Brian Cox, professor of psychiatry, psychology and community health sciences at the University of Manitoba in Winnipeg, Canada wrote in the New England Journal of Medicine that medication is an inappropriate form of treatment for people with social anxiety disorder (SAD). In reviewing the book Shyness: How Normal Behavior Became a Sickness, Cox agreed with the author, Christopher Lane, that drug companies are promoting social phobia as commonplace and medication as necessary. Cox claims that the change in terminology from social phobia to social anxiety disorder in the DSM-IV has led to people being prescribed medication more often because it sounds like a more serious illness.
I’m not sure which community Dr. Cox is referring to when he says that medication is more likely to be prescribed because the disorder sounds more serious. This is a very scary thought indeed – that the choice of treatment would be based on the terminology used to describe a disorder. Should the onus not be on the community of psychiatrists and physicians to properly diagnose SAD – including a thorough evaluation of the degree of disturbance and impairment in functioning? Of course the general public will be influenced by drug campaigns and think that ordinary shyness deserves a dose of Paxil. In the end, however, it is the responsibility of the medical community to 1) properly diagnose the disorder and 2) determine whether medication is appropriate for treatment. When these steps are followed, the use of medication in treating severe SAD is most certainly justified.