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When shyness is the sign of something more
October 17th, 2011
12:01 AM ET

When shyness is the sign of something more

“Cut him some slack. He’s just a teenager.”

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.”


soundoff (33 Responses)
  1. Jennifer

    I have to say, the medications are absolutely useless for this. If you suffer from this, do yourself a favour and stay away from doctors, they'll only make things worse. Hard-learnt lesson.

    October 17, 2011 at 08:10 | Report abuse | Reply
    • Darthlawsuit

      No we wants your monies!!! We give you cure you gives us monies!!! Will power and situation has nothing to do with it, you just have a chemical imbalance and my drugs will solve your problems!!! Just ignore the side effects *cough* liver failure, kidney spontaneously combustion, and a complete and total reliance on this drug/cure *cough*

      October 17, 2011 at 15:17 | Report abuse |
    • DoYourResearch

      That is quite wrong.

      My own diagnosis came in the 6th grade, but it was incorrect.

      It wasn't until college that the diagnosis was revised and proved accurate. Since that time (the early 1990s) I've had a variety of medication "on board".

      It has allowed me to get married, complete my MBA, start my own small company, and in general... survive.

      Do your own research people. What works for some may not work for all. Unless you reach out and try, you will never know. Don't suffer unnecessarily.

      October 17, 2011 at 17:25 | Report abuse |
    • Steve

      Darth...unfortunately it is your amateur thought process and overall ignorance that do the greatest harm.

      October 17, 2011 at 22:47 | Report abuse |
    • Brandi

      I am 32 years old. From the time i was 12 years old, when i became aware of myself, as far as how i saw my maturing body and began to care how otheres saw me, i suffered from social phobia. It took a good amount of time for my dr's to get my medicine correct, but in the end they did and i feel better then i ever have. medicine takes time to get right. You have to adjust some and add others or take some away. If you give your dr time he or she will get it right. But medicine isn't enough, you have to have therapy also.
      I am sorry for those who only give their drs a couple of time to get their medicine right then give up on the dr. You will never allow yourself to get better if you don't give it time.

      October 18, 2011 at 13:05 | Report abuse |
    • Shreyas

      I agree with Jen. Shyness in your child should be handled with behavioral therapy. It requires lot of moral support from family.
      The road to medicines is vicious circle and never actually solves the problem. Medicines only work temporarily. None have been evaluated or tested for long term effects. In the end the effect of medicines wean out leaving you in cold, only to go for higher dosage. Family support, raising self esteem and to understand problems your child is having is best solution.

      February 3, 2012 at 18:36 | Report abuse |
  2. Scared

    That redhead kid in the middle is freaking me out – looking at me like he is going to burn my house down!

    October 17, 2011 at 09:52 | Report abuse | Reply
    • Suezeee

      hahahahahahahaha your comment just made my day!

      October 17, 2011 at 10:45 | Report abuse |
  3. Elmer117

    Almost a decade ago, in conjunction with working with a great therapist, my family physician put me on Effexor XR, 150 mg daily. That drug has absolutely revolutionized my life. I had crippling social anxiety and had even suffered at least one panic attack, yet there was a "real me" trapped inside, who longed to be outgoing–the person dancing, having a great time, having people over to my home frequently, going to their homes, meeting them for lunch, performances, etc. After starting Effexor, the anxiety went away. The real me I remembering being "out" the last time at age 6 was back again! I am now doing everything I longed to do, but kept myself from doing. I have had a revolution in my life, one that I sought but had been unable to attain. I can't tell you how wonderful my life is now. I truly believe extreme shyness and social anxiety is biological, and it is hereditary.

    October 17, 2011 at 10:31 | Report abuse | Reply
  4. Past Sufferer

    Jennifer, I have to disagree with you. Medications can have a resounding impact on social phobia, though admittedly it should be just one piece of your treatment and should not be relied on solely. I suffered with intense social phobia for over 15 years. It wasn't until I started on medication (in addition to cognitive behavioral therapy) where I began to even have an ounce of nerve to combat this problem head on. I think the key is to find the medication that works for you. I was on Prozac, Celexa, Effexor, before finally getting to Paxil which turned out to be a miracle drug for me. Something finally clicked where my fear subsided in social situations subsided just enough that my therapy began to have some effects. After continuing to pursue dual treatment of medication and therapy, I was finally able to pull my life together to the point where today I am able to fully function as a "normal" person.

    I am not a very emotional person (which might be a function of feeling that I was getting the shaft, so to speak, for my entire adolescent life) however I am highly empathetic to anyone going through the terror of what is social phobia. My message to anyone out there suffering from this is to hang in there and please seek treatment. Cognitive behavioral therapy was a terrific tool that helped me conquer this illness. It is about facing your fears, in incrementally small doses. Eventually you will become confident enough that you will no longer need medication as you will have learned the tools to face your phobias on your own.

