A new national study of US teenagers dispels the idea that normal shyness is the same as social phobia or social anxiety disorder, a disabling psychiatric condition where the person is overwhelmed by anxiety and excessive self-consciousness in everyday social or performance situations. Social phobia can also occur independently of shyness, say researchers from the US National Institute of Mental Health (NIMH), who reported their findings in the 17 October online ahead of print issue of Pediatrics.

First author Dr Marcy Burstein, and colleagues at NIMH, wanted to do the study because there have been criticisms that social phobia is just a hyped up label, a “medicalized” normal variation of human temperament, applied by psychiatrists and drug companies to increase sales of medication, especially for young people.

For their study, they looked at data from a nationally representative, face-to-face survey of more than 10,000 youngsters aged from 13 to 18 that is sponsored by NIMH, the National Comorbidity Survey-Adolescent Supplement (NCS-A).

They assessed the rate of normal shyness and the extent to which it overlapped with social phobia.

Social phobia was assessed using the diagnostic criteria set out in DSM-IV, the American Psychiatric Association’s Diagnostic and Statistical Manual and shyness was assessed from the participants’ responses to questions about how shy they felt around people their age they did not know well.

When they analyzed the data they found that:

  • About half of the participants identified themselves as shy.
  • Only 12% of these also met criteria for lifetime social phobia.
  • Compared to participants characterized as shy, those with social phobia showed greater impairment in work, at school, among family and peers, and were also more likely to have numerous other psychiatric disorders, such as disorders of anxiety, mood, behavior, and substance use.
  • But these teens were no more likely to be on prescribed medication than others of the same age.
  • Rates of prescribed medication use were low for all groups.
  • 2.3% of those who met social phobia criteria were taking the antidepressant paroxetine (commonly used to treat anxiety disorders), while 0.9% of those who described themselves as shy were taking it.
  • Among adolescents who did not identify themselves as shy, about 5% met criteria for social phobia, suggesting the two are not necessarily directly related and in some cases may be independent of each other.

The researchers concluded that the results suggest social phobia is not medicalized shyness, but rather a condition that affects a minority of youngsters and only a small percentage of those who identify themselves as shy.

Also, despite the impairment it causes in their lives and the greater chance they will also have another psychiatric condition, youngsters with social phobia are no more likely to be receiving treatment than others their age.

The researchers said these results question the idea that youngsters with social phobia are receiving unnecessary medical treatment:

“Such findings raise questions concerning the ‘medicalization’ hypothesis of social phobia,” they write.

Written by Catharine Paddock PhD