Professor Says Normal Shyness Now Labeled Social Anxiety Disorder

In a new book that is critical of how seemingly normal behavior is now classified as an social disorder, Northwestern University professor Christopher Lane, Ph.D., talks about the "highly unscientific and often arbitrary way" that widespread revisions are made to The Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM.

The DSM, sometimes called the bible of psychiatry, is used for the diagnosis and treatment of psychiatric illnesses. It's said to be a highly scientific manual and is consulted daily by numerous professionals, from psychiatrists, psychologists and mental health workers, to social workers, schools, prisons, courts and pharmaceutical and insurance companies. The first DSM was published in 1952, followed by three revisions. The DSM-IV was published in 1994; the DSM-V is expected to be published in 2012.

Lane maintains that revisions made to the DSM are not as scientific as they're represented to be. He specifically cites the unscientific way normal shyness has morphed into a diagnosis of "social anxiety disorder," treatable by drugs. He questions why it's wrong to be shy and when and how bashfulness and other normal or ordinary behaviors in both children and adults have become psychiatric disorders treatable with powerful, potentially dangerous drugs.

According to Lane, the number of mental health disorders the general population might exhibit increased from 180 in 1968 to more than 350 in 1994. He takes issue with the rationale for such a dramatic increase and questions whether all of the new psychiatric labels were really necessary or even accurate.

By labeling shyness and other human personality traits as disorders with biological causes, says Lane, the doors opened to a pharmaceutical industry primed and ready to provide a pill for every alleged chemical imbalance or biological problem imaginable.

In an online interview in September 2007, Lane was asked about his criticism of the diagnosis of social anxiety disorder, which resulted in his book, "Shyness: How Normal Behavior Became A Sickness." He said it all started when he "felt bombarded by all the pharmaceutical ads for social anxiety disorder that came out a few years ago. I wanted to find out what was behind them and, indeed, what the psychiatrists meant by 'social anxiety disorder.' The phrase sounded so ominous and, at the same time, so peculiar."

From there, Lane began to do some research on the subject and on the DSM. Specifically, he "wanted to know how this complex manual went through so many dramatic changes. Who was behind them? And what was motivating their desire to add so many dozens of new disorders to the manual? Above all, were they right, and were their changes necessary and helpful?"

What he found lead him to be "far more concerned about psychiatry now than I was going into this project." After reviewing hundreds of the psychiatrists' letters and memos, he learned a lot about the revisions they pushed for. He said "some of them pushed for their own disorders to get adopted. Some wanted to promote their friends or thwart their enemies, and openly joked about that. Some of their sample sizes were embarrassingly low. In one case involving just one person, the advocate of the disorder had himself treated. That's no basis for saying a disorder belongs in the DSM, especially not if you're claiming the manual is highly scientific."

Lane said he concluded from his research that DSM revisions to social anxiety disorder had the diagnostic bar too low. As a result, what used to be called shyness has become social anxiety disorder, a mental illness common enough to be considered, according to recent studies, third only to alcoholism and major depression.

In 1999, Paxil became the first FDA approved drug for treating social anxiety disorder, which resulted in a multi-million dollar media campaign dubbed "Imagine Being Allergic to People." From there, Americans began to change their thinking about shyness, anxiety and treatment with medication.

In the press release Lane quotes a Paxil representative: "Every marketer's dream is to find an unidentified or unknown market and develop it. That's what we were able to do with social anxiety disorder." Lanes says that in 2001, with 25 million new prescriptions written for Paxil, the drug's U.S. sales alone increased by 18 percent from the year before.

According to the release, psychiatrists insist the line between ordinary shyness and social anxiety disorder is sharply defined. Lane, however, claims psychiatric literature repeatedly confuses doctors and puts patients at risk of over-diagnosis and unnecessary, sometimes harmful treatment.

Sources:

Press release, "Shyness: How Normal Behavior Became Illness;" http://www.newswise.com/articles/view/534255/

Interview, "An Interview With Christopher Lane;" http://www.furiousseasons.com/archives/2007/10/an_interview_with_christopher_lane.html