Half of teens shy, but for a few it's serious

Half of teens shy, but for a few it's serious

Nearly half of teenagers say they're shy, perhaps a bit surprising in our say-anything society. But a study finds a small fraction of those teens show signs of a troubling anxiety disorder that can be mistaken for extreme shyness.

The report challenges criticism that the terms “social phobia” or “social anxiety disorder” medicalize normal shyness.

“Shyness is a normal human temperament,” says lead researcher Dr. Kathleen Merikangas of the National Institute of Mental Health, whose teachers always noted her own childhood shyness on her report cards.

But just as it can be hard to tell when feeling sad turns into depression, “there is a blurred boundary between people who describe themselves as shy and clinically significant impairment,” Merikangas adds.

The difference: The shy can be drawn out and adapt, while teens or adults with full-fledged social anxiety become so paralyzed during social situations that it interferes with everyday functioning.

“I didn't go out on dates or do any of the things that other kids did,” recalls Cynthia Kipp of Tehachapi, Calif., who shared her story of years struggling with social phobia with the Anxiety Disorders Association of America. Now 48, she thinks her first anxiety symptoms began in fourth grade, when she can remember hiding under her coat in class, but worsened in high school when she tried drugs and alcohol for relief. Eventually she found treatment that worked.

The report also opens a window into the broader field of temperament research. Even garden-variety shyness worries parents, particularly fathers of boys, says Dr Nancy Snidman of Children's Hospital Boston.

In school-age boys especially, “shyness isn't very well tolerated in the United States,” says Snidman who wasn’t involved with the new research.

Snidman and colleagues at Harvard Medical School have tracked infants to their college years, and know that babies who react very negatively to new people and objects tend to grow into shy children. That’s not a bad thing — caution is considered an important evolutionary adaptation.

Usually, the clinging tot does just fine as he or she grows older and finds a niche, Snidman says. Girls may think the shy teen boy is nice because he's not macho, for example, or the shy kids wind up on the school newspaper so they can write instead of do public speaking. Many outgrow their shyness.

Yet a very shy child is considered more at risk than others of later developing some type of anxiety disorder — just as the opposite extreme, a very outgoing child, can be at greater risk for attention or conduct disorders, she says.

Social phobia tends to appear during adolescence when kids take their first real steps toward independence, but there’s little information about how often.

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