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Arlin Cuncic

Social Anxiety: Real or Just in Your Head?

By August 14, 2010

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In a recent article in the Irish Times, Jason Walsh discusses the issues surrounding diagnosis, mental health, and the upcoming revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Some argue that mental health providers have gradually moved toward over-diagnosis and over-medicalization. Social anxiety disorder (SAD) is often one of the first disorders to come under fire. The comment is usually, "When did ordinary shyness become a disease"?

On the other hand, many realize that the DSM allows providers to identify disorders based on clusters of symptoms and offer treatment that works; be it medication, therapy, or a combination of the two. In the end, isn't that what the profession should be about?

Perhaps what is needed is a change in the way mental health diagnoses are viewed. If there were less stigma attached to a diagnosis, more people might get the help they need.

When we can talk openly about mental health issues the way we do about our physical health, maybe then we can start discussing over-medicalization. Until then, I think a lot of people are just blowing smoke.

What do you think? Is social anxiety normal behavior or worthy of a diagnostic label?

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August 15, 2010 at 4:05 pm
(1) Melissa21 says:

Diagnosis is important really just to give a name to the reason insurance should pay for treatment, whatever that looks like. Everyone can find a disorder that fits them if they look through the DSM. The difference between a “mental illness” and normal mental functioning is based on the individuals ability to live life and function in society. If that is impaired by a severe symptom then there’s a problem, if the person is happily living life and not hurting themselves or others then they have no problem.

August 16, 2010 at 9:44 am
(2) squ33ble says:

Melissa21 summed it up very well. If a person has symptoms of a mental illness, they may be able to live without treatment; it could be minor enough in their life that it doesn’t affect them. For many, though, the symptoms do affect them. I think SAD is worthy of a diagnostic label, as you say, because while some may function fine with a mild case of it (what is usually seen as just shyness that is “normal”), others live their life in fear and with anxiety over basic things that cause them to miss out on things in life they would have liked to do. If it interfers with their lives or the lives of others in a way that they do not like, they should be allowed to be given treatment and not be seen as shy people that just need to “get over it”.

The argument that “When did ordinary shyness become a disease?” parallels the arguments against depression being real, and frankly it’s just as full of crap.

August 26, 2010 at 3:25 am
(3) Zobot says:

Is SAD worthy of diagnostic criteria, and attention from mental health professionals? Is it a “real” psychological/ emotional/ behavioral issue? I guess those are fair enough questions…and my answer would be, “Gee, if SAD isn’t real, then I must be pretty SAD, indeed!” (see what I just did there? It was a pun…because I am terminally nerdy). And do you see what I just did THERE?! I just insulted myself, because I have abysmally low self-esteem, and I’m too self conscious to simply leave a joke hanging in the breeze.

SAD is not only real, it’s PAINFULLY real. It’s not just “shyness”, as some would have us believe. There is nothing wrong with being shy—shyness is simply sincere introversion, absent of the disruption and disability that true social anxiety can inflict upon the disordered individual.

I have suffered with SAD since my mid-teens. A chronic health condition (chronic urticaria, a.k.a. hives) thrust me into an previously unfamiliar state of morbidly low self-esteem. This persisted for years, unchecked. Now, at twenty-nine-years-old (and combined with many other negative, compounding factors), I can honestly say that my life is at a total stand-still because of long-held beliefs I have about myself—all of which make it nearly impossible for me to muffle the fear of being watched/ judged/ appraised by others.

I lost my job because of SAD. That is as real as it gets.

I am presently undergoing intensive CBT, to try to mitigate the oppressive grip that social anxiety still has on my life. And I miss people. I love people. That’s probably why I fear them so much. But it’s painful, depressing, and life-sapping—it’s as real and awful as any other mental disorder I can possibly imagine. Questioning and trivializing SAD, will only make us (the suffers) SAD-der (see? I did it again! Lol!).

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