Christopher Lane has an excellent article in yesterday’s The Boston Globe about the murky line between normal shyness and something called social anxiety disorder (also known as social phobia). The article examines the difficulty in telling “normal behavior” from something that’s diagnosable as a mental disorder, and rightfully picks on this disorder as a prime example of the blurred line. But first Lane drives a dagger into what passes for science on social anxiety disorder:
The Society of Nuclear Medicine has been touting a new study that suggests we’re one step closer to solving the riddle of social anxiety disorder. Researchers believe the origins of the disorder are biological. […]
Once you start calling fear of criticism a psychiatric disorder, it’s easy to ignore the countless social and psychological factors that cause stress and anxiety. Yet the justification for calling the disorder biological turned out to be modest at best. MRI scans of five women and seven men who met the criteria for social anxiety disorder suggested that minor fluctuations of dopamine and serotonin “may play a role in the neurobiology of social anxiety disorder.”
That’s a bit like saying, “Exercise will increase your heart rate” or “Caffeine is a stimulant.” Microscopic fluctuations of dopamine and serotonin impact the brain all the time, helping determine our moods. It’s a stretch to predict the health of 15 million Americans from a brief focus on only a dozen of them.
Indeed. Researchers get excited when they seem some correlation within their data, but then almost universally over-extend and generalize the meaning of that correlation and data.
Much of these types of studies that purport to find some sort of brain chemical link for a specific disorder have amounted to very little in changing the way most disorders are diagnosed and treated.
But the larger point Lane makes in the article is about the fuzzy lines between the diagnostic criteria for many mental disorders, and what most of us would consider normal behavior. He picks on social anxiety disorder, and rightfully so, because it is one of the most useless diagnoses in the entire diagnostic manual.
What he glosses over, though, is that for a person to meet the diagnosis of social anxiety disorder, he or she must meet a total of 8 different criteria. Some criteria he doesn’t mention in his article are things like:
- The person recognizes that the fear is excessive or unreasonable.
- The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
- The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
- In individuals under age 18 years, the duration is at least 6 months (so much for the senior prom example in the article).
I highlighted some of the words. These are the words trained mental health professionals look for when diagnosing someone with this particular disorder. If you’re just experiencing a few butterflies in your stomach before making an annual presentation to your boss, that’s not social anxiety disorder.
I agree with Lane’s overall theme that perhaps professionals (and especially health professionals like family physicians with little specific mental health training) are over-diagnosing many mental disorders these days due to inexact diagnostic criteria. But I also believe overdiagnosis is also happening because of a simple lack of adherence to the criteria that do exist.
Shyness, as Lane reminds us, is not a mental disorder, and social anxiety disorder is not the same as being shy or having a personality that favors shyness. Shyness is just a normal, everyday trait that some people have — and it’s perfectly okay.
But the problem of overdiagnosis, like Lane believes, is a real one and must be addressed:
To restore public and professional confidence in the manual, the organization needs to raise, not lower, its diagnostic thresholds and delete every reference in the manual to mild or routine suffering, so that it’s possible once more to distinguish between the chronically ill and the worried well.
I concur. We must do a better job with the validity of this diagnostic system in its next revision, and seek to continually improve upon our abilities to reliably diagnose these disorders. Because suggesting someone is “ill” and in need of treatment when they are perfectly healthy helps no one.
Read the full article: Shyness or social anxiety?
9 comments
I was diagnosed as being a social phobic; being agoraphobic without panic disorder; and as having avoidant personality disorder. Consequently, I’ve read quite a few articles about all three, and they seem to overlap so much as to be meaningless. Besides, they’re all “anxiety” disorders, which means little to me. People are anxious about taking a test or meeting their in-laws for the first time; what *I* feel isn’t anxiety–it’s abject fear.
As a person who has severe generalized anxiety, panic attacks, social anxiety and a rather hefty phobia of other people, I found that being labeled as “shy” prevented me from getting the help I needed.Family menbers always said , oh, she’s just shy or you’re just shy Tracey. It took me many years of agonizing “shyness” before I realized that this went way beyond the norm.
I found that I had the same reactions to people as I would to any kind of dangerous situation. A neighbor walking up to me and saying “Hi” was met with the same amount of terror on my part as if they had just robbed me at gun point!
This “shyness” caused me to not do well in grade school, high school and caused me to be unable to continue with college even though i was on the deans list. I became just to terrified to go into the classrooms and buildings.
Where is the line to be drawn between social anxiety and “shyness”? I would say that if you live your life in terror, then it has gone beyond shyness.
I am so glad that “extreme shyness” has at last been recognized as a rather painful mental illness and that there has been an attempt to provide those of us who need it with some sort of relief. My life is better now, and i can even sometimes leave the house when other people are out in the neighborhood or go to the grocery store with the help of medications and my panic attack predicting service dog.
Im 60, and have suffered from something, that made me feel less of a person as long as I can remember. I quit kindergarten,{that was permitted in 1953}Then I had to go to 1st grade.Mostly I was ok in the classroom,but once outside when I was supposed to interact,the fear of being approached by others was crippling.I was physaclly sick,vomitting and severe pain, kept me out of school, but doctors could find anything wrong and concluded;”It’s only her nerves.” So I blamed myself. The 4th grade was probably my 1st full fledged panic attack. I went to sleep and woke up in the hospital. I had stopped breathing. Still the diagnosis was the same, “her nerves”. When I started Jr. High I decided I wasn’t going to be sick anymore. So I stiffened up and bore it. I continued to do that, and lead me to have sex with, get pregnant by, marry and be controlled by the first boy that showed me real attention. by the way still married to and controlled by. I suffer from fibromyalgia, 1st diagnosised in me in 1970, when it was still called fibrisitis. I have arthritis, to the point I can hardly walk. I have asthma, and I can trace all these real diseases back to when I started sucking up the stress of my fear when I was in Jr. High.App. 10 years ago I was diagnosised with S-A-D. and my life is and always has been very sad, because I never got an acurate diagnosis or treatment.
Jude, you really hit the nail on the head. I am someone who has had severe social phobia to the point where I couldn’t answer the phone without shaking. This eventually turned into agoraphobia and I didn’t leave my house for 3-4 years. Anxiety DOES NOT DESCRIBE what it is like. It’s more like total shutdown and a complete inability to function. Even the word fear doesn’t suffice. It’s a completely disorganizing feeling.
I have since made a lot, lot of progress with my social issues but I still maintain a very low level of social functioning. I’ve no friends, never have had any sort of relationship, pretty much depend on my nuclear family, etc… but the good news is I can leave my house almost all the time without anxiety/fear and I can talk to people I have just met with a twinge of anxiety/fear.
I have progressed to a place which looks almost like normal shyness / social anxiety (rather than pathological anxiety) except for the fact I cannot really enter any personal relationships.
I hate, hate reading books about social anxiety. They’re a joke. They describe people who quite frankly DON”T have any real social anxiety problem…people who are *normal* even charming and engaging but get a little nervous and scared when they give an acceptance speech. That’s not social anxiety people!