Social anxiety disorder (technically known as social phobia) is one of those disorders that wasn’t diagnosed very often a decade or so ago. Occasionally you would see a patient with this disorder, but it was very, very rare.
For better or worse, there are now medications for social anxiety disorder, and with that, greater education and focus on this disorder. Naturally, more diagnoses of this disorder have occurred.
Furious Seasons has a great interview with Christopher Lane, an English professor at Northwestern University who is the author of an op-ed piece in the New York Times that was critical of this disorder and its seeming overdiagnosis.
In the interview, which is worth a read, Lane talks a little bit about the very human and perhaps less-than-scientific process that went into the creation of the Diagnostic and Statistical Manual of Mental Disorders (we assume he’s talking about the DSM-IV, the latest edition of the professional manual of mental disorders). I was in graduate school when the DSM-IV first came out and it was very much touted and marketed as far more scientific than previous volumes.
But the history of the DSM is that it has always been a manual based upon personalities and politics of its authors than science. For instance, by a vote, homosexuality was removed from the book as a “disorder” in the early 1970s. Hardly the rigorous scientific method at its best there.
The fact that the latest incarnation, first published in the early 1990s, also suffered from similar biases is unsurprising to professionals in the field. Sometimes its sciences is overemphasized, to its own detriment. Because while a good attempt to introduce a scientific background for every disorder included, it still is lacking in many respects.
Should it be thrown away? Well, no. The DSM-IV is a good foundation and is supported by the ICD-10 as well. It’s not ideal nor perfect (and few diagnostic manuals are). Will the DSM-V do better? One can only hope. (If “Internet addiction” shows up as a real, full-blown diagnostic category, we will know it has not done any better.)
Lane also talks about how powerful psychiatric medications are prescribed to children far too easily in today’s society, with rarely a thought to the fact that many lack FDA approval for child prescriptions, or significant, large-scale studies that support their use for a specific disorder.
I agree, and it prodded me to write a piece I’ve been meaning to pen for some time now, Changing the Treatment Conversation. It needs to change, because we’re going down a road that may lead to more Rebecca Riley cases in our future if we’re not careful.
Oh, BTW, the cure for social anxiety disorder? Sure, medications are one option. But consider the many skills one can readily learn to overcome social anxiety (or at least try), in addition to self-help books on the topic.
(9 votes, average: 3.33 out of 5)
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15 Responses to “Social Anxiety Disorder and Its Cure” (Pingbacks/trackbacks not shown below)
Xtina at 8:11 pm on
October 2nd, 2007
I am confused by this article. Mostly by the disparity between the title and the bulk of the article, which was about the DSM-IV.
John M. Grohol, Psy.D. at 8:32 pm on
October 2nd, 2007
Good point, but the major points of the entry were:
A. Social anxiety disorder as a “popular” diagnosis is rather new and driven by profitable treatments.
B. It is not likely a diagnosis born merely out of a single professional’s or researcher’s desire to have it included in the DSM. (I admit I got side-tracked on the DSM issue…)
C. It is being treated by primary care physicians (e.g., family docs) in primary care settings, to the detriment of most people, simply with medications.
D. It is to most people’s benefit to try non-medication based treatments first (or at least in conjunction with meds) for this social disorder, which is clearly not a “brain disorder” on the same level as schizophrenia or bipolar disorder.
E. The “cure” for social anxiety disorder has been readily available for years, through readily available and inexpensive books like the one linked to above.
Sorry for the lack of clarity in my stream of consciousness, that’s the way blog entries sometimes go…
Da Downs at 10:52 pm on
October 2nd, 2007
This seems to be an oddly opinionated piece, given that it seems to want to disparage some things(DSM-IV? Diagnosis of individuals with Social Phobia?) as being based more in opinion or personal and corporate agenda than in experimental evidence. Or am I mis-reading it?
As one diagnosed and medicated years prior to the social phobia “fad” reaching the pharmaceutical sales and advertising departments, I can provide 1 piece of evidence from direct experience: medication - in and of itself - can be darned near miraculous in its relief of relentless anxiety and periodic panic attacks that can result from severe social phobia/social anxiety disorder. Relief of anxiety symptoms enabled subsequent behavioral work…including collecting and studying a small library of books, conscientiously implementing their recommended exercises, and participating in cognitive behavioral therapy and exposure therapies with a Psy. D.
