November 27, 2007

Shyness, social phobia, or none of the above?



In a recent Washington Post article, the question of what constitutes social anxiety disorder is explored.

I posted about public speaking fear vs. phobia a while back, and this article brings up, again, the question: When does plain old shyness or minor anxiety become a psychological disorder?

For social anxiety disorder to be included in the Diagnostic and Statistical Manual of Mental Disorders, 3rd. Edition (aka DSM III, published in 1980), clinical trials had to be performed and solid evidence gathered.

However, one of the members of the original task force assembled to define new disorders for the DSM was quoted as saying, "There was very little systematic research, and much of the research that existed was really a hodgepodge -- scattered, inconsistent and ambiguous."

The author of the Washington Post piece says,

"The manual went on to list dislike of eating alone in restaurants as the prime symptom of social phobia, with fear of hand-trembling a close second and avoidance of public restrooms third. With the inclusion of more and more behaviors -- public-speaking anxiety, concern about dealing with people in authority, even dating anxiety -- the diagnostic category ballooned until it overlapped with common shyness, as several key studies suggested, including a 1990 article in Behaviour Research and Therapy by University of Pittsburgh psychiatrist Samuel M. Turner and his colleagues."

". . . By 1987, a revised edition of the 1980 DSM had removed the phrase 'a compelling desire to avoid' fear-inducing situations, requiring only 'marked distress.' Signs of this could include concern about saying the wrong thing -- a fear afflicting almost everyone on the planet."

I'm not suggesting that there aren't people who suffer from true social anxiety or public speaking phobia. This article makes it clear, however, that flexible definitions of "shyness," "phobia," and "anxiety" are driving people to psychiatrists in droves, looking for pharmaceutical intervention.

Philip Dawdy and Ross Bowring addressed the use of Seroquel (which is apparently a miracle drug) for public speaking anxiety on their blogs earlier this year and Bert Decker talked about beta blockers; the side effects alone - memory loss, for example - make me wonder why someone would use drugs to help with public speaking anxiety, when there are so many other solutions.

Before accepting a psychological disorder as a diagnosis and starting down the path to drugged-land, explore all your options for dealing with anxiety.

Last word to Ross:

"Toastmasters. Dale Carnegie courses. Private public speaking coaches. Even the humble blog. They can all help someone overcome their phobia in a more humanistic, thoughtful and effective way than the mindless popping of a pill. A pill that does nothing to address the root issues that lay beneath the phobia."

More posts on this:

More on shyness and social phobia

Take two Prozac and call me in the morning

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