The controversial diagnosis “social phobia” is a legitimate psychiatric condition and is not the same as shyness, U.S. government researchers say in a new report.
Based on a large national survey, they found cases of social phobia among teens who described themselves as shy as well as among those who didn’t.
“Shyness is not necessarily social phobia and that’s the point of our paper,” said Kathleen Merikangas of the National Institute of Mental Health in Bethesda, Md..
Her team also found that fewer than 8 per cent of adolescents with social phobia said they had been treated with antidepressants.
According to the new report, in the journal Pediatrics, that suggests social phobia isn’t a concept created to sell medications to people experiencing common emotions like shyness, as some critics have worried.
“I think their article is a welcome reminder that psychiatric diagnoses aren’t some kind of conspiracy on the part of the pharmaceutical industry,” said Ian Dowbiggin, a historian and the author of The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society.
But to him, the new findings don’t challenge the idea that “social phobia” is just a new label for experiences that were once considered normal.
“They left out the whole debate about how much our society and culture influence the way people report their emotional states,” said Prof. Dowbiggin, of the University of Prince Edward Island in Charlottetown.
“We are currently living in a culture of ‘therapism,’” he said. “It encourages shy people to conclude that they suffer from a significant impairment in their social functioning.”
According to the National Institute of Mental Health, social phobia is characterized by “persistent, intense and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions.”
And the condition is tied to a host of problems in daily life, Dr. Merikangas added.
“Many of these kids won’t go to school on days they have to speak in class, or they won’t go to parties,” she said. “They are so upset by having to be in some of these social contexts that it really does impair their educational performance.”
Dr. Merikangas said that many of teens with social phobia can be helped by education, talk therapy or medications such as antidepressants.
Her team also found that adolescents who fit the American Psychiatric Association’s criteria for the disorder were more likely to be depressed, have behavioural problems and abuse drugs than teens who were just shy.
The researchers assessed shyness by asking teens directly to rate their “shyness around people their own age who they didn’t know very well” on a four-point scale, and asked parents to rate their own children on the same question.
Around half of the more than 10,000 U.S. teens interviewed in the survey said they were shy to some degree, whereas only about 9 per cent met the criteria for social phobia.
One in eight of the self-described shy children were estimated to have had social phobia, also called social anxiety disorder, at some point. That compared to one in 20 of those who weren’t shy.
Glen Spielmans, a psychologist at the Metropolitan State University in Saint Paul, Minn., cautioned that the study’s estimates are fraught with uncertainty.
“With most psychiatric disorders, we have to be a little careful,” he said. “What often happens is the people who are doing the interviews are not mental health professionals.”
That means they might be too quick, or slow, to diagnose a certain disorder.
Mr. Spielmans also said the study was “dated,” noting that the interviews had been done in 2001 and 2002 and that prescription of antidepressants has shot up since then.
What’s more, he said, medications for social phobia have primarily been marketed to adults, not children.
“The extent to which we might be pathologizing normal behaviour in adults is still an open question that could benefit from some investigation,” Mr. Spielmans said.