I share frustration with what I perceive as excessive attention to details of diagnostic criteria, seemingly at the expense of research on neuropsychological causes and development and testing of clinically proven therapies. However, I am excited by the recent research exploring neuromolecular bases of fear learning and fear memory and its potential implications for people with a vast range of disabling disorders. Research on use of cycloserine-D in conjunction with exposure therapy to diminish anxiety seems to hold promise as well…pending additional clinical research.
I am puzzled by your comment that social phobia/social anxiety disorder “is clearly not a ‘brain disorder’ on the same level as schizophrenia or bipolar disorder.” I am aware of scales that attempt to measure “life impact” of various disorders. I can appreciate that schizophrenia and bipolar disorder might be judged to be at a higher “level” of impact on such a scale. I hope you are not suggesting, however, that social phobia/social anxiety disorder does not have similar roots in the physical, chemical function of the brain. That would be a tough argument to support, given evidence from mainstream scientific research.
It is indeed profoundly distressing that some pharmaceutical companies unabashedly promote self-diagnosis and over-diagnosis of medical conditions and psychological disorders in order to sell product. As noted in your citation of the New York Times article, this has proven to be dangerous and even lethal for victims. Let us hope, however, that critics of these disreputable practices don’t respond by “throwing the baby out with the bath water” by trivializing real and disabling disorders, and projecting the squalid behavior of ‘big pharm’ onto recipients who genuinely suffer and need help.
I have not read Mr. Lane’s New York Times piece, and so don’t intend to implicate him in my comments. I will read it, however, and hope that my concern doesn’t apply to him.
John M. Grohol, Psy.D. at 7:39 am on
October 3rd, 2007
Not sure how to respond to the “oddly opinionated” comment. Sometimes I am, indeed, oddly opinionated.
I also never meant to insinuate, if indeed you got that I did, that medications aren’t and couldn’t be extremely helpful. Only that the research clearly shows that non-medication treatments are also extremely helpful for this disorder.
As for the brain disorder theory of “chemical imbalance,” that’s been largely refuted in recent years. The research shows that mental disorders are far more complex than a simple or single neurochemical being “out of balance” in the brain.
Which isn’t to say that the brain isn’t implicated in some manner in this and other disorders. Just that what those roots are is still very much up in the air.
Social phobia doesn’t mean a lot to me, although it is my official diagnosis. I didn’t accept the diagnosis of “anxiety” either because to me, it’s feels like fear. You can drive yourself crazy trying to prove to a psychologist that you have a particular disorder. I have OCD. No you don’t–you’ve never mentioned it before. I have agoraphobia. You don’t have panic attacks, so it doesn’t count. That’s the danger of diagnosis with the DSM-IV. The value of diagnosis (including self-diagnosis–after all, I’m inside this head, not you) is that by classifying yourself, you can more easily get help (although I’m no longer trying).
alexandra_k at 7:56 am on
October 8th, 2007
The similarity between the DSM and ICD isn’t due to their independently hitting upon the way the world is, rather, it reflects something along the lines of ‘truth by consensus’. The DSM and ICD are careful to stay fairly much in synch, to the advantage of both.
There are indeed some really good examples of how the DSM is driven by political agenda rather than by science. One is (as was noted) the removal of homosexuality from the DSM in response to lobby group pressure. Another was the introduction of PTSD due to lobby group pressure from war vets. Another was the introduction of panic disorder as a disorder in its own right after the development of some drug for it (sorry but I forget which one).
Sometimes disorders are differentiated on the basis of finding a treatment for them. Neurosyphilis was carved off from Schizophrenia with the development of anti-biotics that worked for a subset of people with Schizophrenia (those with Neurosyphilis, basically). Since we have now discovered the spirochette that results in syphilis that is further support for the idea that it is a distict disorder from Schizophrenia, however.
Social phobia is indeed really controversial. Some people regard it to be ‘pathologising shyness’. It draws attention to the rather problematic boundary between ‘mentally disordered’ and ‘not mentally disordered’ and it is unclear what we should say about it. Of course people with social phobia suffer - but not ALL cases of suffering are mental disorders. To say that social phobia isn’t a mental disorder isn’t to undermine or invalidate the suffering of the people who have been diagnosed with it - it is just to say that it doesn’t constitute a kind of condition that should be in the DSM / ICD.
I’d just like to say… That it is controversial whether people with more traditionally ‘biological’ disorders should be so quick to jump to medications as a first port of call either. If you want to teach someone to cook you will have more luck with environmental interventions (teaching them how) than with psychosurgery or medication yet of course neurological changes are required in order to teach a person how to cook. Similarly, I’m sure nobody denies that social phobia has a neurological basis. The million dollar question is how we are best to treat the people who we currently diagnose as being socially anxious. And… Whether social phobia is a distinct disorder in its own right.
