Teens enter my office for many different reasons. Most times, parents initiate the contact. Other times, it’s schools. Adults’ concerns are usually—and correctly—about the teen’s safety. So, teens who have problems with self-injury, suicidal thoughts, and aggression are often identified and sent to someone like me. Other behaviors that prompt such action include defiance, oppositional behavior, school refusal, argumentative behavior, and social isolation.

And so treatment begins. And sometimes it’s brief. And more often it’s longer. And when their behavior is regulated, when teens are no longer self-injurying or suicidal, aggressive or using substances…we find the underlying problems. What’s underneath all this unsafe behavior? Would you guess…social anxiety? In my office, I’ve seen a higher-than-expected number of self-injurying teens who actually—before all the unsafe behaviors—had developed Social Anxiety Disorder. And they still have it. Because these kids can be outrageous in appearance and behavior, people often suppose they have similarly bold personalities. Not true.

These teens scowl because they feel as if they are in the glare of the public eye, and that the public is waiting to criticize them. They don’t scowl because they hate the system.

These teens break eye contact not because they don’t like you, but because looking you in the eye paralyzes them with a flood of adrenaline.

These teens end conversations quickly because they are over-analyzing the situation and struggle to think of what to say next. They don’t stop talking because they think you’re boring or stupid.

These teens prefer the company of one close friend—or of no one at all—not because they can’t stand people, but because they can’t stand how they feel around people. It’s miserable.

When I ask these teens how others describe them, one word keeps coming up: “Intimidating.” Their peers tell them that they are intimidating, that they don’t seem to like anyone, and that they are kind of scary. People assume these teens are irritable and that they are verbally or physically dangerous.

But they are none of these, really. They are consumed by a sometimes-panic level of anxiety when they are in social situations. So they’ve found ways to hide anxiety. Some dress in crazy fashions. Others isolate. Some use drugs to feel comfortable around others (this only makes anxiety worse down the road; it’s not a solution). Some teens act obnoxious and outrageous.

Of course, not all self-injurying teens have Social Anxiety Disorder. Many teens dress in crazy clothes because they just like them; they’re not hiding anything. And of course, teens can be obnoxious without any diagnostic label.

But take a look at yourself and your friends…could there be anxiety under all that behavior? If you fix the anxiety, you’ll be more effective. You won’t have to do those things that get you in trouble or draw negative attention. You’ll feel well, again. Like you did when you were a little kid.