Sunday, October 21, 2007

Labeling Human Traits: Is it Shyness or Social Anxiety Disorder?

In honor of World Mental Health Day, which took place on October 10th, I would like to address issues that have been stirring the mental health community for some time now. Rick Nauert, Senior News Editor for the Psych Central website recently wrote an article looking at how a book, titled Shyness: How Normal Behavior Became a Sickness, challenges the method by which human behaviors are classified as psychiatric disorders. In his book, the author, Christopher Lane, a Northwestern University professor, brings attention to how labeling human traits as disorders leaves the doors wide open for the pharmaceutical industry to intervene and prescribe medication to fix the presumed biological imbalances. Lane argues that recent changes made to the Diagnostic and Statistical Manual of Mental Disorders (DSM) have set the diagnostic bar too low and more people may be diagnosed as having social anxiety disorder when in fact they may just be suffering from normal shyness. Issues such as these definitely need to be taken into consideration during the upcoming revisions to the DSM, because further ambiguity in diagnostic criteria will surely lead to high rates of over-diagnosis and harmful treatments. By examining the treatment for social anxiety disorder, for example, we can see how medications may not always be an effective approach to treating the disorder.

With more and more shy people being diagnosed with social anxiety disorder it would seem apparent that the DSM-IV is in need of revisions. In a New York Times article, “Shy on Drugs”, Lane reveals that, troublingly, in the fundamental handbook of psychiatry “the diagnostic criteria for shyness are far from clear.” Since the team of people who will oversee the development of the newest edition of the DSM, version V, scheduled to be published in 2012, has already been announced, it will be up to these professionals to make sure that diagnostic criteria are made clearer when it comes to disorders like social anxiety. In regards to the new edition of the DSM, Lane states that “this time they should make sure to carefully distinguish normal—even healthy—shyness from social anxiety disorder.” By making the language in the next DSM more direct and precise, mental health care providers might avoid misdiagnosing patients as having a serious disorder when the individual is only exhibiting typical personality traits.

It is also important to note that the drug industry has taken advantage of these high recurring disorders. The makers of Paxil, for example, came out in the late 1990s saying that it could treat social anxiety as well. Let us keep in mind that this drug was originally used to treat depression. Lane stresses the fact that “after being prescribed Paxil or Zoloft for their shyness and public-speaking anxiety, a disturbingly large number of children, studies found, began to contemplate suicide and to suffer a host of other chronic side effects.” In October 2004, the Food and Drug Administration placed a black box warning on all antidepressant medications. Dr. Lester M. Crawford, Acting FDA Commissioner, said that these actions “represent the FDA’s conclusions about the increased risk of suicidal thoughts and the necessary actions for physicians prescribing these antidepressant drugs and for the children and adolescents taking them.” The prescription of these dangerous drugs is undoubtedly unacceptable, especially if they are being used to treat symptoms that do not actually constitute a real disorder.

The fact that a more than 1.4 billion antidepressant prescriptions are being issued to children per year goes to show that too many in the United States are now opting for what seem to be quick fixes and not considering alternative treatments. Mental health care providers should discourage the use of medications when it comes to treating conditions such as social anxiety disorder because studies have shown that there are other available options. For instance, one study published in the Journal of Child Psychology and Psychiatry examined the efficacy of a school-based, cognitive-behavioral intervention on adolescents with social anxiety disorder. The study found that emphasizing exposure and rehearsal of social skills during the intervention was highly efficacious. It also proved that effective interventions can be transported to nonclinical settings like schools. Non-medication treatments such as this one are a safer option, especially for those individuals whose diagnosis may be on the borderline of normal shyness and social anxiety disorder.

According to the Social Phobia/Social Anxiety Association approximately 7% of the population suffers from social anxiety disorder. Therefore, it is important that the above mentioned and unclear diagnostic criteria issues be resolved soon because many people may be suffering more from a misdiagnosis than from an actual disorder. This issue of diagnostic uncertainty does not only pertain to social anxiety but to other disorders as well. I believe that the release of the new DSM will help ease the number of black box warning prescriptions being issued because it will make diagnostic criteria more precise. But as the mental health community awaits the release it is important that we keep other forms of treatments in mind.


CH said...

I would like to start off by saying I thought your post was very informative and interesting. Your title caught my attention because I never thought shyness could be categorized as a social anxiety disorder. As for other strengths I found in your post, I like how you based it on Mental Health Day, a current event, that I was not very aware of. As well, I think your style of writing is very professional and to the point especially when you say "how labeling human traits as disorders leaves the doors wide open for the pharmaceutical industry to intervene and prescribe medication to fix the presumed biological imbalances." I completely agree with this point because I know many people who abuse the prescription system. In addition, your pictures are very useful, especially the first one on the top.

As for areas for improvement, they are minimal. First, you mention "effective interventions can be transported to nonclinical settings like schools" This could be a stronger point if you provided an example of how to do this. Simply, I would have liked to read more about your opinion. Your post was very informative, but I would have liked to go more in depth when you said "many people may be suffering more from a misdiagnosis than from an actual disorder" Include what are the long term effects and how this effects society as a whole.

Overall great post and I can't wait to read more!

Anonymous said...

As an effective medicine, paxil would surely provide you immense relief if you are in the grip of panic disorder, depression or generalized anxiety disorder but it is altogether true that the usage of Paxil occasionally facilitates certain side-effects such as headache, low blood pressure, irregular heartbeat et al. These side-effects can yield serious results if not treated immediately hence take this medicine only on proper prescription.

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