Feature Archive

Is Shyness a Mental Disorder?

Most of the time, no. But when it becomes anxiety, watch out.

WebMD Feature

April 10, 2000 (Petaluma, Calif.) -- "I'm to the point I stay home. I won't go anywhere alone," one visitor confides.

"I almost always skip classes, except when I have to take exams," says another. "I don't really know what triggers my panics, but in just one second my heart starts beating like crazy. ..."

"Has anyone out there tried medication?" someone else asks. "Does it help?"

These visitors to an anxiety chat room are among thousands of the shy and socially awkward who have found that the Internet can be a refuge, a place where they can go without fear of being embarrassed or ridiculed. Many suffer from more than just shyness, experts say. They have a condition called social anxiety disorder, also known as social phobia.

The condition has been officially recognized as a psychiatric disorder since 1980. But it hit the headlines just last year, when the U.S. Food and Drug Administration gave the pharmaceutical giant SmithKline the green light to advertise the first drug for social phobia, Paxil, generically known as paroxetine. The drugmaker launched a nationwide ad campaign with the slogan, "Imagine being allergic to people."

How do you know if you're painfully shy -- or a social phobic? And if fear of social situations is short-circuiting your life, is there anything you can do?

According to a 1998 study called the National Comorbidity Survey, conducted by Ronald Kessler, PhD, at Harvard Medical School, more than 13% of Americans experience the symptoms of social anxiety disorder at some point in their lives. The same survey found that at any given time, a startling 4.5% of the population meets the diagnostic criteria, making social anxiety disorder the third most common mental disorder in the nation, after depression and alcoholism. Experts like R. Bruce Lydiard, MD, professor of psychiatry at the Medical University of South Carolina, applaud the new attention being given to social phobia. "The biggest problem we face is reaching these patients," he says. "Many are too afraid to see a doctor."

Shrinking Violet or Social Phobic?

But others worry that garden-variety shyness could end up being labeled as a mental illness. Lynn Henderson, who directs the Shyness Clinic in California, and Philip Zimbardo, a psychologist at Stanford University, caution that medication is being promoted as "a shyness cure-all, a magic pill," when the problem for many people is nothing more serious than inadequate social skills.

Like any personality trait, shyness occurs across a spectrum -- from being uncomfortable at parties to being unable to leave the house for fear of being seen and judged by others.

Social anxiety becomes a problem when it seriously interferes with people's ability to live their lives, says Jonathon Davidson, MD, professor of psychiatry at Duke University Medical Center's Anxiety and Traumatic Stress Program. To diagnose the condition, Davidson has developed a widely used inventory of 17 questions. A mini-version of the test, he says, with only three questions, can correctly diagnose social phobia with 93% accuracy. The questions are:

  • Does fear of embarrassment cause you to avoid doing things or speaking to people?
  • Do you avoid activities in which you are the center of attention?
  • Are being embarrassed or looking stupid among your worst fears?

If people answer yes to at least two of these questions, says Davidson, they are probably phobic. If these fears cause you to hide at home or avoid contact with anyone but your closest friends, you may want to consider therapy.

Drugs, Counseling, or Both

Untreated, social phobia can lead to serious problems, so it's important to identify and treat this condition. Psychiatrist Murray Stein and his colleagues at the University of California at Los Angeles have found that almost six in ten social phobics are clinically depressed, and one in four have recently been treated for substance abuse, according to a review article published in the December 1999 Journal of Clinical Psychiatry. The researchers speculate that the isolation brought on by social phobia contributes to the other disorders.

Luckily, a variety of treatments can help. In a study published in the August 26, 1998 Journal of the American Medical Association, 55% of patients taking Paxil reported that their symptoms improved after 11 weeks, compared to only 23.9% of those taking a placebo. Scores on a widely used test that measures social phobia, called the Liebowitz Social Anxiety Scale, fell by 39.1% in the Paxil group compared with only 17.4% in patients given the placebo.