ارتباط روانپزشکی کمرویی دوران کودکی در یک نمونه بعنوان نماینده ملی کشور

Relations between adult anxiety and mood disorders and retrospective reports of excessive childhood shyness were investigated in the US National Comorbidity, Survey (n=5877). Results indicated that 26% of women and 19% of men described themselves as ‘very shy’ when they were growing up. Of these shy individuals, 53% of women and 40% of men met criteria for a lifetime diagnosis of one or more anxiety or mood disorders. Relations between excessive shyness and each of the anxiety and mood disorders were examined after adjusting for elevated neuroticism, self-criticism, and low maternal care. The largest odds ratios were found for social phobia in both men and women, particularly for the complex subtype of this disorder. Significant associations also emerged for posttraumatic stress disorder in women and for major depressive disorder in men. Childhood shyness remained significantly associated with a lifetime history of social phobia when individuals with current (past year) social phobia were excluded from the analysis. The results of this study suggest that childhood shyness is strongly related to the complex subtype of social phobia in the general population. Excessive shyness does not appear to be strongly associated with other anxiety and mood disorders when related psychosocial and developmental dimensions are statistically controlled. Finally, many individuals who report excessive childhood shyness do not meet criteria for any anxiety or mood disorder. In a similar fashion, approximately 50% of individuals with a lifetime history of complex social phobia did not view themselves as very shy when growing up.

The title of an authoritative text on the nature and treatment of social phobia (‘Shy Children, Phobic Adults,’ Beidel & Turner, 1998), underscores the widespread interest in understanding how closely shyness and social phobia are linked. If a close relationship is indeed found to exist, there are a number of important implications that could arise such as: (a) the identification of treatment targets in cognitive behavior therapy for social anxiety disorder, (b) the addition of valuable information for research questions in studies of developmental trajectories of psychological functioning, and ultimately (c) the development of new knowledge to guide early intervention efforts for emerging anxiety disorders. Yet there have been very few direct comparisons between shyness, social phobia, and other forms of psychopathology. A preliminary clinical study of treatment-seeking individuals in an outpatient setting found a higher level of perceived childhood shyness (76%) in 52 adults with generalized social phobia compared to a 52% frequency of childhood shyness reported by 25 normal controls (Stemberger, Turner, Beidel, & Calhoun, 1995). Although these initial group comparisons appear promising, there is a lack of research that has addressed the issue of psychiatric correlates of childhood shyness in unselected samples. To begin to address this research need, Heiser, Turner, and Beidel (2003) conducted a cross-sectional study of the prevalence of social phobia and other psychiatric diagnoses in relation to perceived shyness in a university student sample (n=200). Using a computer-administered version of the Composite International Diagnostic Interview, Heiser et al. found that the prevalence of social phobia was significantly higher in individuals who were classified as shy based on self-reports of shyness compared to individuals who were not shy. Despite this significant difference, the majority of shy individuals (82%) did not meet diagnostic criteria for social phobia. Further, the prevalence of several other anxiety disorders and mood disorders was significantly elevated in the shy group compared to the non-shy individuals. Finally, the severity of self-reported shyness was only moderately correlated (r=0.39) with diagnoses of social phobia. Heiser et al. (2003) were able to reach several tentative conclusions that warrant further study. First, social phobia does not appear to be the equivalent of severe shyness. They appear to be overlapping but separable conditions, and the fact that the two were only moderately correlated in this study questions whether they are on the same continuum. Most people with elevated shyness did not have social phobia. Further, the two conditions did not share an exclusive relationship based on the increased rates of other anxiety disorders and mood disorders associated with elevated shyness. Rather, the results were more consistent with the conceptual writings of Heckelman and Schneier (1995) as well as Beidel and Turner (1999) who view shyness as a broad and heterogeneous construct that can be associated with a variety of forms of psychopathology. From this perspective, shyness may be one of several potential contributing factors to the development of social phobia. The preliminary findings on the relationship between excessive shyness and social phobia in clinical patients (Stemberger et al., 1995) and in college students (Heiser et al., 2003) raise several interesting questions, and there is a need to extend this line of investigation. In this regard, it is noteworthy that there has never been a nationally representative survey of excessive childhood shyness and how it relates to adult psychopathology in the general population. The present study pursued this research objective using data collected in the landmark National Comorbidity Survey (NCS; Kessler et al., 1994). The NCS was a large community mental health survey of the United States general population aged 15–54 years. Its purpose was to assess the prevalence and correlates of DSM-III-R (American Psychiatric Association, 1987) psychiatric disorders using a detailed and reliable structured diagnostic interview (the Composite International Diagnostic Interview; CIDI 1.0; Robins, Wing, Wittchen, & Helzer, 1988; World Health Organization, 1990). An extensive psychosocial battery was administered to a large representative subsample of respondents (NCS Part II; n=5877). This psychosocial assessment included questions about personality and developmental factors, including a question about perceived shyness when growing up. The NCS determined that social phobia is one of the most common mental health problems in the general population with an estimated lifetime prevalence of 15.5% for women and 11.1% for men (Kessler et al., 1994). The NCS also facilitated the first population-based study of social phobia subtypes. Using latent class analysis, Kessler, Stein, and Berglund (1998) were able to identify two subtypes: (1) speaking-only fears, and (2) complex social phobia. The speaking-only subtype contained individuals with social phobia with only pure speaking fears (i.e., public speaking, speaking in front of a small or large group). The complex subtype contained individuals with social phobia with one or more interaction or performance fears (with or without speaking fears). Kessler et al. found that the complex subtype was associated with the greatest impairment and appeared to reflect a more severe form of social phobia. To evaluate the unique effects of excessive shyness in relation to social phobia and other anxiety and mood disorders in the NCS, all of the analyses in the current study controlled for three psychosocial and developmental dimensions that have been shown to have robust though non-specific associations with a variety of forms of psychopathology and which also appear to share some overlap with shyness. The first covariate was neuroticism. This broad personality domain denotes an enduring tendency to experience negative emotionality and distress disorders (Eysenck, 1986; Goldberg, 1992). Neuroticism is a fundamental temperamental sensitivity with a strong heritable component (Carey & DiLalla, 1994). Heiser et al. (2003) found that shy individuals scored significantly higher on a measure of neuroticism compared to individuals without excessive shyness. The second covariate was self-criticism. This psychological trait refers to extreme negative self-evaluation and feelings of worthlessness that is believed to originate in early childhood years (Blatt, 1974). Cox, Fleet, and Stein (in press) found that self-criticism was elevated in individuals with the complex social phobia subtype and also major depression in the NCS. Cox et al. suggested it may represent a key psychological process in complex social phobia. In this context, it is important to control for the effects of self-criticism when evaluating the unique role of shyness in social phobia. The third covariate involved perceptions of low maternal warmth during childhood years. This form of maladaptive parental bonding experience was associated with a wide range of psychopathology in the NCS (Enns, Cox, & Clara, 2002). As part of the goal of determining the unique effects of poor childhood relations in the form of excessive shyness, it is important to control for the effects of poor childhood attachment relations involving maternal bonding. There were three hypotheses in the current study: (1) excessive shyness would be most strongly associated with social phobia, but would also be significantly associated with several other Axis I disorders as suggested in Heiser et al. (2003) study with university students, (2) excessive shyness would remain significantly associated with social phobia even when only past history of social phobia (more than 1 year ago) was examined, and (3) the strongest associations between excessive shyness and social phobia in the NCS would be found for the complex subtype.