Prof. Murray B Stein MD and Prof. Dan J Stein MD, in The Lancet, Volume 371, Issue 9618, Pages 1115 – 1125, 29 March 2008.

Abstract:

Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more sophisticated appreciation of its prevalence, its chronic and pernicious nature, and its neurobiological underpinnings. Social anxiety disorder is the most common anxiety disorder; it has an early age of onset—by age 11 years in about 50% and by age 20 years in about 80% of individuals—and it is a risk factor for subsequent depressive illness and substance abuse. Functional neuroimaging studies point to increased activity in amygdala and insula in patients with social anxiety disorder, and genetic studies are increasingly focusing on this and other (eg, personality trait neuroticism) core phenotypes to identify risk loci. A range of effective cognitive behavioural and pharmacological treatments [SSRIs] for children and adults now exists; the challenges lie in optimum integration and dissemination of these treatments, and learning how to help the 30—40% of patients for whom treatment does not work.

Listen to the podcast (interview starts at minute 6:00).

My notes from the podcast–bolded items in abstract plus:

  • like sadness vs depression, shyness vs social anxiety exist on a spectrum, and it is the “most shy person you know” where this disorder may interfere with their life, and is worth treatment.
  • diagnosable in 5% of the population
  • easy to diagnosis.  physician/therapists asks: “Does you shyness interfere with your life?”  A yes answer is a strong predictor.
  • stigma:  eg. General Physicians often themselves consider it trivial

Also in the issue Simon Wessely provides a dissenting view, reviewing How shyness became social phobia by Christopher Lane.

Pathologising shyness, eccentricity, or sadness does few any favours—neither those who receive unhelpful labels, nor those with major mental disorders who need all the resources and research we can muster.