Shyness – excessive

Many people think they are shyer than they actually are. According to psychologists at Stanford University in California, 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 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.

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. Recent 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.

• Reversible inhibitors of monoamine oxidase, or RIMAs for short, make the person feel generally more able to participate socially.
• Selective serotonin reuptake inhibitors, or SSRIs for short, help to ease the anxiety symptoms and panic feelings that go with social phobia.
• 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.