OGO5-7967 90 $3.00+ 0.00 copyright c 1990Pergamon Press plc
Befrac.Res. I-her. Vol. 28. No. 6, pp. 497-505. 1990 Printed in Great Bntain. All rights reserved
SOCIAL PHOBIA:
RELATIONSHIP
TO SHYNESS
SAMUELM. TURNER,*DEBORAH C. BEIDEL and RUTH M. TOWNSLEY Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213, U.S.A. (Received 31 May 1990)
Summary-The characteristics of social phobia and shyness were compared on six dimensions: somatic features, cognitive characteristics, behavioral responses, daily functioning, clinical course. and onset characteristics. The results revealed that shyness and social phobia have a number of similar features. However, as currently conceptualized, the two syndromes differ in a number of important aspects as well. Definitive distinctions are hampered by the lack of empirical studies directing comparing the two conditions and by the heterogeneity of the shy population. Recommendations for clarifying some of the ambiguities are made.
Social phobia as a diagnostic entity was introduced into the diagnostic nomenclature with the publication of the DSM-III (American Psychiatric Association, 1980), although the syndrome had been described as early as 1970 by Marks. Currently, social phobia is defined as “a persistent fear of one or more situations (the socially phobic situations) in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in any way that will be humiliating or embarrassing” (American Psychiatric Association, 1987, p. 241). Social phobia may include fear of specific social situations such as public speaking, eating in public or writing in front of others, or may involve fear of more general social interactions such as casual conversations and parties (American Psychiatric Association, 1987). Finally, social phobia is divided into specific and generalized subtypes. Specific social phobia is characterized by circumscribed social fear such as in public speaking. The generalized subtype is characterized by fear in most social situations. Although these subtypes were introduced with the publication of the DSM-III-R, to date there are few data available to support such a distinction. Social phobia and shyness
Clinicians have had a growing interest in social phobia since the introduction of the DSM-III but shyness has continued to be thought of as a subclinical condition. Thus, in contrast to social and personality psychologists who have conducted the majority of research in the area of shyness, clinicians have shown little interest. Interestingly, the central elements of social phobia, that is discomfort and anxiety in social situations and the associated behavioral responses (i.e. inhibition of socially appropriate behavior, avoidance of social situations, various somatic symptoms) are also present in persons who are shy. These similarities between social phobia and shyness indicate that the boundary between these ostensibly independent conditions is worthy of study. It is unclear at this juncture how they might be related since in the DSM-III-R classification social phobia is an Axis I disorder and shyness is not part of the diagnostic schema. Shyness has been most often thought of as a ‘personality’ or ‘temperamental’ attribute. Given the high degree of similarity between the two syndromes, however, it seems likely that there is some overlap. One possibility is that the two terms describe the same syndrome. However, that is unlikely since there are considerable differences in the prevalence rates for social phobia and shyness. Based on data obtained through the Epidemiologic Catchment Area Survey, the prevalence of social phobia in the general population is 2% (Pollard & Henderson, 1988; Robins, Helzer, Weissman, Orvaschel, Greenberg, Burke & Regier, 1984). On the other hand, the self-report of shyness within the general population is much more common. For example, in a survey of almost 5000 Americans, Zimbardo (1977) found that over 40% considered themselves to be currently shy and over 90% reported that ‘To whom all correspondence
should be addressed. 497
198
SAMLTLM.TLR~R~~
al.