    October 17, 2011 at 11:38 | Report abuse | Reply
    • Jennifer

      But how long did you take those medications for? Long enough to get the long-term side-effects? They mess your body up if you take them for too long and to have that happen when they haven't even worked just makes it worse.

      October 17, 2011 at 14:44 | Report abuse |
    • Past Sufferer

      I don't recall the precise length of time I was on the meds but if I had to guess, I was on Prozac, Effexor and Celexa for probably 12-24 months each. For Paxil, I believe I was taking that for 3-4 yrs. Fortunately I did not incur any significant side effects (other than maybe a decreased libido). I can certainly understand your feelings towards meds, especially if you experienced long term side effects. Generally speaking, I tend not to want to be on medication for a long time, if I can help it. But in this case the benefits outweighed the risks for me.

      I certainly don't want to belittle your point about drugs being useless since it sounds like your experience was far from a positive one, but I just wanted to make sure that people who might be suffering from social phobia realize that medication can potentially be a stepping stone to getting better.

      October 17, 2011 at 14:55 | Report abuse |
  5. SuesieQ

    I think I might have Social phobia. I'm 20 years old and still vary shy. I'm never sure what to say around people. I don't like to be around people my own age and people I don't know. The only people I really ever talk to is people older then me or way younger. I have always been nervous when I had to talk to people at school, cause I would concentrate to hard of what to say so I won't make a full of myself. By the time I do talk up I end up making a full of myself. Is this Social phobia or am I just anti social?

    October 17, 2011 at 12:10 | Report abuse | Reply
    • kevi

      live your life the way you want to. Being anti social or what ever they call it now does not mean that your weird, just say f**ck you. I personally do not like people because of this they try to tell you that your different when you arent

      October 17, 2011 at 16:05 | Report abuse |
    • Ginger

      I grew up very shy and had similar feelings. If you look for work, try to work where you are working with customers. You will learn how to make small talk and eventually feel less shy. I am concerned about this new mental illness relating to shyness. Social phobia is part of being shy. It also becomes less as we age, at least it has with me. I sometimes like to be by myself and that is who I am. I would never let it interfere with my life. I believe the author is referring to 'easy to tell' behaviours. As we age, we experience and take in a lot of people interaction. Hence as we gain a greater understanding of ourselves and experience the common threads of human connections, our social phobias decrease.
      Please do not read to much into this. Shyness does go away...or contained.

      October 17, 2011 at 21:48 | Report abuse |
    • Sunnye

      I can definitely relate. There's a big difference between being shy and having a social phobia. If it interferes with your life, I would say that you probably have social anxiety. Therapy and/or medication can help.

      October 17, 2011 at 22:18 | Report abuse |
    • Richard Waldman (coachmerich)

      Hi SuesieQ:

      It's not you, but rather the chatter in your head that is creating your shyness. Is either one of your parents shy? More often than not we "pick-up" what around us. Your shyness is nothing more than being fearful that you might be judged by those who you attempt to communicate with. Know that you are a bright and intelligent individual who has much to give. To learn more about how to deal with this "chatter in our head" that runs us around, check out my video, "How to Identify What Moves You Forward and What Holds You Back" by clicking on or pasting this link into your browser http://www.youtube.com/watch?v=29SSuVwc78M

      October 18, 2011 at 19:10 | Report abuse |
  6. kevi

    That's what alcohol is for.

    October 17, 2011 at 16:00 | Report abuse | Reply
    • Ginger

      No doubt alcohol works for shy people.... but what a price! I think what really works is being the best you can be from appearance to knowledge. Good feedback, whether expressed by words or body language does wonders.
      Take courses, pay attention to grooming, join groups.

      October 18, 2011 at 10:31 | Report abuse |
  7. T3chsupport

    “[It] means being quiet, introverted, introspective, and sometimes self-isolating,”

    Is it really a disorder if you just like being quiet and alone? Why is everyone saying that every little variance in personality is a disorder anymore?

    October 17, 2011 at 16:34 | Report abuse | Reply
    • db

      No, please read more closely; that's what Gardere said *normal shyness* was about, not social phobia. Shyness is nowhere near as crippling as clinically-recognized social phobia.

      October 17, 2011 at 21:30 | Report abuse |
  8. Simon

    I don't see this as a mental disorder that needs drugs for treatment, it's not like one is trying to shrink a tumor. Humans originated in small groups, the large numbers of people we face today just aren't what humans back the in environment we adapted to are used to.

    Oh and another thing, if you are struggling with anxiety, panic attacks, and social phobia, try removing caffeine from your diet. It's really not helping.

    October 17, 2011 at 18:30 | Report abuse | Reply
    • Ccb27

      Really? Remove caffeine from your diet as a solution? I am naturally very shy to the point of having social phobia and drink no caffeine on a regular basis. I do not see the connection. What has helped is learning to overcome to fear of talking to others. Someone that has not experienced this has no idea what it feels like.

