کمرویی: ارتباط با هراس اجتماعی و دیگر اختلالات روانی

The relationship between shyness, social phobia and other psychiatric disorders was examined. The prevalence of social phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of social phobia, but the data suggest that social phobia is not merely severe shyness. Social phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with social phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with social phobia from those without social phobia. The proportion of the shy group with psychiatric diagnoses other than social phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and social phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.

Social phobia and shyness are terms used to describe those who are reticent in social situations, and there has been considerable speculation on their relationship (e.g., Beidel and Turner, 1999 and Turner, Beidel and Townsley, 1990). Although social phobia is a clinical disorder defined in the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV) (1994) and shyness is a less well-defined lay term, descriptions of the two syndromes are remarkably similar. The DSM-IV defines social phobia as “a marked and persistent fear of one or more social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others” (p. 416). The disorder ranges from rather circumscribed performance anxiety (specific or circumscribed subtype) to the more common pattern of anxiety in most social settings (generalized subtype). Interestingly, the description of shyness is not all that different, particularly the most recent characterizations of the condition. Shyness has been described as anxiety and discomfort in social situations, particularly those involving evaluation by authority figures (Crozier, 1979); discomfort and inhibition in interpersonal situations (Henderson & Zimbardo, 1998); and fear of negative evaluation by others (Buss, 1985). Clearly, one can see from these brief descriptions that the behaviors associated with the two conditions are similar. Indeed, examination of the extant literature reveals that social phobia and shyness share similar symptomatology. For example, Turner et al. (1990) examined studies that described the characteristics of social phobia and shyness. Based on these indirect comparisons, they found that shyness and social phobia appeared to be similar in terms of somatic (e.g., trembling, sweating, blushing), cognitive (e.g., fear of negative evaluation by others), and behavioral symptoms (e.g., distress in and avoidance of social situations). However, shyness was noted to differ markedly from social phobia in a number of ways. The most striking difference was in prevalence rate. Based on numerous studies, the prevalence of shyness was far greater than that of social phobia. The 12-month prevalence rate for social phobia in the Epidemiologic Catchment Area study (ECA; Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992) was estimated to be about 3%, but in the more recent National Comorbidity Study (NCS; Kessler et al., 1994), the estimated 12-month prevalence rate was 8%. The variability in these prevalence estimates at least partly reflects differences in the assessment and sampling methodology used in the two studies (Beidel & Turner, 1998). Prevalence estimates of shyness are much higher than those of social phobia, ranging from 20 to 48% (Carducci and Zimbardo, 1995, Henderson and Zimbardo, 1998, Lazarus, 1982, Zimbardo, 1977 and Zimbardo, Pilkonis and Norwood, 1975). Thus, although variability in the prevalence estimates of both shyness and social phobia exist, the prevalence estimates of shyness consistently are markedly higher than those of social phobia. There also is evidence that shyness and social phobia may differ in other important ways as well. For example, shyness is often a transitory condition (Beidel and Turner, 1999, Bruch, Giordano and Pearl, 1986 and Zimbardo, Pilkonis and Norwood, 1975), whereas social phobia is thought to be a chronic, unremitting condition (Turner & Beidel, 1989). In addition, although social phobia and shyness are both associated with emotional and social difficulties, preliminary evidence suggests that those who are shy, on average, do not experience the degree of daily impairment that is experienced by social phobics (Turner et al., 1990). However, because this evidence is based on indirect comparisons, the extent to which these conditions can be distinguished based on the degree of impairment will need to be determined by future direct comparison studies. Despite some effort to delineate the boundary between the two conditions, the relationship between social phobia and shyness remains blurred. One hypothesis is that the two conditions are completely different (Carducci, 1999). Carducci (1999) concluded that “shyness is also not a social disease such as social phobia or avoidant personality disorder…Shyness is not listed in the Diagnostic and Statistical Manual of Mental Disorders IV…because it’s not a mental illness, merely a normal facet of personality” (p. 6). A second hypothesis is that the conditions are essentially the same. Rapee (1998) noted that “many words and terms have been used to describe shyness, including social phobia, social anxiety, avoidant personality disorder…they all refer basically to the same thing” (p. xi). Yet a third hypothesis is that social phobia is an extreme form of shyness. Marshall and Lipsett (1994) concluded that shyness is a form of social anxiety and generalized social phobia in particular is an extreme form of shyness. Consistent with this view, Henderson and Zimbardo (1998) described shyness as varying “from mild social awkwardness to totally inhibiting social phobia” (p. 497). A fourth hypothesis put forth by Heckelman and Schneier (1995) is that shyness is a more heterogeneous category than social phobia, that it may overlap with mild cases of social phobia, and that it may also “extend outside of the social phobia spectrum” (p. 11). Similarly, Beidel and Turner (1999) concluded that the overlapping behavioral features of shyness and social phobia support the notion that a relationship between them exists, but the specific nature remains to be elucidated. In their proposed model of the relationship among shyness, social phobia, and other constructs of social reticence (i.e., behavioral inhibition and social isolation), social phobia represents a relatively small group of individuals, and one that overlaps with shyness, behavioral inhibition, and social isolation. Beidel and Turner (1999) suggested that shyness might be a contributing but not a necessary factor for the development of social phobia. Consistent with this view, Stemberger, Turner, Beidel, and Calhoun (1995) found that a history of childhood shyness was more common in the backgrounds of those with social phobia than of those without psychiatric disorders. However, they suggested that the presence of a predispositional factor such as shyness or behavioral inhibition does not necessarily lead to the development of social phobia. Thus, Beidel and Turner (1999) concluded that, although there appears to be a relationship between these two conditions characterized by social reticence, the exact relationship between them is unclear. The current study was designed to examine the relationship between shyness and social phobia by directly comparing the two conditions in the same sample. Specifically, the study examined the overlap in social phobia and shyness, the relationship between the severity of shyness and social phobia, and the relationship of shyness to other disorders. In addition, the relationship between shyness, social phobia, neuroticism, and introversion was examined.