimism
• Irritability, restlessness, anxiety
• Feelings of guilt, worthlessness and/or helplessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, waking up during the night, or excessive sleeping
• Overeating, or appetite loss
• Thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Does this list of symptoms and signs make you think of one of your friends? Well, this is a reminder. As much as you might like to, you can’t talk a friend out of being depressed. Even a kick in the pants won’t help. Depression is a biological illness.

What you can do

• If you are a good friend, there are some ways in which you can help and possibly make a difference:
• You can listen carefully, provide support, and offer to spend some time doing things you enjoy together (taking a walk or bicycle ride, or going to a movie).
• You can offer to help her with concrete tasks she can’t accomplish on her own because she feels so overwhelmed or has no energy.
• Try to be patient---and never be pushy. Don’t dismiss her feelings. Show that you understand them but encourage her to realize that these feelings are only temporary and will eventually pass.
• Don’t pussyfoot around the issue. Remind her that depression is a treatable illness and encourage your friend to seek treatment.
• If she resists your initial suggestion, try again but don’t nag. Don’t make demands or set ultimatums. Many depressed people need time to find their way to treatment and some people just want to be left alone.
• If you worry that your friend may be harboring suicidal thoughts, you have certain ethical obligations. Be direct and ask her if she feels suicidal. If she does, remind her that she is important to you and that she needs immediate professional help. Never allow the burden of having a depressed friend be yours alone. Be sure to inform someone else (e.g. her partner or closest relative.) If you’re her partner, tell her doctor.

Recognize that you can only be a friend, not a mental health professional. There is just so much that friends can do and so much that they can give. You may need to reluctantly cut loose and be there for her when she begins to recover.

Note: This post is about friendship and isn't intended as medical advice.

This post can also be read on The Huffington Post.