Dr. Paul LatimerShyness is something many people experience both as children and adults. Most of us probably feel somewhat unsettled when we meet new people or are expected to give a presentation to our peers. However, severe shyness can be a hallmark of several anxiety disorders and can cause real problems in work and social settings.

Social anxiety disorder and avoidant personality disorder are two conditions that fall at the more severe end of the shyness continuum.

People with social anxiety disorder (SAD) have a serious and persistent fear of social situations in which they must interact or perform for people.

This is more than the usual butterflies most people experience because it causes dysfunction in the person’s life. SAD is fairly common, affecting almost 10 percent of us, and sufferers are plagued with fear. Although they know it is irrational, individuals with SAD believe people are watching and judging them and are particularly fearful that others will notice their anxiety.

Common situations that cause distress for SAD sufferers include public speaking, writing, working or eating while others are watching, social gatherings, using public washrooms or being the centre of attention. Often, a person with this disorder will go out of his or her way to avoid these situations and would rather fail or drop out of school than give an oral presentation.

By avoiding fearful situations, people with SAD typically do not perform to their potential in their careers or in building and maintaining personal relationships.

A related, but more severe, disorder is avoidant personality disorder. This also involves fear of criticism, disapproval and rejection, but is more pervasive and long standing. Avoidant personality disorder is life-long and affects all areas of a person’s life. This disorder is associated with difficulty maintaining relationships and avoidance of all occupational and social situations that involve personal interaction. Obviously, this leads to a lonely, unfulfilled life.

While no specific cause has been identified, these disorders are known to have a strong genetic component. For example, children with social inhibition traits can often be identified under the age of two. When followed up as adults, these children are much more likely than others to have ongoing anxiety problems.

It is also well known that both SAD and avoidant personality disorder can be made better or worse by environmental influences. Given their sensitivity to criticism and disapproval, it is not hard to imagine the sorts of experiences that can make this worse. Harsh criticism, public humiliation, various types of abuse and lack of nurturing can all make anxious traits worse and are common experiences in the adults with these disorders.

These disorders may be frightening, but they can be successfully treated. Usually, the most effective strategy is to combine cognitive behaviour therapy and medication. Many of the medications that are used for treating depression are also effective at treating these conditions. Also, since depression is a commonly co-existing disorder, it is possible to treat all symptoms with one medication.

Cognitive behaviour therapy involves encouraging patients to face situations that are being avoided. This can involve engaging in more social situations, but in a gradual manner – working from relatively non-threatening situations to more challenging ones.

Organizations such as Toast Masters can be very useful in providing opportunities for engaging in feared situations. In order for the patient to face his or her fears, it is very important that each exposure be supportive and successful. Criticism or humiliation can make things worse.

Although treatment is usually effective, it does not mean a complete change of personality. Even with treatment, people with these disorders will not become the life of the party – but will at least be able to lead successful, satisfying lives without living in constant anxiety. Often, treated individuals enjoy meaningful relationships, employment, friends and family.

If you or a loved one experiences persistent serious fear in social situations, consider that it may be more than normal shyness. Consult your family doctor about this condition.

Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.

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