Panic Attacks at 9:36 am on
December 30th, 2007
“Lane also talks about how powerful psychiatric medications are prescribed to children far too easily in today’s society, with rarely a thought to the fact that many lack FDA approval for child prescriptions, or significant, large-scale studies that support their use for a specific disorder.”
That statement should be an alarming wake up call to parents everwhere. Scary, scary stuff.
Vin at 2:07 am on
January 1st, 2008
I kinda knew there would be nothing new
in this article much less an actual cure.
A simple question comes to mind. Does secondary
adrenal fatigue and social anxiety have
any linkage. Is it me or am I being simplistic
when I link social anxiety to lowered
cortisol, epinephrine and seritonin counts?
Is malabsorbtion a contributing factor.
Are bio-identical hormones and nutrients the actual cure for social anxiety?
david townend at 9:03 pm on
January 1st, 2008
52 years old male with mental illess has great trouble relating to female
Panic Attacks at 1:53 pm on
January 5th, 2008
Dr. Grohol: I read your piece “Changing The Treatment Conversation” and I agree with you completely. It’s really sad that in today’s fast-paced world people are so impatient that they’ll throw caution to the wind and gamble their health on a quick fix - despite the consequences.
Great work. Thanks for your viewpoint.
I’m with Vin regarding adrenal fatigue and bio-identical hormones. I think this will soon become a main focus for the treatment of social phobia….
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I am confused by this article. Mostly by the disparity between the title and the bulk of the article, which was about the DSM-IV.
Good point, but the major points of the entry were:
A. Social anxiety disorder as a “popular” diagnosis is rather new and driven by profitable treatments.
B. It is not likely a diagnosis born merely out of a single professional’s or researcher’s desire to have it included in the DSM. (I admit I got side-tracked on the DSM issue…)
C. It is being treated by primary care physicians (e.g., family docs) in primary care settings, to the detriment of most people, simply with medications.
D. It is to most people’s benefit to try non-medication based treatments first (or at least in conjunction with meds) for this social disorder, which is clearly not a “brain disorder” on the same level as schizophrenia or bipolar disorder.
E. The “cure” for social anxiety disorder has been readily available for years, through readily available and inexpensive books like the one linked to above.
Sorry for the lack of clarity in my stream of consciousness, that’s the way blog entries sometimes go…
This seems to be an oddly opinionated piece, given that it seems to want to disparage some things(DSM-IV? Diagnosis of individuals with Social Phobia?) as being based more in opinion or personal and corporate agenda than in experimental evidence. Or am I mis-reading it?
As one diagnosed and medicated years prior to the social phobia “fad” reaching the pharmaceutical sales and advertising departments, I can provide 1 piece of evidence from direct experience: medication - in and of itself - can be darned near miraculous in its relief of relentless anxiety and periodic panic attacks that can result from severe social phobia/social anxiety disorder. Relief of anxiety symptoms enabled subsequent behavioral work…including collecting and studying a small library of books, conscientiously implementing their recommended exercises, and participating in cognitive behavioral therapy and exposure therapies with a Psy. D.
I share frustration with what I perceive as excessive attention to details of diagnostic criteria, seemingly at the expense of research on neuropsychological causes and development and testing of clinically proven therapies. However, I am excited by the recent research exploring neuromolecular bases of fear learning and fear memory and its potential implications for people with a vast range of disabling disorders. Research on use of cycloserine-D in conjunction with exposure therapy to diminish anxiety seems to hold promise as well…pending additional clinical research.
I am puzzled by your comment that social phobia/social anxiety disorder “is clearly not a ‘brain disorder’ on the same level as schizophrenia or bipolar disorder.” I am aware of scales that attempt to measure “life impact” of various disorders. I can appreciate that schizophrenia and bipolar disorder might be judged to be at a higher “level” of impact on such a scale. I hope you are not suggesting, however, that social phobia/social anxiety disorder does not have similar roots in the physical, chemical function of the brain. That would be a tough argument to support, given evidence from mainstream scientific research.
It is indeed profoundly distressing that some pharmaceutical companies unabashedly promote self-diagnosis and over-diagnosis of medical conditions and psychological disorders in order to sell product. As noted in your citation of the New York Times article, this has proven to be dangerous and even lethal for victims. Let us hope, however, that critics of these disreputable practices don’t respond by “throwing the baby out with the bath water” by trivializing real and disabling disorders, and projecting the squalid behavior of ‘big pharm’ onto recipients who genuinely suffer and need help.
