When shyness is the sign of something more

How many times have you heard a parent utter that phrase to explain away a child’s moodiness? It’s no secret that teenagers are prone to mood swings and sometimes like to keep to themselves. But according to a study published Monday by the American Academy of Pediatrics, some adolescents’ feelings extend beyond normal human shyness to a debilitating psychiatric disorder: Social phobia.

The authors of the study, which was funded by the National Institutes of Mental Health, analyzed a previously conducted face-to-face survey of more than 10,000 adolescents, aged 13 to 18 years. They found that roughly 1 in 10 of those who identified themselves as shy also met the criteria for social phobia.

Shyness is defined by the American Psychological Association as “the tendency to feel awkward, worried, or tense during social encounters, especially with unfamiliar people.”

“[It] means being quiet, introverted, introspective, and sometimes self-isolating,” says clinical psychologist Jeff Gardere, an adjunct clinical assistant professor at Touro College of Osteopathic Medicine in New York. “But a shy person can still be drawn out by others and, if needed to, can interact socially, albeit uncomfortably. Many of our children outgrow their shyness and become much more socially interactive as they make friends, associate with peer groups, and mature through life.”

Social phobia, on the other hand, can prove to be far more problematic. According to the study, relative to adolescents who were characterized as shy, “adolescents affected with social phobia displayed significantly greater role impairment and were more likely to experience a multitude of psychiatric disorders, including disorders of anxiety, mood, behavior, and substance use.”

“Social phobia is a real psychiatric condition,” adds Gardere, “especially when it interferes with the social, occupational, and academic functioning of our children. It’s a condition that can be intensely difficult to live with and can be crippling with regard to social situations and the intense fear of interacting with others.”

Every mental disorder has a biological and environmental feature.  “Disorders come and go based on cultural pressures, ” says Wendy Walsh, a doctor of psychology and co-host of “The Doctors.”   “Today, we have higher rates of postpartum depression due to the pressures on mothers to work and be sexual creatures soon after childbirth.”

Adolescents were asked to rate their shyness around people their own age whom they didn’t know very well using a 4-point scale. For simplicity’s sake, the highest ratings (3 & 4) and lowest ratings (1 & 2) were combined to more easily delineate shy vs. not.

Of the 46.7% of respondents who classified themselves as shy, just 12.4% met the criteria for “lifetime social phobia,” as classified by the DSM-IV. Among those who did not classify themselves as shy, only 5.2% met the criteria for social phobia.

Shyness was more common among males than females, but gender had no significant bearing on the prevalence of social phobia. Furthermore, while shyness was more common in younger respondents, the pervasiveness of social phobia increased with age.

“Although adolescents with social phobia showed significantly higher levels of impairment than did adolescents with shyness, there were no more likely to obtain professional treatment,” concludes the study. “Notably, nearly 80% of adolescents with social phobia failed to seek or to obtain professional treatment for their anxiety.” Additionally, those who characterized themselves as shy or were classified with social phobia were no more likely to be using prescribed medications.

After all, a clinician is limited by what insurance companies will cover. “Long-term talk therapy that might better address the environmental issues is far more expensive than a pill,” says Walsh. “So we get a pill and only deal with biology.”

“In the meantime,” says Gardere, “we all need to calm down and keep it real. Being shy is absolutely fine. In fact, it can be an endearing and attractive quality. The reality is that not everyone needs to be a party animal. Who knows? If we get too many of those, we may start diagnosing them as manic or bipolar and making them the new candidates for medication.”

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