The fine line between normal shyness and a medical condition

In children, shyness should not be confused with selective mutism
In children, shyness should not be confused with selective mutism / SUR
  • Actively listening to children and looking out for certain signs can help to detect a problem which can affect their education, self-esteem, social relations and even their adult lives

People say that Mark Zuckerberg is an introverted person, and maybe that is what led him to create the famous Facebook, so he could communicate with others from the solitude of his home. Churchill, despite his shyness, became one of the finest orators ever and, although to overcome his timidity he used to imagine that everyone present had a hole in their socks, his speeches showed that a great deal of work had gone into them.

Shyness in itself need not be a problem; in fact, between 16 and 25 per cent of people are considered shy and it makes no difference... usually. We do however, often ignore the fact that shyness can sometimes become an illness, a type of social phobia which can cause major problems.

In recent years studies have been carried out which show that about 20 per cent of schoolchildren could be considered shy. “You do however have to bear in mind that it is very complicated to measure something like this and the percentages can never be really accurate. It is probable that more children suffer from shyness than we realise, and for some it can be a serious problem,” says Estefanía Lema Moreira, a doctor of Psychology in Health and lecturer in the Department of Family, School and Society at La Rioja International University.

When it is a problem

As a general rule, adults pay little attention to childhood shyness because they don’t think it is a problem, but it can reach a serious level if it is not given the attention it needs. Isolation, low self-esteem, difficulties in relating to others, victimisation, behavioural problems due to anxiety, low performance at school, depression and substance abuse can be some of the consequences when shyness becomes an illness.

“All of those problems can be mitigated or eliminated altogether if we work correctly with the child, but at present people still don’t perceive shyness as a problem which may eventually need assistance,” says Dr Lema.

What determines whether shyness is so severe that it becomes chronic, an illness or social phobia? “It is when it is a paralysing type of shyness, so severe that it means you can’t react or act the way you would like to. It is a type of self-limitation. There is nothing objective, nothing external, which stops someone from doing something, but there is an internal limitation,” she explains.

The line between normal shyness and a degree of timidity which is considered an illness is pretty thin, so it is something which needs to be looked at carefully. In other words, if a child is shy we should monitor whether this becomes excessive, and consider the different criteria regarding what is ‘normal’ and what is not. The criteria to decide when timidity is considered an illness are described in the DMS-V manual of mental disorders.

In children, it is important not to confuse shyness with the selective mutism which affects some pupils at school. That does share some of the same characteristics, but is not counted as shyness as such.

Shyness and education

At an educational level, this condition can have serious effects. “We are talking about otherwise normal children who won’t put their hand up in class because they are worried about what the other pupils will think of them, for example. This affects them badly, because it often means they are too shy to say they don’t understand something and they then suffer the consequences through low academic performance. Sometimes it means that the children don’t want to go to school at all,” says Dr Lema.

Shyness is also associated with low sense of self-esteem. When a child feels guilty about ‘not having dared’ to do something, it can lead to self-deprecation and a feeling of inferiority. This shouldn’t be the case, says Dr Lema, but the children do feel that way and parents and teachers need to look out for it to ensure that it does not lead to serious problems such as depression, eating disorders etc.

“I must stress that this happens in very few cases, so we shouldn’t be alarmist, but we do need to be observant and act with prevention in mind where necessary,” she says.

We mentioned earlier that shyness can affect the way a child relates to other people because they are afraid of being judged; this can also lead to social isolation and makes them vulnerable to bullying, because they are afraid of responding to a person or the situation, etc.

How to help

When situations such as these arise it is time to seek expert help. For example, when shyness seriously affects the way children socialise and their self-esteem, or when their reaction in certain situations is exaggerated, for example by a dramatic bout of crying.

There are different types of treatment programmes available, including therapy, mediation, ways to develop social skills, etc.

“We need to bear in mind, as we said before, that every case is different and nothing we do is going to be miraculous or provide an immediate change. What is most important is that the child is aware that there is nothing objective limiting his or her social behaviour, and they can therefore behave and speak without fear. The way we achieve that depends on each case. For schoolchildren, it is very helpful if, as well as receiving therapy, they are given some type of support at school, either through programmes to improve social skills or by implementing cooperative learning programmes in the classroom. The programmes for mediating in social relationships are very interesting and usually provide positive results,” says Dr Lema.

She explains that one fundamental question when talking about intervention in general, and shyness in particular, is the timescale. “Usually, when we are working with therapy it takes some time for there to be any change, and that is something we should always bear in mind,” she says.

Parents can help their child by actively listening because people in general, and children in particular, say much more than we hear. It is essential to understand their perception and not force them to do anything for which they don’t feel prepared. It is important to be patient and respect the child’s own timescale.

Schools can help through cooperative learning, for example, and outside school it is often helpful for the child to join groups for activities which are of interest. Ideally, other members of the groups will be children of the same age but who attend a different school.

Shyness in adults

If serious timidity in childhood is not treated, there is the possibility of it continuing into adulthood. In this case, it can lead to depression, anxiety and also social phobia, an extreme which is one of the most common mental

disorders among the adult population.

At this stage of life there are two aspects to bear in mind. In some cases the shyness is obvious and can influence people’s lifestyles, and in other cases it may be more difficult to detect.

“In adults, this extreme timidity manifests itself as social anxiety. It can affect people’s work and their relationships with others in the workplace, so it can also lead to them losing their job or make it difficult to find one. That is one of the most common examples, but in adulthood it can also affect their emotional relationships, which are essential in human development,” says Dr Lema.

With regard to detecting excessive shyness, it is more complicated in the sense that it often goes unrecognised and that makes it difficult for people to admit that they suffer from it.

“It means that many people feel doubly ‘ashamed’: they are ashamed in situations which make them feel timid, and ashamed of admitting that they have this problem, even with people they trust. This ‘double shame’ makes them even more isolated socially and makes it more difficult to overcome the problem,” explains Dr Lema.

For adults, there are different types of therapies on a psychological level such as, for example, cognitive therapies or other techniques based on neuropsychology such as EMDR, which stands for Eye Movement Desensitisation and Reprocessing. These techniques are used in the processing of physiological information.

“Through bilateral stimulation we try to facilitate the connection between both brain hemispheres and reduce the anxiety load that way. Another option is group therapy, which is also very effective for adults,” says Dr Lema.