Is being shy a disorder

Is Shyness a Mental Disorder?

Most of the time, no. But when it becomes anxiety, watch out.

April 10, 2000 (Petaluma, Calif.) -- "I'm to the point I stay home. I won't go anywhere alone," one visitor confides.

"I almost always skip classes, except when I have to take exams," says another. "I don't really know what triggers my panics, but in just one second my heart starts beating like crazy. ..."

"Has anyone out there tried medication?" someone else asks. "Does it help?"

These visitors to an anxiety chat room are among thousands of the shy and socially awkward who have found that the Internet can be a refuge, a place where they can go without fear of being embarrassed or ridiculed. Many suffer from more than just shyness, experts say. They have a condition called social anxiety disorder, also known as social phobia.

The condition has been officially recognized as a psychiatric disorder since 1980. But it hit the headlines just last year, when the U. S. Food and Drug Administration gave the pharmaceutical giant SmithKline the green light to advertise the first drug for social phobia, Paxil, generically known as paroxetine. The drugmaker launched a nationwide ad campaign with the slogan, "Imagine being allergic to people."

How do you know if you're painfully shy -- or a social phobic? And if fear of social situations is short-circuiting your life, is there anything you can do?

According to a 1998 study called the National Comorbidity Survey, conducted by Ronald Kessler, PhD, at Harvard Medical School, more than 13% of Americans experience the symptoms of social anxiety disorder at some point in their lives. The same survey found that at any given time, a startling 4.5% of the population meets the diagnostic criteria, making social anxiety disorder the third most common mental disorder in the nation, after depression and alcoholism. Experts like R. Bruce Lydiard, MD, professor of psychiatry at the Medical University of South Carolina, applaud the new attention being given to social phobia. "The biggest problem we face is reaching these patients," he says. "Many are too afraid to see a doctor."

Shrinking Violet or Social Phobic?

But others worry that garden-variety shyness could end up being labeled as a mental illness. Lynn Henderson, who directs the Shyness Clinic in California, and Philip Zimbardo, a psychologist at Stanford University, caution that medication is being promoted as "a shyness cure-all, a magic pill," when the problem for many people is nothing more serious than inadequate social skills.

Like any personality trait, shyness occurs across a spectrum -- from being uncomfortable at parties to being unable to leave the house for fear of being seen and judged by others.

Social anxiety becomes a problem when it seriously interferes with people's ability to live their lives, says Jonathon Davidson, MD, professor of psychiatry at Duke University Medical Center's Anxiety and Traumatic Stress Program. To diagnose the condition, Davidson has developed a widely used inventory of 17 questions. A mini-version of the test, he says, with only three questions, can correctly diagnose social phobia with 93% accuracy. The questions are:

  • Does fear of embarrassment cause you to avoid doing things or speaking to people?
  • Do you avoid activities in which you are the center of attention?
  • Are being embarrassed or looking stupid among your worst fears?

If people answer yes to at least two of these questions, says Davidson, they are probably phobic. If these fears cause you to hide at home or avoid contact with anyone but your closest friends, you may want to consider therapy.

Drugs, Counseling, or Both

Untreated, social phobia can lead to serious problems, so it's important to identify and treat this condition. Psychiatrist Murray Stein and his colleagues at the University of California at Los Angeles have found that almost six in ten social phobics are clinically depressed, and one in four have recently been treated for substance abuse, according to a review article published in the December 1999 Journal of Clinical Psychiatry. The researchers speculate that the isolation brought on by social phobia contributes to the other disorders.

Luckily, a variety of treatments can help. In a study published in the August 26, 1998 Journal of the American Medical Association, 55% of patients taking Paxil reported that their symptoms improved after 11 weeks, compared to only 23.9% of those taking a placebo. Scores on a widely used test that measures social phobia, called the Liebowitz Social Anxiety Scale, fell by 39.1% in the Paxil group compared with only 17.4% in patients given the placebo.

In clinical practice, psychiatrists are discovering that other drugs similar to Paxil, including Serzone, Effexor, and Zoloft, can also effectively treat social phobia, says Lydiard.

Are such drugs likely to be overused? Probably not. They seem to work only in people with serious social anxiety, according to Davidson. Paxil won't turn a normally shy person into a social butterfly, in other words. And most people are willing to take a prescription drug -- which usually costs them money and can have side effects -- only if they perceive that they have a real problem.

