Aaron is a 45-year-old postal employee who claims to have felt constantly depressed since the first grade, without a period of "normal" mood for more than a few days at a time. His depression has been accompanied by lethargy, little or no interest or pleasure in anything, trouble concentrating, and feelings of inadequacy, pessimism, and resentfulness. His only periods of normal mood occur when he is home alone, listening to music or watching TV. Upon further questioning by the counselor, Aaron reveals that he cannot ever remember feeling comfortable socially. Even before kindergarten, if he was asked to speak in front of a group of his parents' friends, his mind would "go blank." He felt overwhelming anxiety at children's parties, which he either avoided or attended in total silence. He could only answer questions in class if he wrote down the response first, and even then he would mumble and have trouble getting the words out. He met new children with his eyes lowered, fearing their scrutiny, and expecting to feel humiliated and embarrassed. He was convinced that everyone around him thought he was "dumb" or a "jerk."

As he grew up, Aaron had a couple of neighborhood playmates, but he never had a "best friend." His school grades were good, but suffered when oral classroom participation was expected. As a teenager he was terrified of girls, and to this day has never gone on a date or even asked a girl for a date. This bothers him because he would like to meet someone, but he is often so depressed that he feels he has little energy or interest in dating.

Aaron attended college and did well for a while, then dropped out as his grades slipped. He remained very self-conscious and "terrified" of meeting strangers. He had trouble finding a job because he was unable to answer questions during interviews. He passed a civil service test at age 24 and was offered a job at the post office on the evening shift. He enjoyed this job as it involved little contact with others. He was offered, but refused, several promotions because he feared the social pressures. Although he now supervises a number of employees, he still finds it difficult to give instructions, even to people he has known for years. He has no friends and avoids all invitations to socialize with others.