Social Phobia in Youth: More Than Just Shyness

Article excerpt


Social phobia is an impairing psychiatric disorder that transcends typical human shyness, according to findings from the National Comorbidity Survey-Adolescent Supplement, which examined the rate of shyness and its overlap with social phobia in a nationally representative sample of adolescents. Yet, no significant differences were seen between adolescents characterized as shy and those who met the diagnostic criteria for social phobia in the use of prescribed medications.

The findings of the study, which involved face-to-face interviews with 10,123 adolescents aged 13-18 years, suggest there is little overlap between shyness and social phobia. The absence of differences in the use of prescribed medications between the two groups raises questions about the "medicalization hypothesis" of social phobia, which is a prevalent belief that the entity of social phobia is little more than medicalization of normal shyness, Marcy Burstein, Ph.D., and her colleagues from the National Institute of Mental Health in Bethesda, Md., argue in the November issue of Pediatrics (2011;128:917-25).

In fact, only 12.4% of 4,749 youth who described themselves as shy, and 10.6% whose parents considered them shy, also met the DSM-IV lifetime diagnostic criteria for social phobia. Furthermore, 5.2% and 5.5% of those who were not considered shy by their own or their parents' reports, respectively, met the diagnostic criteria for social phobia.

Compared with adolescents with shyness, those with social phobia had significantly greater impairment in school and/or work (mean impairment score of 4.32 vs. 2.68 on a 10-point scale), family relationships (mean scores of 2.23 vs. 1.22), and social life (mean scores of 4.41 vs. 2.80). They also were more likely to be affected by anxiety disorders (odds ratio, 2.79), major depressive disorder (OR, 2. …