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Shyness or Social Anxiety Disorder?

Ever since the term “social phobia” appeared in the DSM-III in 1980, there has been confusion as to the differences between “shyness” and “social anxiety disorder" (the new diagnostic category formerly called “social phobia”).

Some have wondered if psychiatrists have taken a personality trait, like shyness, and ascribed additional negative attributes to it.

Others question the premise that social anxiety disorder is the same construct as shyness, or even correlates with it well.

Recent research, published in the Journal of Current Psychiatry, Volume 12, No. 11, answers many of these questions.

We have summarized the results of recent studies published in scientific journals.  After the summary of findings, a more detailed and comprehensive article continues.

SUMMARY of FINDINGS

  • Shyness and social anxiety disorder are two different things.
  • Shyness is a personality trait.
  • Many people who are shy do not have the negative emotions and feelings that accompany social anxiety disorder.  They live a normal life, and do not view shyness as a negative trait.
  • While many people with social anxiety disorder are shy, shyness is not a pre-requisite for social anxiety disorder.

It is not true that all people with social anxiety disorder are shy.  I have personally worked with many people with personalities that were extroverted.  Having social anxiety held them back and restricted them from doing what they wanted to do in life.  When they overcame social anxiety, they found they enjoyed being the center of attention and the life of the party.

The definition of “social anxiety disorder” has shifted over the past thirty years as the seriousness of the situation became clearer, and government epidemiological data consistently showed a larger percentage of the general population suffering from social anxiety symptoms.

Minor changes were made in the latest version, the DSM-5, to indicate that the “fear, anxiety, or avoidance is persistent, typically lasting 6 or more months."

The question about what constitutes “shyness” as opposed to “social anxiety disorder” originated because of the problems of over or under-diagnosing the amount of social anxiety felt.

If we treat everyone who is simply “shy” as having a disorder, it leads to stereotyping and waste of resources.  If we under-diagnose social anxiety disorder, then people with the symptoms will not receive needed treatment.

Whereas social anxiety disorder and shyness have similarities, there are distinct differences between the two.  Consider the definitions of both terms:

Shyness:  anxiety, inhibition, reticence, or a combination of these in social and interpersonal situations, and nervousness or anxiety about  evaluation by others.  Shyness is considered a normal facet of personality that combines the experience of social anxiety and inhibited behavior, but is also described as “stable temperament.”1

Shyness is classified as a personality characteristic.

Social Anxiety Disorder is classified as a significant amount of fear, embarrassment or humiliation in social performance-based situations, to a point at which the affected person often avoids these situations entirely, or endures them with a high level of distress.2

High levels of anxiety and fear cause avoidance, even of activities people want to engage in.

 

People with social anxiety disorder endure high levels of anxiety in daily activities, and this high level of anxiety makes them avoid situations in which they would like to participate.

A key difference between the two definitions is that social anxiety disorder is not considered a “normal” facet of personality, or a personality characteristic, whereas shyness is.

In fact, people who are shy may view this condition as a positive quality, whereas a person with social anxiety disorder would not describe their condition positively.

People with social anxiety experience fear, anxiety, stress, embarrassment, and humiliation on a daily basis.  The amount of anxiety experienced is enough to inflict great emotional pain and cause people to avoid situations, rather than facing them and experiencing fear and anxiety.

The manner in which “significant” impairment or distress is defined impacts whether social anxiety symptoms are classified as disordered or non-disordered.  What constitutes “significant” impairment and distress is subjective, and so the number of people with social anxiety disorder varies from 1.9% to 20.4% of the population, depending on the differing definitions of “significant” impairment.4

The oft-quoted 7% social anxiety disorder figure is arrived at by defining significant impairment as a medium amount of anxiety.  It is likely that this percentage is conservative.

A question exists as to whether shyness and social anxiety differ qualitatively or quantitatively, but the answer seems to be that they are different in both qualitative and quantitative ways...

If there was only a quantitative difference, it would require all people with social anxiety disorder to be shy, and this is not the case.

Only about one half of those diagnosed with social anxiety disorder report having been shy.

Looked at another way, less than 25% of shy persons meet the criteria for social anxiety disorder3, meaning that many people are shy without having fear, anxiety, and distress about it.

Qualitatively, a diagnosis of “social anxiety disorder” is associated with:

  • Greater presence of co-existing or additional disorders with reference to an initial diagnosis (i.e., comorbidity with other anxiety disorders, depression, dysthymia, etc.)
  • Greater severity of avoidance, and impairment in life
  • Poorer quality of life1,3,5

 

Conclusions

  • The boundaries of shyness and social anxiety disorder overlap, yet they are completely different constructs that encapsulate qualitative and quantitative differences.2
  • There is a spectrum of shyness that ranges from a normal level to a higher level that overlaps the experience of SAD, but the two states represent different constructs.5
  • More severe anxiety paired with distress about having anxiety and significant impairment in multiple areas of functioning might indicate more problematic social anxiety – a diagnosis of social anxiety disorder – not just “normal” shyness.
  • Persons with clinically significant social anxiety, rather than shyness, tend to report greater negative effects on their relationships and on work or school performance, as well as greater distress about having anxiety.
  • Cognitive-behavioral therapy is the recommended therapeutic treatment, particularly for mild to moderate cases of SAD.  In severe cases, SAD can be treated with a combination of CBT and medication with the goal of eventually discontinuing medication over time.

 

Citations

Burstein M, Ameli-Grillon L, Merikangas KR. Shyness versus social phobia in US youth. Pediatrics. 2011;128:917-925.

Chavira DA, Stein MB, Malcarne VL. Scrutinizing the relationship between shyness and social phobia. J Anxiety Disord. 2002;16:585-598.

Dalrymple, K. L., & Zimmerman, M. (2013, November). When does benign shyness become social anxiety, a treatable disorder?. Current Psychiatry, 12(11), 21-38.

Furmark T, Tillfors M, Everz PO, et al. Social phobia in the general population: prevalence and sociodemographic profile. Soc Psychiatry Psychiatr Epidemiol. 1999;34:416-424.

Heiser NA, Turner SM, Beidel DC, et al. Differentiating social phobia from shyness. J Anxiety Disord. 2009;23:469-476.

Richards, TA, Comprehensive Cognitive-Behavioral Therapy for Social Anxiety Disorder.  https://socialanxietyinstitute.org/comprehensive-cognitive-behavioral-th.... Retrieved 2014: January 22.