Medication is only one approach. Psychotherapy can also help. At the University of California at Los Angeles' Social Phobia Clinic, patients meet once a week for 14 weeks of group sessions designed to help them replace negative thoughts ("She won't like me," or "I look stupid") with more positive thinking. In behavioral therapy sessions, patients are put in anxiety-producing situations in order to defuse their fears.

So it turns out that chatting about this problem does help, as more and more social phobia sufferers are discovering by going online to share their feelings with others. Several social phobia experts believe chat groups are useful to patients with the disorder. It's good to know that there's at least one place on the Internet -- so often blamed for isolating us -- where people can go to escape feelings of isolation.

Peter Jaret is a contributing editor at Health and National Wildlife magazines. His work has appeared in Newsweek, National Geographic, Hippocrates, Men's Journal, Vogue, Glamour, and many other magazines. He lives in Petaluma, Calif.

Social anxiety disorder, social phobia vs. being shy

Is social anxiety disorder just another name for being really shy?

Written by Gina Shaw

Many people are a little bit shy, but those with social anxiety disorder (also called social phobia) can become overwhelmed with anxiety in simple social situations.

Peter (not his real name) was a smart, savvy businessman with a PhD and a bright future. He had quickly climbed the corporate ladder, but when he was offered another promotion -- one that would put him at the top of his division -- he turned it down, jeopardizing his career. Why? The thought of being the center of attention in a major meeting, required in the new position, threw Peter into a blind, desperate panic, complete with physical symptoms like flushing, sweating, and heart palpitations.

Peter had what psychiatrists call circumscribed social anxiety disorder (SAD) -- an intense, irrational, and persistent fear of being scrutinized or negatively evaluated by other people. People with SAD, also known as social phobia, tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. Social anxiety disorder can be "circumscribed," like Peter's (he only feared being scrutinized at work), or "generalized" -- a much more debilitating condition that can make everything from walking to a table at a restaurant to attending your best friend's wedding a cause for sheer terror.

In February, two antidepressant drugs, Effexor and Zoloft, were added to a list of about a dozen approved medications for social anxiety disorder, sparking renewed interest in this little-known condition. Is social anxiety disorder just another name for being really shy?

Putting the Brakes on Life

Not at all, say many leading psychiatrists. "Many people are a little bit shy. If you're shy, you might be somewhat uncomfortable in situations such as going to a party where you don't know anyone, but you do it. You give yourself a push, you go to the party, after a while you relax and talk to people," says Rudolf Hoehn-Saric, MD, who heads the Anxiety Disorders Clinic at Johns Hopkins University School of Medicine. "The social phobic person, at the prospect of the same party, would be overwhelmed by such anxiety that [he or she] would have a physical reaction -- perhaps nausea, sweating, heart racing, dizziness -- and would avoid it if at all possible. It's a matter of degree."

In other words, being shy can complicate your life. Having social phobia can stop it in its tracks. "The hallmark of social anxiety disorder is that it causes impairment in your function," explains Sy Atezaz Saeed, MD, chair of the department of psychiatry and behavioral medicine at the University of Illinois College of Medicine at Peoria and co-director of the University's Anxiety and Mood Disorders Clinic. A high school student -- many adolescents have social anxiety disorder -- might be so overwhelmed by the fear of standing up to give a report that they can't complete assignments and fails classes. For Peter, the businessman, social anxiety disorder endangered his career advancement.

"I've treated patients who are very competent, but have jobs well below their capacity because they're afraid of asking for a promotion or going out and looking for a better job," says Hoehn-Saric. This might explain why some 70% of people with SAD are on the lower end of the socioeconomic scale and nearly 50% fail to complete high school.

More Common Than You Think

How common is social anxiety disorder? Figures vary, but according to the most recent studies, about 8% of the population experiences social phobia in a given year -- making it the third most common psychiatric disorder, trailing only major depression and substance abuse. It's also widely underdiagnosed, says Saeed. "In one study, less than 1% of the patients with SAD were diagnosed and treated."

Part of the problem: SAD often accompanies major depression, in a which-came-first cocktail of mental health conditions, so psychiatrists may diagnose and treat the depression without taking note of the social anxiety disorder.

When it is diagnosed and treated, though, people with social anxiety disorder can look forward to major improvements in their lives. Saeed's patient, Peter, has seen his career take off after treatment for SAD. Hoehn-Saric describes a high school student whose social phobias were so great that they couldn't even enter the cafeteria at school; after struggling at several colleges, with treatment they found a small New England institution that understood their needs and is excelling academically and socially.