they had been shy at one time in their life (Zimbardo, Pilkonis & Not-wood, 1975). In a sample of fifth grade students, Lazarus (1982) found that 38% of the children sampled considered themselves to be shy. Finally, among 8-10 yr olds, 28% of boys and 32% of girls were considered to be shy by their parents (Caspi, Elder & Bern, 1988). These disparate prevalence rates suggest that not all shy people are socially phobic, However, Zimbardo (1977) described four subgroups of shy college students and one of these subgroups closely approximated the characteristics of social phobics. These students were overly concerned with violating social rules and cultural expectations and frequently monitored their social behavior for transgressions. Given these data, and the similarity in the definitions of shyness and social phobia, it is unclear if these conditions represent parallel, overlapping, or completely different syndromes. Therefore, the purpose of this review is to compare and contrast the parameters of these two syndromes, and to determine if there are data to suggest differences which may serve to sharpen the distinction between the two conditions. In order to accomplish this, social phobia and shyness will be compared on six dimensions: somatic response, cognitive characteristics, behavioral responses, the impact of shyness and social phobia on day to day functioning, course and onset characteristics. In contrast to the rather specific criteria now used to diagnose social phobia, shyness is a rather ill-defined construct which has defied simple definition (Pilkonis & Zimbardo, 1979). Moreover, shyness is a social rather than a psychological term (Harris, 1984). In general, shy individuals are described by the lay public as appearing nervous or uncomfortable in social situations and as reticent to engage in social discourse though they truly desire to do so. Consistent with this conception, investigators in the area have attempted to develop objective definitions. For example, Pilkonis (1977a, b) defined shyness as “a tendency to avoid social interaction and to fail to participate appropriately in social situations” (p. 585). Crozier (1979) defined shyness as anxiety and discomfort in social situations, particularly those involving evaluations by authority. According to Crozier, this anxiety and discomfort result in silence and withdrawal, lack of overt behavior, “self-consciousness, unhappiness, inhibition, preoccupation with self and the impression being made, and difficulties in expression and communication of thought” (p. 121). Buss (1980) defined shyness as reactions of tension, concern, feelings of awkwardness and discomfort, gaze aversion, and inhibition of normally expected social behavior. Finally, Jones, Briggs and Smith (1986) defined shyness as discomfort, inhibition and responses of anxiety, self-consciousness, and reticence in the presence of others. They also stressed that shyness is related particularly to threats from interpersonal situations rather than other potentially threatening stimuli. It should be evident at this point that nothing in these descriptions of shyness could be used to differentiate it from social phobia. To the contrary, these statements could be easily applied to characterize the social phobic. Somatic features
We know of no direct comparison of shy and social phobic Ss on the physiological dimension. However, there are a number of reports describing the psychophysiological characteristics of the two syndromes. The somatic responses reported by socially phobic individuals include blushing, muscle twitching, heart palpitations, trembling, and sweating (Amies, Gelder & Shaw, 1983; Gorman & Gorman, 1987). Recent empirical studies have served to validate this particular symptom constellation. For example, from an initial list of 10 somatic anxiety symptoms, heart palpitations, sweating, blushing, shaking, and urinary urgency were the only symptoms endorsed significantly more often by social phobic Ss when in social situations when compared to normal controls (Turner, Beidel, Dancu & Stanley, 1989). In the laboratory, systolic blood pressure and heart rate have been the most commonly studied physiological variables. Assessing these parameters during an impromptu speech, a sample of clinically diagnosed social phobics had higher systolic blood pressure increases, but not significantly higher heart rate increases than a group of normal controls (Turner, Beidel & Larkin, 1986). Similar to the findings in the adult literature, test anxious children (which included some children with a DSM-III diagnosis of social phobia; Beidel, 1988) had higher heart rates when engaged in social-evaluative tasks than their non-test anxious peers. In addition, heart rates of the test anxious children did not decline over the course of the task, as was the case for the normal controls.
Social phobia:
relationship
to shyness
499
Somatic discomfort also appears to be an important aspect of shyness. Pilkonis (1977a) asked students to rate the relative importance of five aspects of their shyness. Of the five aspects rated, internal discomfort was judged to be the second most distressing aspect following failure to respond appropriately in social situations. Other investigators have found a positive relationship between parental ratings of children’s shyness and heart rates during stressful task. For example, heart rate assessed during a selective attention task was modestly, but significantly, correlated with parental ratings of emotionality and shyness (Boomsma & Plomin, 1986). In perhaps the most extensive investigation of autonomic correlates of ‘shyness’, 6 yr longitudinal heart rate data for ‘behaviorally inhibited’ and non-behaviorally inhibited children have been reported by Kagan and his colleagues (Kagan, Reznick & Snidman, 1987, 1988). Ss for these studies were selected at either 21 or 3 1 months of age and the physiological and motor% behaviors of these children were assessed over the course of 6 yr of development when placed in unfamiliar settings (for a detailed account, the reader is referred to the original sources). To briefly summarize the results here, children who were selected at 21 or 31 months of age as behaviorally inhibited had heart rates which were higher and more stable than the comparison group of non-inhibited children. In addition, correlations between individual differences in absolute heart rate and heart rate variability when engaged in challenging tasks were preserved from 21 months to 7.5 yr in one cohort (r = 0.62 and r = 0.54, respectively, both Ps ~0.001) and from 31 months to 5.5 yr in a second cohort (r = 0.59 and r = 0.61, respectively, both Ps
Befrac.Res. I-her. Vol. 28. No. 6, pp. 497-505. 1990 Printed in Great Bntain. All rights reserved
SOCIAL PHOBIA:
RELATIONSHIP
TO SHYNESS
SAMUELM. TURNER,*DEBORAH C. BEIDEL and RUTH M. TOWNSLEY Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213, U.S.A. (Received 31 May 1990)
Summary-The characteristics of social phobia and shyness were compared on six dimensions: somatic features, cognitive characteristics, behavioral responses, daily functioning, clinical course. and onset characteristics. The results revealed that shyness and social phobia have a number of similar features. However, as currently conceptualized, the two syndromes differ in a number of important aspects as well. Definitive distinctions are hampered by the lack of empirical studies directing comparing the two conditions and by the heterogeneity of the shy population. Recommendations for clarifying some of the ambiguities are made.