I have not read Mr. Lane’s New York Times piece, and so don’t intend to implicate him in my comments. I will read it, however, and hope that my concern doesn’t apply to him.
Not sure how to respond to the “oddly opinionated” comment. Sometimes I am, indeed, oddly opinionated.
I also never meant to insinuate, if indeed you got that I did, that medications aren’t and couldn’t be extremely helpful. Only that the research clearly shows that non-medication treatments are also extremely helpful for this disorder.
As for the brain disorder theory of “chemical imbalance,” that’s been largely refuted in recent years. The research shows that mental disorders are far more complex than a simple or single neurochemical being “out of balance” in the brain.
Which isn’t to say that the brain isn’t implicated in some manner in this and other disorders. Just that what those roots are is still very much up in the air.
Social phobia doesn’t mean a lot to me, although it is my official diagnosis. I didn’t accept the diagnosis of “anxiety” either because to me, it’s feels like fear. You can drive yourself crazy trying to prove to a psychologist that you have a particular disorder. I have OCD. No you don’t–you’ve never mentioned it before. I have agoraphobia. You don’t have panic attacks, so it doesn’t count. That’s the danger of diagnosis with the DSM-IV. The value of diagnosis (including self-diagnosis–after all, I’m inside this head, not you) is that by classifying yourself, you can more easily get help (although I’m no longer trying).
The similarity between the DSM and ICD isn’t due to their independently hitting upon the way the world is, rather, it reflects something along the lines of ‘truth by consensus’. The DSM and ICD are careful to stay fairly much in synch, to the advantage of both.
There are indeed some really good examples of how the DSM is driven by political agenda rather than by science. One is (as was noted) the removal of homosexuality from the DSM in response to lobby group pressure. Another was the introduction of PTSD due to lobby group pressure from war vets. Another was the introduction of panic disorder as a disorder in its own right after the development of some drug for it (sorry but I forget which one).
Sometimes disorders are differentiated on the basis of finding a treatment for them. Neurosyphilis was carved off from Schizophrenia with the development of anti-biotics that worked for a subset of people with Schizophrenia (those with Neurosyphilis, basically). Since we have now discovered the spirochette that results in syphilis that is further support for the idea that it is a distict disorder from Schizophrenia, however.
Social phobia is indeed really controversial. Some people regard it to be ‘pathologising shyness’. It draws attention to the rather problematic boundary between ‘mentally disordered’ and ‘not mentally disordered’ and it is unclear what we should say about it. Of course people with social phobia suffer - but not ALL cases of suffering are mental disorders. To say that social phobia isn’t a mental disorder isn’t to undermine or invalidate the suffering of the people who have been diagnosed with it - it is just to say that it doesn’t constitute a kind of condition that should be in the DSM / ICD.
I’d just like to say… That it is controversial whether people with more traditionally ‘biological’ disorders should be so quick to jump to medications as a first port of call either. If you want to teach someone to cook you will have more luck with environmental interventions (teaching them how) than with psychosurgery or medication yet of course neurological changes are required in order to teach a person how to cook. Similarly, I’m sure nobody denies that social phobia has a neurological basis. The million dollar question is how we are best to treat the people who we currently diagnose as being socially anxious. And… Whether social phobia is a distinct disorder in its own right.
“Lane also talks about how powerful psychiatric medications are prescribed to children far too easily in today’s society, with rarely a thought to the fact that many lack FDA approval for child prescriptions, or significant, large-scale studies that support their use for a specific disorder.”
That statement should be an alarming wake up call to parents everwhere. Scary, scary stuff.
I kinda knew there would be nothing new
in this article much less an actual cure.
A simple question comes to mind. Does secondary
adrenal fatigue and social anxiety have
any linkage. Is it me or am I being simplistic
when I link social anxiety to lowered
cortisol, epinephrine and seritonin counts?
Is malabsorbtion a contributing factor.
Are bio-identical hormones and nutrients the actual cure for social anxiety?
52 years old male with mental illess has great trouble relating to female
Dr. Grohol: I read your piece “Changing The Treatment Conversation” and I agree with you completely. It’s really sad that in today’s fast-paced world people are so impatient that they’ll throw caution to the wind and gamble their health on a quick fix - despite the consequences.
Great work. Thanks for your viewpoint.
I’m with Vin regarding adrenal fatigue and bio-identical hormones. I think this will soon become a main focus for the treatment of social phobia….
