While only Susan Boyle's doctors can comment on her specific medical condition, the extreme anxiety reaction to sudden media exposure is a common phenomenon. "When a person has significant public exposure, a number of stressors can lead to an extreme state of discomfort," says Dr. Pillay. "There can be an escalating sense of expectations, internal pressure to perform, embarrassment at not achieving goals, and at exposing a part of oneself that one didn't expect to expose publicly." The level of media exposure can determine whether common performance anxiety turns into an anxiety disorders--defined as a condition that disturbs social and occupational functioning. These anxiety disorders can range from "adjustment disorders," in which symptoms disappear within six months, to "social phobia," a more serious condition in which one is afraid to go out in public, to "generalized anxiety disorder," a still more serious condition.  "It makes a difference whether you're exposed to two people, or 50, or 50 million," says Dr. Pillay.  "Celebrity exposure often leads to stress-related symptoms, which may or not fall within psychiatric syndromes." Performance anxiety, for example, is not a psychiatric condition, but social phobia and generalized anxiety disorder are.

Ironically, the best  treatment for people with anxiety disorders is often to return to the original cause of stress fairly soon--but not too soon, and only under professional care. Some medications, such as beta-blockers, can help calm an individual down to the degree they can perform again in a controlled environment, which builds confidence and sets the stage for a recovery. Other medications take several weeks to take effect. One of the most effective treatments is a "talk" therapy, often conducted in concert with medications: Cognitive Behavior Therapy, in which the individual is exposed to the stressor (fear of heights, for example) in graded increments and helped to reframe her thoughts ("no, my heart beating so fast doesn't mean I'm having a heart attack, this is just my anxiety").

But it can't happen too soon-or without professional help.

So perhaps after a few weeks of medical and cognitive-behavioral therapy, Susan Boyle might benefit from a small concert. She could work with her therapist, both before and afterwards, to recover her confidence and learn to control anxiety symptoms. Then she can move on to bigger stages.

Whether she'll have the opportunity to travel that healthy path is another question. "I highly recommend treatment for anxiety disorders because they are so treatable," says Dr. Pllay. "And treatment can significantly improve one's quality of life."

To learn more:

Five Ways to Stop Negative Thinking

Are My Moods Normal?

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