Most Shy Children Do Not Suffer From Social Phobia

From Medscape Medical News > Psychiatry Fran Lowry October 19, 2011 — Many children describe themselves as being shy, but only 1 in 10 may actually have social phobia, a disabling psychiatric disorder that goes beyond normal human shyness, new research shows. Debate has recently surfaced over whether the diagnostic term social phobia "medicalizes" normal human shyness, resulting in unnecessary treatment, especially in youth, senior author Kathleen R. Merikangas, PhD, from the National Institute of Mental Health, Bethesda, Maryland, told Medscape Medical News. "We wanted to examine the prevalence of shyness and social phobia, and the only way we really get to know about the scope of these problems is by going after the general population," she said. The study was published online October 17 in Pediatrics. Disabling Disorder Dr. Merikangas and colleagues collected household and school data from across the United States to garner a nationally representative sample of adolescents aged 13 to 18 years and create the National Comorbidity Survey–Adolescent Supplement, a face-to-face survey. The data in the survey included 10,123 adolescents and 6000 parents. Participants were asked about a variety of mental disorders, including social phobia. "Social phobia is a very disabling psychiatric disorder. It interferes with a person's social life, their educational activities and success in school, and limits outside activities. Those affected feel uncomfortable to the point where they avoid contact with others or speaking out in class, and this is where we draw the threshold between a normal trait and disorder," said Dr. Merikangas. The researchers found that almost half of the adolescents (46.7%) rated themselves as shy, and that about 62.4% of parents reported that their teenagers were shy. "It's almost like a normative trait to describe yourself, or for the parents to describe their kids, as being shy. It's just like saying someone has blue eyes or brown eyes, or they are extroverted or introverted. Shyness is one of those, and it's a normal human trait," Dr. Merikangas said. Increases With Age The study also found that of the children who report themselves as shy, 12% had social phobia, or substantial impairment from their shyness. In addition, the rate of social phobia increased with the age of the children. For 13-year-olds, the rate was 6.3%; for 15- to 16-year-olds, it was 9.6%; and at age 17 to 18 years, it was 10.4%. Social phobia is treatable, Dr. Merikangas emphasized. "Parents of children who have social phobia can modify their child's environment; help them to have gradual exposure to the things that exacerbate their social phobia. Behavioral and exposure therapy, similar to fear-of-flying programs that some of the airlines put on, can help," she said. The education system could also help these children, she added. "If the education system were to recognize it, more teachers may be less harsh in grading kids who don't raise their hand in class, or who don't talk in class. If they are aware of social phobia, they may help them, rather than punish them." Gateway Disorder Commenting on the study for Medscape Medical News, Anne Marie Albano, PhD, from Columbia University and the New York State Psychiatric Institute, New York City, said: "I think it's a critical study. It has quantified and clarified what we have known in psychiatry, which is that shyness is a normally distributed trait that is not a clinical syndrome, and it is distinct from social phobia or social anxiety disorder, which is disabling." Dr. Albano agreed that there is much that can be done for kids with social phobia. "There are highly effective treatments in cognitive behavioral therapy that teach them skills for managing the anxiety and making their way into the social world they need to live in," she said. For those who develop more impairment in functioning, the combination of medication and psychotherapy is effective, she added. "One of the big things about social phobia that we know is it's a gateway disorder. It usually occurs first, and it's a gateway to depression and substance abuse, so it's critical that we get kids help for this and not dismiss it as a normal personality trait," she said. This study was supported by the Intramural Research Program of the National Institute of Mental Health. Dr. Merikangas and Dr. Albano have reported no relevant financial relationships. Pediatrics. Published online October 17, 2011. Abstract