Social phobia as a diagnostic entity was introduced into the diagnostic nomenclature with the publication of the DSM-III (American Psychiatric Association, 1980), although the syndrome had been described as early as 1970 by Marks. Currently, social phobia is defined as “a persistent fear of one or more situations (the socially phobic situations) in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in any way that will be humiliating or embarrassing” (American Psychiatric Association, 1987, p. 241). Social phobia may include fear of specific social situations such as public speaking, eating in public or writing in front of others, or may involve fear of more general social interactions such as casual conversations and parties (American Psychiatric Association, 1987). Finally, social phobia is divided into specific and generalized subtypes. Specific social phobia is characterized by circumscribed social fear such as in public speaking. The generalized subtype is characterized by fear in most social situations. Although these subtypes were introduced with the publication of the DSM-III-R, to date there are few data available to support such a distinction. Social phobia and shyness
Clinicians have had a growing interest in social phobia since the introduction of the DSM-III but shyness has continued to be thought of as a subclinical condition. Thus, in contrast to social and personality psychologists who have conducted the majority of research in the area of shyness, clinicians have shown little interest. Interestingly, the central elements of social phobia, that is discomfort and anxiety in social situations and the associated behavioral responses (i.e. inhibition of socially appropriate behavior, avoidance of social situations, various somatic symptoms) are also present in persons who are shy. These similarities between social phobia and shyness indicate that the boundary between these ostensibly independent conditions is worthy of study. It is unclear at this juncture how they might be related since in the DSM-III-R classification social phobia is an Axis I disorder and shyness is not part of the diagnostic schema. Shyness has been most often thought of as a ‘personality’ or ‘temperamental’ attribute. Given the high degree of similarity between the two syndromes, however, it seems likely that there is some overlap. One possibility is that the two terms describe the same syndrome. However, that is unlikely since there are considerable differences in the prevalence rates for social phobia and shyness. Based on data obtained through the Epidemiologic Catchment Area Survey, the prevalence of social phobia in the general population is 2% (Pollard & Henderson, 1988; Robins, Helzer, Weissman, Orvaschel, Greenberg, Burke & Regier, 1984). On the other hand, the self-report of shyness within the general population is much more common. For example, in a survey of almost 5000 Americans, Zimbardo (1977) found that over 40% considered themselves to be currently shy and over 90% reported that ‘To whom all correspondence
should be addressed. 497
198
SAMLTLM.TLR~R~~
al.
