If women are less out-going than men, why is it males who are most often treated for "social phobia" - usually known as shyness?
When being shy is not a virtue, 'wallflowers' will rejoice
Under the scrutiny of 50 eyes during a class presentation, Waleed could feel his mouth drying up. A mysterious wobble had crept into his voice, and - in spite of the room being on the chilly side of cool - a bead of sweat had formed on his forehead and was now working its way down his face. This was perspiration born of fear and panic.
But why? The audience comprised Waleed's friends and classmates, none of whom meant him harm. What exactly was he afraid of?
What Waleed feared, more than anything else imaginable, was negative evaluations by other people. He was terrified that others might think him strange, crazy, boring. Or that they might find him unacceptable and reject him.
These are common fears, but for some they become so extreme and disabling that they earn the psychiatric label "social phobia".
Social phobia is the commonest of all the psychiatric conditions categorised as "anxiety disorders", with some community based studies reporting prevalence rates as high as 18 per cent. In its most debilitating form, social phobia involves an extreme fear of most performance situations (public speaking, giving a presentation at work or college) and social interactions (talking on the phone, asking for directions).
This fear generally leads to the avoidance of such situations, thereby greatly reducing a person's social and occupational functioning.
One of the more intriguing aspects of social phobia to emerge in recent years is its connection with culture and gender. Research has shown socially phobic males and females generally fear the same types of situations, with a few notable exceptions. Females report greater levels of anxiety than males when it comes to conversing with authority figures or speaking in public. Males report anxiety related to using public rest rooms and returning items to a store.
More consequential however, is the fact that despite women reporting higher levels of social anxiety in general, most studies find that it is men, rather than women, who wind up seeking treatment for social phobia. This stands in stark contrast to other anxiety disorders and most common mental health problems - panic disorder, depression or eating disorders - which all tend to afflict females disproportionately.
One explanation for social phobia's unusual male preponderance is that culturally it is generally less acceptable for males to be socially anxious and reticent. English phrases such as "blushing bride" and "wallflower" express our acceptance and even our appreciation of social anxiety (shyness) in females, but shy boys get a much harder time.
Studies exploring this idea report that males who were socially anxious as children tended to marry later in life and also begin their careers later than their non-shy counterparts. This pattern of delayed life-goal attainments does not hold true for women with a childhood history of social anxiety.
Consider traditional Arab gender roles (which are not too dissimilar from those reported in western societies). Males are generally expected to be assertive, outgoing and adventurous, while such attributes are mostly discouraged in females. Within such societies we might expect to find high levels of anxiety among females, but a far greater number of males seeking help for social phobia.
Recent regional research lends much support to this idea. One study reported in the journal Social Behaviour and Personality examined rates of anxiety across 10 Arab nations, consistently finding higher levels of anxiety reported by females. Another study, reported in the journal Depression and Anxiety, looked at treatment-seeking at an outpatient mental health clinic in Saudi Arabia. That study reported that 90 per cent of all the patients who received a diagnosis of social phobia were male. Is it particularly stigmatising for a Saudi male to be socially anxious, or is it just highly acceptable for Saudi females to be shy, retiring and socially reticent?
Perhaps as more Gulf women begin entering the workforce, we will see more equal gender ratios in terms of treatment seeking for social phobia. Of course, in an ideal world, it would be better if we could just reduce the number of males seeking help. This could be achieved by our societies becoming more accepting of social anxiety regardless of which gender exhibits it.
Justin Thomas is an assistant psychology professor at Zayed University in Abu Dhabi
On Twitter: @jaytee156