Extreme Shyness Affects 10M

Marissa Turner thought she was "weird" because she spent most of her time alone as a child.

She was terrified of raising her hand to answer questions in class because she feared she would embarrass herself or her classmates would make fun of her. She would sweat and tremble, and her throat would tighten if a teacher called on her.

"I was afraid of a lot of people," said Turner, now 26.

Turner is among the roughly 10 million Americans who are so shy they are considered to suffer from "social anxiety disorder," ranked the third most widespread mental health problem in the nation, just after depression and drug or alcohol abuse.

Their shyness is taken to such an extreme it affects everyday living - talking to coworkers, friends or family or even ordering a snack at the corner coffee stand. It often goes untreated for years, even decades, because the very nature of the disorder prevents sufferers from seeking help. Some stay at home, even confining themselves to a single room to avoid contact with others.

"It's an awful experience for the people who suffer a severe form of it," said Dr. Michael Resnick at Oregon Health Sciences University in Portland.

In Turner's case, the problem persisted into adulthood as she moved to the Washington, D.C., area to find a job.

"The average reaction for me walking into a room full of people would be a rapid heart rate, sweaty hands, that kind of racing feeling in my head and a sort of fuzziness," she said. "I found it very hard to focus mentally on anything."

Estimates vary, but doctors say 3 percent to 5 percent of Americans are so shy they need clinical treatment.

Although it is widespread, social anxiety disorder is considered mild compared to less common but more profound mental diseases, such as schizophrenia. Still, it can ruin lives and disrupt families, businesses and schools.

"I see kids in my practice who can't function in class, who can't participate in class. They don't have friends, they eat alone," said Dr. Robert Reichler of the Pacific Institute of Mental Health in Seattle.

He tells of a woman who "did date in high school but she was so uncomfortable she could never talk to her date, and never got asked out again by the same guy."

Many who suffer from the disorder "say they have trouble getting a job, they have trouble handling job interviews, their hearts pound, they sweat, they can't talk," he said.

"It's really a major, major impairment, not just shyness," said Reichler.

The basis of social anxiety disorder is biological, Resnick said. Ancient humans evolved a certain level of anxiety to cope with danger and survive against wild animals when hunters barely had the advantage of rocks and sharp sticks.

"But some people have more of this (anxiety) than others," he said, "and it gets to the point that it's not helpful It goes haywire, and instead of a protective mechanism, it's actually harmful."

Steve Fox, who did not begin suffering symptoms of the disorder until he began high school in Salt Lake City, said he was as skeptical as his family at first, even though he started skipping school because of his fear of social situations.

"I knew it was unreasonable, but I couldn't cope with it. I couldn't get it to subside," Fox said. "I did tell my folks about it, but my whole family was skeptical. I remember my sister told me it's nothing real, you should be able to go to school."

Eventually, Fox and his parents sought psychiatric help for him, exactly what Turner's husband cajoled her into doing.

In a study presented to the American Psychiatric Association last year, Dr. Mark Olfson of Columbia University said the average delay from onset of the disorder to first professional contact was nearly 13 years.

Further, the average sufferer waited nearly eight years to confide in a friend or family member about the problem, Olfson said.

Some new drugs have been effective in treating the disorder, including Paxil. But often the best remedy is to train patients to confront their fears about social situations and force themselves to overcome it, doctors say.

"The longer you have it, the more you avoid the situation, and the worse it gets," Reichler said.