Most experts advocate a combined approach, using both approved medications and what's called cognitive behavioral therapy, to treat SAD. "Medication does decrease the general anxiety and also the depression that is frequently present in people who don't function so well socially," says Hoehn-Saric. "It can combat the surge of anxiety when you go into a social situation, and if you can diminish the initial responses -- chin quivering, hands shaking and sweating, face flushing -- if you take away those triggers, the person doesn't get into a vicious cycle of embarrassment. "

But that's usually not enough. Cognitive behavioral therapy for social anxiety disorder usually involves "exposure" -- confronting the patient's fears. "First, people imagine the situation, and look at it as an outsider. How realistic are their fears? They're taught to reorganize their thinking, and then they expose themselves to social situations to decrease their anxiety," says Hoehn-Saric.

Group therapy often works particularly well for social anxiety disorder, since people with SAD are usually uncomfortable in groups and being exposed to other people. "They see that other people are like them, and they're doing better now, so there's some hope for them too. And as they start to feel more comfortable in a therapeutic group setting, they can transfer that to other social situations."

It's a long process. Don't expect social anxiety disorder to disappear after eight weeks of treatment, says Saeed -- closer to eight months or a year may be more realistic. "One of the difficulties with SAD is that since people have had it for so long, they've had to start avoiding things," he says. "Even when the symptoms are under control, unless you go out and engage in the activities you've been fearing, you won't know what your response is. So ultimately you have to face your fears."

We will identify the causes of dysmorphophobia and prescribe a competent treatment - Allianz Central Medical Center

Rarely do you meet a person completely satisfied with their appearance. There is always something to work on. But sometimes dislike for one's own body or some part of it reaches the scale of a mental disorder. This disease is called dysmorphophobia.

Dysmorphophobia (dysmorphophobia, dysmorphia, dysmorphic disorder) is a mental disorder in which a person is overly worried about a flaw in his body.

The cause of anxiety can be both general signs (excess weight or thinness, high or short stature, "broad bone", acne skin), and more specific ones (the shape and size of the nose, chest or buttocks, the condition of the waist or abdomen, the presence of a birthmark, leg shape and more).

The dysmorphophobia syndrome significantly worsens the quality of life - the patient thinks about his flaw for several hours a day, feels embarrassed about it, tries to hide it, can avoid contact with people up to refusing to leave the house. Work, study, communication with friends suffer, personal relationships do not go well. It seems to a person that everyone looks at his shortcoming, laughs at him or is disgusted (although people do not notice what is bothering the patient or do not attach such importance to it).

In a dysmorphic disorder, the "causal" organ may look quite aesthetically pleasing, have a minor flaw, or even be very attractive. Therefore, people around often perceive dysmorphophobia as a whim or a desire to attract attention. However, this disorder does not depend on the will of the patient and does not go away without the intervention of a doctor, joining other diseases (generalized anxiety disorder, depression, anorexia, up to the delirium of a physical handicap).

There are usually several reasons for the development of dysmorphophobia. Characteristic personality traits (suspiciousness, emotional lability) in combination with parenting, teasing or criticism, sexual or other emotional trauma can lead to this disorder. The influence of the media environment also plays a certain role.

Dysmorphic disorder has the following symptoms:

  • symptom of a mirror - a constant desire to look into a mirror and other reflective surfaces, the search for an advantageous angle, in which the flaw is not so noticeable; sometimes - complete avoidance of mirrors;
  • a symptom of photography is a categorical refusal to be photographed. In the era of selfies, another variation appeared, consonant with the symptom of a mirror - an obsessive desire to take selfies in search of the most advantageous angle that compensates for the lack;
  • excessive attention to one's own appearance - diet and exercise, cosmetic procedures up to plastic surgery, excessive use of cosmetics, use of defiant clothing and accessories in order to divert attention from the defect; sometimes - shapeless clothes, loosening hair on the face to hide a flaw;
  • constant talking about a flaw, asking relatives, searching for information on the Internet, comparing yourself with other people;
  • depression, social isolation.

If a patient with dysmorphophobia is not treated in a timely manner, other disorders and diseases may be added. A psychotherapist should treat a dysmorphic disorder. Unfortunately, due to ridicule, patients often do not believe that someone will understand them and be able to help. In fact, this is not so. It is important not to delay contacting a doctor, because the state of dysmorphophobia will not go away on its own, and attempts to correct the deficiency will not bring satisfaction.

