Dr Jonathan Haverkampf, M.D.
The world as one sees it
Shyness itself is not a medical condition. It is a subjective perception, which is triggered by a complex set of emotions. One actually has to see oneself as being shy. If an individual does not perceive oneself as shy, then there is no shyness. This may sound counterintuitive, but even if one is very introverted and prefers to spend all day reading a book, one does not have to experience shyness. It depends on where one sees oneself in a social context. Only if one’s expectations are different from present reality, one may experience negative emotions, which may lead to a sense of shyness.
Shyness is not social anxiety
Social anxiety, unlike shyness, is a psychiatric diagnosis and it is present if certain criteria are met.
Manifestations of shyness
Shyness means feeling apprehension and discomfort around other people. Quite frequently, there is concern about what other people think about oneself. Minor details of one’s outward appearance, voice or behavior are focused on repeatedly. This constant analyzing of other people’s opinions and thoughts about oneself is often associated with low self-esteem, depressed thoughts, anxiety and setting high standards for oneself. One becomes very self-conscious in the presence of other people rather than being really self-aware. One’s own unrealistic expectations about the outcome of a situation may make it even more difficult. It is quite often the fact that shy people often expect too much rather than two little in social settings. Romantic Hollywood movies with love on first sight or rousing boardroom speeches that completely turn the destiny of a company are not what usually happens in the real world. Most social interactions are much more mundane, which does not make them less important. To see this can be quite liberating to a shy person.
Shyness is most likely to occur during unfamiliar situations, although not always. Unfortunately, situations remain unfamiliar if shy people avoid them. Shyness may fade with time, but avoiding unfamiliar situations. Usually shy individuals want contact to other people and relationships, which makes them struggle against shyness. However, this often makes the problem worse. By focusing on shyness as a problem within oneself self-esteem and self-confidence can further be lowered.
Developing social skills may help, but it may not take care of the underlying problems. Especially if there is low self-esteem, there is a risk the newly learned social skills merely cover up a problem further down below. This can have a negative effect on one’s self-esteem and self-confidence in the long-run because deeper down the individual does not believe the image he/she is projecting into the world.
Learning communication skills can be helpful in giving shy individuals more confidence. Behavioral traits in social situations such as smiling, easily producing suitable conversational topics, assuming a relaxed posture and making good eye contact, may not be second nature for a shy person. It may also be worthwhile to explore other communication channels. The internet, for example, has helped shy people become more active in a dating environment. Exchanging a number of messages and photos first, makes the other person less unknown, which helps the shy person be less intimidated and self-conscious.
Communication training can improve the situation as the individual learns to more easily interact with others and receive valuable feedback in return. Focusing on an exploration of one’s values, interests and aspirations can facilitate communication by raising one’s confidence in talking about certain issues. If one sees meaning and value in a topic, it is far easier to converse about it.
Predisposition for Shyness
There is some evidence for a genetic predisposition for shyness. Some research has indicated that shyness and aggression are related—through long and short forms of the gene DRD4, but this is merely a working hypothesis. Further, it has been suggested that shyness is related to obsessive-compulsive disorder. However, because of the numbers of factors involved and the difficulties in linking a basic cell mechanism to a group of thoughts and behaviors, this remains speculative.
A long form of the serotonin transporter promoter region polymorphism (5-HTTLPR) seems to be somewhat correlated with shyness in grade school children.  Interestingly, a connection between this form of the gene and both obsessive-compulsive disorder and autism has been shown in previous studies.  The dopamine D4 receptor gene (DRD4) exon III polymorphism, had been the subject of studies in shyness and aggression and “novelty seeking” traits.
Substances from the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can be used to treat shyness in individuals who feel inhibited in their daily life because of low self-esteem and psychological symptoms, such as depression or loneliness. They can often be a valued support in combination with psychotherapy. As the individual can better communicate with his or her environment they may no longer be needed after a while. They are generally viewed as non-addictive and can be discontinued relative easily, but to solidify and maintain any positive changes they should be taken for at least a year, and especially in cases of social anxiety longer, if they are well tolerated.
Psychotherapy can help uncover some of the conflicts and emotions underlying the anxiety and fears in the presence of unknown others. Often there are issues from one’s personal history that add difficulties and fears. If they are dealt with, the shyness can become much less or even disappear. Imagining situations and developing a good communication skill set can go a long way. Ultimately, the explorations of one’s values, interests and aspirations can relieve stress, psychological pressure and help one avoid situations that are more harmful than beneficial, such as unwanted relationship constellations or work situations that lack meaning. (Re)establishing a sense of the inner compass can work miracles in cases of shyness.
According to research, early intervention methods that expose shy children to social interactions involving teamwork, especially team sports, decrease their anxiety in social interactions and increase their self-confidence later on. One possible reason is that a greater set of skills in communicating information, such as emotions and needs, to other people, allows for more variation and better adaptation to different communication situations and environments.
Shyness can seem to be a part of one’s personality. The difference between this and anxiety is fluid. The important question is whether we are really dealing with shyness or heightened sensitivity and insight, which can also be central to creativity. The key is to find out what the person values and finds important and how the individual can lead a more fulfilling and happier life, which frequently resolves the subjective problems with shyness in the process.
 Arbelle, Shoshana; Benjamin, Jonathan; Golin, Moshe; Kremer, Ilana; Belmaker, Robert H.; Ebstein, Richard P. (April 2003). “Relation of shyness in grade school children to the genotype for the long form of the serotonin transporter promoter region polymorphism”. American Journal of Psychiatry. 160 (4): 671–676. doi:10.1176/appi.ajp.160.4.671.PMID 12668354.
 Brune, CW; Kim, SJ; Salt, J; Leventhal, BL; Lord, C; Cook Jr, EH (2006). “5-HTTLPR Genotype-Specific Phenotype in Children and Adolescents with Autism”. The American Journal of Psychiatry. 163 (12): 2148–56. doi:10.1176/appi.ajp.163.12.2148. PMID 17151167.
Dr Jonathan Haverkampf, M.D. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at firstname.lastname@example.org or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.