Excessive shyness
Many people think they are shyer than they actually are. According to psychologists at Stanford University in California, USA, 30–40% of people say they are shy, but when their behaviour is observed only 15–20% behave in a shy manner (but of course they may still be feeling shy inside).
An extreme form of shyness, known as ‘social anxiety disorder’ or ‘social phobia’, affects 1–2% of men and 2–3% of women. A phobia is a fear, and people with social phobia have a fear of being the centre of attention. They worry that everyone is looking at them and judging them, and that they will make a fool of themselves. They fear being introduced to other people. At a party, they will hover round the edge of the room or stay in the kitchen, avoiding being involved and maybe convincing themselves that they are just claustrophobic. Afterwards, the unpleasant feelings may remain as they worry about what other people thought of them. It is not that they prefer to be alone – in fact, they want to connect with others – but intense self-consciousness makes this impossible for them. Eating and drinking in public may be very stressful. Some people with social phobia can interact with new people on a one-to-one basis, but go into a total panic if they have to speak or perform in front of a number of people. They may drink too much, in an attempt to give themselves extra confidence.
In a few people, social phobia takes the form of being unable to urinate when other people are close by (such as in a public toilet) and is discussed in the section on urination shyness.
What causes social phobia?
About 70% of people with social phobia are female. It usually starts at about 11–15 years of age, and onset after 25 years of age is rare. It seems to run in families, but the cause is not really understood. Some research has suggested that you are more likely to have social phobia if your parents were overprotective or rejecting.
Treatments for shyness
These are increasingly available, especially for social phobia. The first step is to recognize that your shyness is a real disability that needs help. You then need to explain to your doctor that it is affecting your life, and that you think it is beyond ordinary shyness. The very fact that you have social phobia will make it difficult for you to ask for help. One way round this difficulty is to take with you some information about social phobia (see useful contacts) and say to your doctor "I’ve been reading this, and I think I have this problem". Alternatively, you could write a letter to your doctor beforehand to prepare the ground.
- Social skills training, in which the individual is taught simple social skills such as how to start a conversation, is one possibility.
- Another approach is cognitive therapy, in which the individual is taught to think of the social situation in a new way, instead of focusing on their own inadequacies. Research shows that people with social phobia are oversensitive. They believe that if they make a social error other people will think very badly of them and that they actually deserve this bad opinion (J Anxiety Disord 2005;19:245–74). Cognitive therapy can help put things in perspective and overcome this negative thinking.
Cognitive therapy for social anxiety disorder (social phobia)
A person with social anxiety has very negative thoughts, such as:
- “If the conversation stops, it will be my fault”
- “I won't be able to think of anything to say”
- “I'm boring”
- “I'm a social failure”
Cognitive therapy teaches the person to test out and then to correct these thoughts. For example:
- deliberately pause during a conversation and see what happens
- look for real signs (rather than imaginary ones) of whether the other person actually is bored
- recognize that a conversation may dry up because the other person has nothing to say – in general, concentrate on past successes rather than failures
In the past, tranquillizing drugs, such as Valium, were given to people who were over-anxious in social situations. In fact, tranquillizers do not really help, and are also addictive. Nowadays, three other types of drugs are used for social phobia, and an analysis of all the research has concluded that they may help some people, at least in the short term (Cochrane Database Syst Rev 2004, issue 4. CD001206).
- Selective serotonin reuptake inhibitors, or SSRIs for short, help to ease the anxiety symptoms and panic feelings that go with social phobia. Although some people respond quickly, others have to take the medication for 12 weeks before noticing any benefit, so be patient (Lancet 2008;371:1115–25).
- Beta-blockers control the physical signs of anxiety, such as shakiness, so they can make you calmer for a specific event such as public speaking.
- Reversible inhibitors of monoamine oxidase, or RIMAs for short, are sometimes used. Research studies of their effectiveness have given varied results. Therefore they are not available in some countries.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated:
Friday, February 12th 2010
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