We know how to help a person with body dysmorphic disorder. Our experts will help you find the cause of the disorder and work it out. Changing negative attitudes, working with self-esteem and an individually selected medication regimen will give healing, and a comfortable environment will make the path to healing pleasant and calm.

What is dysmorphophobia and is it possible to fight it

First hand

Maria Vinogradova, Svetlana Durboy


With dysmorphophobia, a person considers some features of his appearance to be real deformities, while other people do not even notice them. Afisha Daily spoke with a woman with body dysmorphic disorder, as well as with a psychiatrist and psychologist, about the borderline between self-dissatisfaction and mental illness.


28 years old

I had problems with the perception of appearance at the age of eleven. I wanted to adorn myself, dress up in fashionable clothes, but my mother did not spoil me with fashionable things and forbade me to put on makeup. It was a tragedy because I couldn't even hide my pimples. It seems to me that if at that age I had learned to love myself, there would be no dysmorphophobia.

At school, I realized that I was dumb. Classmates did not let me forget that my nose is like that of Baba Yaga, and my legs are crooked and short. For the rest of my life, I remember the situation when we played "weak", where you had to complete a task or get a kick, and the phrase sounded that it's better to get a kick than to kiss me. Since then, I began to increasingly look for flaws in myself and find them.

I started going to a psychotherapist when I was a teenager, but due to my age I did not take treatment seriously. My mother also took me to medical hypnosis: there they calmed us down with a speech, and then whispered some kind of suggestion about loving yourself into each ear. I never slept there and mostly thought about myself. As an adult, I again began to go to a psychotherapist, to whom my mother also sent me. Then depression and social phobia were added to dysmorphophobia. The doctor said some banal things about how we are all beautiful and we need to love ourselves, and once said that I have an iconic face. Now I continue treatment with a psychotherapist: I drink sedatives, antidepressants, neuroleptics - mainly so as not to be nervous and not take everything to heart.

I can't talk about my ideal of beauty - it causes great mental pain, I get angry. My sore spots are my whole face, as well as my eyes, chin, nose, short crooked legs. I didn’t do plastic surgery, because it seems to me that this is a betrayal of my parents: I’m very afraid of offending my mother, because everything that doesn’t suit me in appearance came from her.

Sometimes I may cry in the street because I am ugly, when a woman "must be beautiful." It is very painful to meet this message in films or literature. Now I cry less often, but before I could not listen to romantic music, read poetry, because they were written for beautiful people. The word "beauty" for me is a trigger (a word or an event that makes a person experience psychological trauma. - Note ed. ).

I constantly convinced myself that I was a slim blonde, I imagined myself to be her. It seemed that life was easier for them, and I would never become like that. At some point, I became addicted to mirrors: I had to look every second to see if everything was in order with my appearance. I don't use webcams and I can't stand uninvited guests - I'm afraid that someone will see me at the wrong time.

Dysmorphophobia brought me to misandry. I was very angry with men, because it was because of their greed and lust that terrible standards of beauty arose, because of which I feel ugly. Everything would not be so tragic if it were not shouted from behind every corner that a woman must be attractive "meat".

I love kind words, even if it's outright flattery - it means that you are somehow important to the person. I feel better from simple compliments, and criticism always hurts. Once I met a young man, and on the first date he gave me a "compliment": he said that I had a nice smile, despite my ugly face. It was a low blow, especially since it was said at the moment when I almost stopped considering myself a freak. After this incident, I began to have reactive depression (formed as a response to the experienced situation. — Note ed. ). Then there were thoughts about suicide as the only way out. And at that moment I decided never to have children, so as not to spread "ugly genes."

Now it is much easier for me, because I have a beloved man. He never made me remarks about my appearance. He always says that I am beautiful. It is very important for me. I continue to carefully monitor myself: it would be easier to score, but I can't. I also stopped being afraid to have children, and if I have a child, I will do everything to make him feel in the first place. I realized on my own - only love heals.

In modern terms, body dysmorphic disorder is an excessive preoccupation with one or more subtle physical defects. The disorder is usually accompanied by stereotypical behavior (actions that are regularly repeated regardless of the context. - Approx. ed. ): people look at themselves in the mirror, take care of themselves excessively, pay close attention to certain parts of the body, compulsively compare themselves with those around them, constantly looking for confirmation that they have a flaw. A person suffering from dysmorphophobia is always sure that he has some kind of defect.

