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.
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.