You're So Sensitive

We have all met'or might even be ourselves'the person known as the 'shy one.' The telltale traits of the shy are easily identified: They're quiet. They blush easily. Their hearts pound at the thought of asking a question in a crowded room. But being shy not only might keep you from getting your questions answered or asking the person you are interested in for a date'it may also affect your health. A study published in the December 15 issue of Biological Psychiatry found that shy gay men who were studied were more likely to have their HIV disease progress to advanced levels of AIDS diagnosis and were less likely to respond to antiretroviral treatment than extroverted men. The reason: the stress shy people experience. The study, led by Steve Cole, Ph.D., an assistant professor at the University of California, Los Angeles, School of Medicine, is the first to find a biological explanation for the link among shyness, stress, and HIV. But it is not the first to show a connection between shyness and infection. Researchers reported in 1990 that people who identified themselves as being very shy had a higher prevalence of hay fever. And at least three studies in which participants were intentionally exposed to the common cold virus, extroversion was related to reduced susceptibility to colds; in the latest study, shy people were twice as likely to get sick as individuals who were the most sociable. In the 1990s Cole and others began observing a link between psychological traits and HIV progression. 'The strongest correlation was being in the closet,' says Cole. 'Gay men with HIV who were closeted got sick two to three years earlier than did men with HIV who were out.' Studies that looked at the effect of anxiety, stress, and depression on HIV have found that these psychological problems could be a factor in HIV progression. But what interested Cole was that the men who were closeted were not more anxious or depressed or stressed than the men who were out. But they did differ in one significant way'their temperament. 'They were more likely to be shy, sensitive people who cared a lot about what others thought about them,' Cole says. The System Shuts Down The dominant theory about shyness, Cole says, is that people who are shy are 'born more sensitive to threatening and ambiguous situations,' and this can trigger the autonomic nervous system and what is known as the fight-or-flight stress response. As a result, the autonomic nervous system goes off much more often in shy people than it does in others. And this may be affecting their health. A previous study by Cole found that norepinephrine, the chemical the autonomic nervous system releases when under stress, made HIV disease progress about 10 times as fast as it typically would. Cole's latest study has evaluated shyness, autonomic nervous system response, viral load, and CD4-cell count in 54 asymptomatic gay HIV-positive men. Thirteen of them were considered ideal subjects because they had never taken triple combination therapy, and they began taking it during the study. Of these 13 men, those who were extroverted had their viral load drop about 162-fold after being on highly active antiretroviral therapy for about 18 months. But the shy men in the group of 13 had a vastly different experience'their viral load decreased only about 20-fold. Jane Leserman, Ph.D., a research professor in the department of psychiatry at the University of North Carolina at Chapel Hill School of Medicine, has studied how stress, depression, and social support affect HIV progression. 'It is certainly possible that some personality characteristics could be involved,' she says. 'But it might not be the shyness per se. It might be some other attribute associated with shyness, like not getting social support. It can be hard to ferret out all of those things.' Can This Be Beaten? For people who want to try to overcome their shyness, cognitive therapy and antidepressants may both be an option. 'You can't actually change the temperament you are born with,' says Cole. 'But you can intervene at the level of brain chemistry. We know that if you put someone on Prozac, Paxil, or other [selective serotonin reuptake inhibitors], these drugs seem to significantly reduce shyness by reducing the brain chemistry that leads people to think that bad events are painful.' Alternatively, it may be possible to protect shy people from how shyness affects the body. Cole is looking at whether beta-blockers'drugs that keep the autonomic nervous system in check and are used to treat heart disease'might help shy people's immune systems. 'If we stop the autonomic nervous system from accelerating the heart rate and the strength of heartbeats,' says Cole, 'we might be able to stop the autonomic nervous system from having its effect on T cells, which might prevent HIV from replicating so fast.' Cole believes his research on temperament might explain why only some studies have found depression or anxiety linked to HIV progression. 'The difficulty that we've had in linking depression or anxiety to disease progression is that these are often, but not always, transient states,' he says. 'So what I think shy people are telling us is that it is not the occasional big psychological things. It's these long-term differences in temperament and how people live their lives.' You Should Know Attention all women: In March 2001 the Centers for Disease Control and Prevention reported that scientists had announced that an HIV patient's personality can affect the speed at which the infection progresses to AIDS. Researchers reported that behavioral evidence of the disease is indicative of the need for stress and support groups as part of standard treatment therapies. The effects of high levels of stress, anger, depression, and higher-than-average blood pressure were also found to accelerate HIV. Researchers from the HIV Epidemiology Research Study reviewed the cases of 765 HIV-positive women between 16 and 55 to determine the association of depressive symptoms with HIV-related mortality and decline in CD4-cell counts. Controlling the study for clinical pathology, substance use, and sociological factors, the authors found that depression among HIV-infected women is associated with disease progression. The findings, they noted, reinforce the need for diagnosis and treatment of depression among HIV-positive women.