According to epidemiological studies, the prevalence of the disease in society ranges from 1.7 to 2.4%. Obvious symptoms usually appear at the age of 13–20 years and are observed with the same frequency in men and women.

If men are characterized by concern about insufficient muscle mass, then women are more likely to pay increased attention to minor skin defects and certain parts of the body (the shape of the lips, eyebrows, nose, anatomical features of the hips, abdomen, legs, and so on).

Adolescents are primarily at risk, since it is at this age that an active process of self-identification begins. Through appearance, a teenager becomes aware of himself, answers the question "What am I", identifies with a social group that is significant for him. And it is appearance that becomes the basis for painful fixation and increased sensitivity to oneself and one's experiences. Also at risk are people for whom appearance is professionally significant: for example, photo models, TV presenters and all those for whom problems with appearance can become a serious obstacle to achieving professional and personal self-realization.

It is important to understand that the identified defects or shortcomings are imaginary, imperceptible to others. According to one of the hypotheses, the appearance of the disease is associated with a violation of the global perception mechanism - in other words, a person perceives only individual details, since the ability to see objects as a whole suffers.

There is a big difference between the usual complexes, psychological trauma, obsessions and body dysmorphic disorder. Preoccupation with acne, overweight, or obvious physical handicaps during adolescence are common pubertal problems that are not manifestations of a disease state. Sometimes people who lack attention behave the same way. This feature refers to personality traits and is not a manifestation of pathology.

We can speak of a disorder when a defect becomes so problematic for a person that it changes his whole life. Behavior, everyday habits, thoughts begin to revolve around this topic. That is, there is a painful fixation, a “stuck”, from which it is no longer possible to get out on your own.

The traditional answer to the question "When is it time to see a doctor?" - the earlier the better. However, in reality, this principle is difficult to implement. If something similar happens to one of your relatives, you need to draw his attention to the situation, advise him to consult a psychotherapist or psychiatrist. We can definitely say that if the symptoms of dysmorphophobia distort everyday life (for example, a person stops leaving the house, withdraws into himself, and so on), this is a serious sign that suggests that you need to contact a specialist as soon as possible.

Treatment for body dysmorphic disorder is usually lengthy and can take months. It includes both medication and psychotherapeutic methods of correction. The first line of therapy, regardless of the severity of disorders, are antidepressants from the group of selective serotonin reuptake inhibitors. Of the psychotherapeutic methods, the methods of cognitive-behavioral and existential-analytical psychotherapy are most widely used.

Dysmorphophobia, that is, the fear of the unattractiveness of one's body, is arranged as follows: a person sees some part of his body as ugly, deformed and strives to correct the defect. The lack may not exist at all, but all thoughts are focused around it. The problem develops more often when two circumstances coincide: external and internal.

External circumstances include widely advertised standards of beauty, and internal circumstances are associated with the emergence of an obsession in a person: a person sees some kind of defect in himself, starts thinking about it, thereby supporting him. He is no longer able to distract himself from this shortcoming, so it becomes obvious not only to the sufferer himself, but also to those around him. For example, a girl who believed that she had an ugly eye shape wore glasses with dark lenses both in sunny and bad weather, thereby drawing attention to her eyes.

Dysmorphophobia can be part of anorexia, when a person seems to have some part of his body fat - for example, cheeks or thighs. A person begins to limit himself in food, but this does not help to lose weight exactly where you want. Then it begins to seem to a person that he is not losing weight well enough, so he begins to restrict himself in food even more. In this case, the disorder can even lead to death.

The line between a critical attitude towards oneself and dysmorphophobia is easy to understand. If an attempt to correct the lack of appearance led to success and the person was satisfied with his appearance, then he had a critical attitude. But if, for example, after a nose correction, a person discovers an irregular shape of the ears, this is a signal that the correction of one defect will entail the discovery of new ones.

In relations with others, a person suffering from body dysmorphic disorder develops a distance. It seems to him that everyone looks only at his shortcoming, they see only his defect.

If a person close to you starts complaining about his appearance to others, the best thing you can do for him at the first stage is to agree that there is a flaw. You can also offer to talk about it strictly at a certain time, no more than half an hour a day. When your relative complains, listen silently. At the end, you can say: "I'm sorry that all this is happening to you.

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