When 'social phobia' first entered the American Psychiatric Association's (APA) lexicon of mental disorders in 1980, shy people had little to fall back on, except perhaps Garrison Keillor's preferred remedy, Powdermilk Biscuits.

Since May they have also had Paxil, the first drug approved by the Food and Drug Administration to treat social phobia or social anxiety disorder. Shy people also have a lot of company, according to the APA, which estimates that one American in eight--nearly 13 percent of the population--fears social situations. Social phobia now ranks as the third most common mental disorder, after depression and alcohol dependence.

'This isn't shyness or stage fright,' says Columbia University psychiatrist Jack Gorman in The Lancet (May 8, 1999). 'It's a fairly serious illness in which patients become so anxious in any performance situation that they can't handle it.'

Social phobics are plagued by the persistent fear that they will do something to embarrass themselves, say something stupid, or otherwise appear inept or inferior to others. They may be unable to attend parties, return things to a store, talk to members of the opposite sex, or speak up at business meetings. To avoid potentially embarrassing situations, they may resort to strategies so elaborate that normal day-to-day functioning is impaired. In the extreme, they may become shut-ins.

But some observers wonder whether the extent of the epidemic hasn't been slightly exaggerated. 'The notion that more than 35 million Americans are adrift on a sea of morbid shyness strains the limits of plausibility,' writes Michelle Cottle in The New Republic (Aug. 2, 1999).

Of course there are individuals who benefit from increased awareness of intense shyness. Cottle's concern is that the numbers have been artificially inflated by medical researchers, mental health practitioners, pharmaceutical companies, and advocacy groups, 'each operating from varying degrees of ambition, scientific knowledge, opportunism, and good intentions.'

Somewhere along the way, the boundaries blurred and we started seeing pathology where once we saw run-of-the-mill insecurity. Social phobia is 'this year's version of attention deficit disorder,' she contends. 'It's a 'hot' disease.'

It wasn't always that way, Cottle tells us. When social phobia entered the Diagnostic and Statistical Manual of Mental Disorders, or DSM-III (the American Psychiatric Association's periodically updated catalog of disorders) in 1980, it was considered 'relatively rare,' affecting some 2 to 3 percent of the population. The initial entry focused on the fear of only one activity--writing, eating, or public speaking, for instance--that compelled the individual to avoid the situation altogether.

By the early '90s, prevalence rates were pushing double digits, in large part due to a landmark journal article that appeared in the mid-'80s and caused the medical profession to take a second look at social phobia. Upon reassessment, the APA relaxed its definition to include a generalized subtype of the condition and removed the phrase 'a compelling desire to avoid' from the diagnostic criteria. At this point, 'marked distress' was enough to define social phobia.With each tweak of the diagnostic criteria, the numbers rose. The higher prevalence rates hinge on nothing more than a semantic shift. Drawing the line between common shyness and true pathology is now a matter of individuals' definitions of 'significant distress.'