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To determine if social phobia (a type of anxiety disorder) is a distinct entity or merely the “medicalization” of common human shyness, NIH investigators analyzed data from 10,123 adolescents (age range, 13–18 years) who participated in the nationally representative National Comorbidity Survey Replication Adolescent Supplement. Adolescents completed a structured diagnostic interview that assessed a broad range of mental health disorders. Those who met all eight lifetime DSM-IV criteria for social phobia, including one or more social fears, were classified as having social phobia, regardless of shyness. Adolescents were considered shy if they reported being “very” or “somewhat” shy around same-aged peers they did not know very well and did not meet social phobia criteria. Other assessments included impairments in the past year during chores, school/work, family relationships, and social life; prescribed psychiatric medication use; and lifetime treatment for anxiety disorders.
Overall, 43% of males and 51% of females rated themselves as shy, but only 12% of these youth met criteria for social phobia. Five percent of youth who did not rate themselves as shy met social phobia criteria. The prevalence of social phobia increased with age (6.3% of 13- to 14-year-olds, 9.6% of 15- to 16-year-olds, and 10.4% of 17- to 18-year-olds). Compared with shy adolescents, those with social phobia were significantly more likely to have an anxiety disorder (odds ratio, 2.79), major depressive disorder (OR, 2.06), oppositional defiant disorder (OR, 1.99), or drug use disorder (OR, 3.27). They also had significantly greater impairment in school/work, family relationships, and social life. Only 23% of adolescents with social phobia sought professional treatment for anxiety, and just 12% received psychiatric medication.
Burstein M et al. Shyness versus social phobia in US youth. Pediatrics 2011 Nov; 128:917.
Comment
These results contradict the notion that social phobia is “medicalization” of a normal human emotion. The major distinction between social anxiety and shyness is that the anxiety associated with social phobia results in impairments that are significant enough to negatively impact one or more life areas (school, work, relations with friends or family). Few adolescents with social phobia ever sought treatment for anxiety or received psychiatric medication, which indicates that we need a better system for identifying these youth and helping them get the care they really need to treat the social phobia and other identified comorbidities. The SCARED screening tool is a standardized instrument to screen for child anxiety disorders in primary care and includes questions about shyness and specific anxieties.