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How is Social Anxiety Disorder Misdiagnosed?

Why SAD Is Commonly Misdiagnosed

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It was not until 1980 that social anxiety disorder (SAD) was officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM). At that time, the term used was social phobia, and fears were described only in relation to performance situations. In 1994, the term "social anxiety disorder" was introduced, and broader anxiety triggers including more general social situations were included in a description of the diagnosis.

As a result, it is not surprising that SAD remains one of the most misdiagnosed and under-diagnosed disorders. There are still many primary care doctors and some mental health professionals who are not familiar with, or have misconceptions about, the diagnosis of SAD.

Add to these issues the inability of many SAD sufferers to seek help, and you have a situation in which many people with the disorder go without a diagnosis or are misdiagnosed. Potential wrong diagnoses include depression, panic disorder, attention defecit hyperactivity disorder (ADHD) and schizoid personality disorder.

For those who have received the wrong diagnosis, or no diagnosis at all, it can be hard to rectify the situation. If you suffer with social anxiety, your symptoms make it difficult to talk to people that you perceive to be in authority, let alone question their authority. Misdiagnosis can mean accepting the wrong treatment and potentially the wrong medication. Perhaps you don't even know that you have been misdiagnosed or that SAD even exists.

In a Canadian study of more than 800 patients presenting to primary care settings, the rate of missed diagnoses for SAD was 97.8%, meaning that only 2.2% of those who met criteria for the disorder were diagnosed with SAD by their primary care doctor. In the same study, 18.7% of those who met criteria for SAD were misdiagnosed; meaning that they had been diagnosed with another anxiety or mood disorder. The overall prevalence rate for SAD in the study was 16.5%. The findings of this study are in line with those found in the National Comorbidity study; in general physicians fail to diagnose mood and anxiety disorders up to half of the time.

Although SAD is the third most common psychological disorder in the United States, it is poorly understood both by the general public and by some working in medical settings. The disorder is rarely discussed in the media because sufferers are too afraid to talk about their fears. Although Oprah Winfrey filmed two shows about the disorder, with Jamie Blythe and Jonathan Knight, there has been little coverage elsewhere.

Depression and panic disorder are two potential misdiagnoses given in place of SAD. Those who suffer with depression avoid social situations because of a lack of pleasure rather than fear of people; when depressive symptoms remit those who were depressed enjoy being in the company of others. For those with panic disorder, avoidance of social situations is to tied fears of having a panic attack in a place that would be difficult from which to escape. In addition, people with panic disorder usually prefer to have a trusted companion along, whereas those with SAD do not.

In general, SAD is a prevalent disorder with poor rates of detection. Ideally, physicians in primary care settings will enhance diagnostic screening to ensure that they do not miss, or misattribute symptoms. At the same time, there is one strategy that you can use when you visit your doctor to increase the likelihood that you receive the proper diagnosis -- and that is, prepare a case summary of your symptoms, to ensure that nothing is left out.

In general, you need a professional who understands the unique symptoms of SAD and the fears that you battle on a daily basis. If you feel like you have been misdiagnosed or a diagnosis has been missed, it is important to bring up your concerns even if it is with the help of a family member or friend. If you feel as though your doctor is not listening to you, it might be necessary to seek a second opinion.

Sources:

Antony M, Barlow DH. Handbook of assessment and treatment planning for psychological disorders. New York: Guilford; 2010.

Anxiety Network. Social anxiety and misdiagnosis. Accessed October 24, 2011.

Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627.

Vermani M, Marcus M, Katzman MA. Rates of detection of mood and anxiety disorders in primary care: A descriptive, cross-sectional study. Primary Care Companion for CNS Disorders. 2011; 13(2).

Weiller E, Bisserbe JC, Boyer P, et al. Social phobia in general health care: an unrecognised undertreated disabling disorder. Br J Psychiatry. 1996;168(2):169–174.

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