      October 18, 2011 at 14:03 | Report abuse |
    • Julie

      Telling somebody that caffeine is the cause of a their health issues is rather insulting, it's often much more complicated than that.

      November 2, 2011 at 23:49 | Report abuse |
  9. lmew

    I'm really shy and I hate it. Sometimes it keeps me from doing things like if I get invited somewhere I won't go because I'm afraid I'll just end up not saying anything to anyone and look stupid so I just stay home and feel depressed about it. It used to be a lot worse when I was in school. I had no friends because I was so shy, so I was always by myself and ate lunch alone. I'm afraid to try to have a conversation with people because I never talk, so I feel like my conversations skills are awful. And I feel like there's no hope for me considering I'm in my 30s. Zoloft helped me feel like I could at least function, but I got off of it. I started taking it again, but it's not doing what it used to do.

    October 18, 2011 at 00:19 | Report abuse | Reply
  10. Kelly

    At 18 months, our daughter went mute. She showed signs just days she was born of having an unusual response in the NICU to stimuli–her specialist remarked that our daughter had a most unusual disposition, one hat she had nit scene in her work with newborns. That was a peak not what was to come.

    Through trials, tribulations, many specialists (not to mention a lot of $$), she was diagnosed with selective mutism–a social anxiety disorder. With much therapy (and learning on our part) she overcame the disorder. And at age 11, she functions very happily.

    She still seeks more solitude than most kids her age, however, she is friendly, funny, and happy.

    On a positive nite, her extrairdinary keen awareness of others gives her a unique look into what others are thinking, doing and will do next. It's never all bad–nor all good.

    Every disability has a genius ability tucked away waiting an opportunity.

    October 18, 2011 at 01:06 | Report abuse | Reply
  11. Dr Bill Toth

    something else to be scared of, another label...another learned fear. We're born with only 3 fears, Fear of Abandonement, Fear of loud noises, and Fear of Falling. And even the last two are learned. And anything that can be learned quickly can be unlearned just as quickly because that's the way the mind works. Live With Intention, DrBillTothCom/blog

    October 18, 2011 at 07:24 | Report abuse | Reply
  12. Chalres E. Rouse

    I think this culture simply assumes that shyness is undesirable and that as you mature you can get over it. Being shy isn't something to "get over," unless you want to. And if you want to, you have a perfect right to work on it. It, including social phobia and, heaven forfend, introspection and thoughtfulness, can be modified if the person wishes it. As for the rest of us introverts, it isn't an illness any more than the shallow sociability of the extrovert is an illness. Different strokes, different folks, Duh.

    October 18, 2011 at 10:41 | Report abuse | Reply
  13. Brandi

    I am 32 years old. From the time i was 12 years old, when i became aware of myself, as far as how i saw my maturing body and began to care how otheres saw me, i suffered from social phobia. It took a good amount of time for my dr's to get my medicine correct, but in the end they did and i feel better then i ever have. medicine takes time to get right. You have to adjust some and add others or take some away. If you give your dr time he or she will get it right. But medicine isn't enough, you have to have therapy also.
    I am sorry for those who only give their drs a couple of time to get their medicine right then give up on the dr. You will never allow yourself to get better if you don't give it time.

    October 18, 2011 at 13:03 | Report abuse | Reply
  14. Rick Dollero

    I think parents should care more about that. Taking medicine is not a long term solution and will make things worse over time.
    I think that children/teenagers that suffer from social anxiety/social fear should get paid their therapy!
    Also there are many self-therapies out their that are fairly unknown. They reviewed some over at http://mysocialfear.com . Although I did not believe in that products the review convinced me and it really helped me out. You should not expect wonders but they teach you some basic methods to help you dealing with you fear.

    October 20, 2011 at 12:22 | Report abuse | Reply
  15. E

    I get that if someone is not happy with their lives they should change it, but medicine should be the last resort. How about sucking it up and going outside to make friends? Whatever issue you have is in your head. Learn to control it. Stop diagnosing yourself because I'm not going to pity you just because you have a "thing". Your "thing" is in your control and you are strong enough to overcome it.

    October 24, 2011 at 14:54 | Report abuse | Reply
    • Julie

      Following that logic, should diabetics just "suck it up" because their health problems are all in their head? Similar situation, bro.

      November 2, 2011 at 23:50 | Report abuse |
  16. Milly Stanbery

    Social phobia (also called social anxiety) is a type of anxiety problem. Extreme feelings of shyness and self-consciousness build into a powerful fear. As a result, a person feels uncomfortable participating in everyday social situations.*,;'

    Most recent blog post on our own web blog <http://www.healthmedicine101.com

    July 5, 2013 at 00:20 | Report abuse | Reply

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