they had been shy at one time in their life (Zimbardo, Pilkonis & Not-wood, 1975). In a sample of fifth grade students, Lazarus (1982) found that 38% of the children sampled considered themselves to be shy. Finally, among 8-10 yr olds, 28% of boys and 32% of girls were considered to be shy by their parents (Caspi, Elder & Bern, 1988). These disparate prevalence rates suggest that not all shy people are socially phobic, However, Zimbardo (1977) described four subgroups of shy college students and one of these subgroups closely approximated the characteristics of social phobics. These students were overly concerned with violating social rules and cultural expectations and frequently monitored their social behavior for transgressions. Given these data, and the similarity in the definitions of shyness and social phobia, it is unclear if these conditions represent parallel, overlapping, or completely different syndromes. Therefore, the purpose of this review is to compare and contrast the parameters of these two syndromes, and to determine if there are data to suggest differences which may serve to sharpen the distinction between the two conditions. In order to accomplish this, social phobia and shyness will be compared on six dimensions: somatic response, cognitive characteristics, behavioral responses, the impact of shyness and social phobia on day to day functioning, course and onset characteristics. In contrast to the rather specific criteria now used to diagnose social phobia, shyness is a rather ill-defined construct which has defied simple definition (Pilkonis & Zimbardo, 1979). Moreover, shyness is a social rather than a psychological term (Harris, 1984). In general, shy individuals are described by the lay public as appearing nervous or uncomfortable in social situations and as reticent to engage in social discourse though they truly desire to do so. Consistent with this conception, investigators in the area have attempted to develop objective definitions. For example, Pilkonis (1977a, b) defined shyness as “a tendency to avoid social interaction and to fail to participate appropriately in social situations” (p. 585). Crozier (1979) defined shyness as anxiety and discomfort in social situations, particularly those involving evaluations by authority. According to Crozier, this anxiety and discomfort result in silence and withdrawal, lack of overt behavior, “self-consciousness, unhappiness, inhibition, preoccupation with self and the impression being made, and difficulties in expression and communication of thought” (p. 121). Buss (1980) defined shyness as reactions of tension, concern, feelings of awkwardness and discomfort, gaze aversion, and inhibition of normally expected social behavior. Finally, Jones, Briggs and Smith (1986) defined shyness as discomfort, inhibition and responses of anxiety, self-consciousness, and reticence in the presence of others. They also stressed that shyness is related particularly to threats from interpersonal situations rather than other potentially threatening stimuli. It should be evident at this point that nothing in these descriptions of shyness could be used to differentiate it from social phobia. To the contrary, these statements could be easily applied to characterize the social phobic. Somatic features
We know of no direct comparison of shy and social phobic Ss on the physiological dimension. However, there are a number of reports describing the psychophysiological characteristics of the two syndromes. The somatic responses reported by socially phobic individuals include blushing, muscle twitching, heart palpitations, trembling, and sweating (Amies, Gelder & Shaw, 1983; Gorman & Gorman, 1987). Recent empirical studies have served to validate this particular symptom constellation. For example, from an initial list of 10 somatic anxiety symptoms, heart palpitations, sweating, blushing, shaking, and urinary urgency were the only symptoms endorsed significantly more often by social phobic Ss when in social situations when compared to normal controls (Turner, Beidel, Dancu & Stanley, 1989). In the laboratory, systolic blood pressure and heart rate have been the most commonly studied physiological variables. Assessing these parameters during an impromptu speech, a sample of clinically diagnosed social phobics had higher systolic blood pressure increases, but not significantly higher heart rate increases than a group of normal controls (Turner, Beidel & Larkin, 1986). Similar to the findings in the adult literature, test anxious children (which included some children with a DSM-III diagnosis of social phobia; Beidel, 1988) had higher heart rates when engaged in social-evaluative tasks than their non-test anxious peers. In addition, heart rates of the test anxious children did not decline over the course of the task, as was the case for the normal controls.
Social phobia:
relationship
to shyness
499
Somatic discomfort also appears to be an important aspect of shyness. Pilkonis (1977a) asked students to rate the relative importance of five aspects of their shyness. Of the five aspects rated, internal discomfort was judged to be the second most distressing aspect following failure to respond appropriately in social situations. Other investigators have found a positive relationship between parental ratings of children’s shyness and heart rates during stressful task. For example, heart rate assessed during a selective attention task was modestly, but significantly, correlated with parental ratings of emotionality and shyness (Boomsma & Plomin, 1986). In perhaps the most extensive investigation of autonomic correlates of ‘shyness’, 6 yr longitudinal heart rate data for ‘behaviorally inhibited’ and non-behaviorally inhibited children have been reported by Kagan and his colleagues (Kagan, Reznick & Snidman, 1987, 1988). Ss for these studies were selected at either 21 or 3 1 months of age and the physiological and motor% behaviors of these children were assessed over the course of 6 yr of development when placed in unfamiliar settings (for a detailed account, the reader is referred to the original sources). To briefly summarize the results here, children who were selected at 21 or 31 months of age as behaviorally inhibited had heart rates which were higher and more stable than the comparison group of non-inhibited children. In addition, correlations between individual differences in absolute heart rate and heart rate variability when engaged in challenging tasks were preserved from 21 months to 7.5 yr in one cohort (r = 0.62 and r = 0.54, respectively, both Ps ~0.001) and from 31 months to 5.5 yr in a second cohort (r = 0.59 and r = 0.61, respectively, both Ps
![[Social phobia].](/assets/img/hold.png)
