I was just reading an op-ed piece in the New York Times that makes the argument we are over-diagnosing and over-treating social anxiety disorder (SAD). This is not the first time this argument has been made. Christopher Lane wrote a book on the topic.
In the article, Susan Cain outlines the “merits” of introversion. These include:
- Introverts are essential to survival of the species because their contemplative nature balances extroverts tendency to leap before looking
- Introverts make great leaders (Eleanor Roosevelt), scientists (Albert Einstein), artists/writers (J.K. Rowling) and entrepreneurs (Steve Wozniak, who co-founded Apple)
- Introverts generally perform better academically and notice more details when working on solitary tasks
- Introverts tend to be more empathic and have stronger consciences
Point taken. But what do the merits of introversion have to do with the diagnosis and treatment of SAD?
Cain goes on to describe her take on an ad for medication for SAD:
“Imagine that the woman in the ad enjoys a steady paycheck, a strong marriage and a small circle of close friends — a good life by most measures — except that she avoids a needed promotion because she’s nervous about leading meetings.”
Cain notes that based on the diagnostic criteria in the DSM-IV, this woman would be diagnosed with SAD.
“…the diagnosis is warranted when anxiety ‘interferes significantly’ with work performance or if the sufferer shows ‘marked distress’ about it. According to this definition, the answer to our question is clear: the young woman in the ad is indeed sick.”
Hold on a second.
First, we don’t have nearly enough information to determine whether the woman described has SAD; and only a trained mental health professional should be making a diagnosis. Second, is this woman really even likely to go to her doctor? If she is, that is a step in the right direction. Rather than being overdiagnosed, SAD is severely underdiagnosed. People with social fears don’t usually seek help.
Cain states that the line becomes blurry between normal shyness and SAD; but it is because of articles like this one. Nowhere in the piece is there a description of what it is really like to suffer with severe social anxiety.
There has never been a debate whether introversion can be a valued personality trait. But, SAD is not introversion.
Cain argues that sensitivity can lead to empathy and leadership if it is nurtured and not excessive. Precisly the point: SAD is excessive sensitivity. It is a hardship; a burden; and a life-ruiner. It is not something to be nurtured.
I do agree with Cain on one point. That we need to encourage those with sensitive personalities to use their gifts.
At the same time, it is important not to trivialize the experiences of those with SAD. People with the disorder do enough of that themselves.
Further Reading
=======================
Stay up to date:
=======================
Photo Microsoft
Filed under Anxiety by on Jun 28th, 2011. 
I was speaking to someone recently who was doing some research about social anxiety disorder (SAD) and navigating About.com and my site to find information. In speaking to her, I realized that what I know like the back of my hand is not necessarily obvious to the first time reader.
To help explain how this site works and make it easier for first-time users, I thought I would do a quick run-down of the different areas of the site, what they are about, and what you can find. Here we go…
Overview
I realized talking to a newcomer that even the basic structure of the site is sometimes hard to grasp. About.com spans a huge variety of topics; each topic has it’s own section of the main site that is managed by a “Guide” – that’s me here on the SAD site. As a guide, we are responsible for managing and writing content for all aspects of our particular area.
SAD Blog
The SAD Blog is featured on the home page of the About SAD site. You can find it in the middle column of the landing page as you scroll down. I generally update the blog once a week.
SAD Articles
Articles on the site span every topic related to SAD. Articles can be found in one of three ways:
- Tabs: Using the tabs across the top of the home page. Here you will see tabs that say “Symptoms/Diagnosis”, “Treatment”, and “Coping”. Within each tab you will find links to the most important articles on the site.
- Must Reads: In the left column of the landing page you will see links to the “Must Reads”, which are key articles that every first-time visitor should read.
- Topic Pages: Below the must reads you can find the topic pages, if you want to browse by general topics.
SAD Forum
If you have never visited the SAD forum, you can get there by clicking on the link that says “Forum” underneath the guide picture (the photo of me). Here you can discuss social anxiety problems and solutions with other readers.
Reader Answers
A big part of the site are the reader answers. These are questions to which readers post their responses, such as “What is it like to live with SAD”, or “How do you handle public speaking”? You can find all of these in the “coping” tab under “Readers Respond” and “Show and Tell”.
Newsletter
If you haven’t already signed up for the SAD newsletter, you can do so by entering your email address in the top right corner of the landing page. The newsletter goes out once per week every Monday morning and contains links to new blogs and articles.
I think that is it. Perhaps not the most interesting post this week, but hopefully understanding the structure of the site and knowing what you can find will make navigation a little easier.
As always, I welcome any questions or comments.
Filed under Anxiety by on Jun 21st, 2011.
Ohm…
Meditation is a practice that dates back thousands of years and draws on Buddhist principles. During meditation you learn to focus your breathing, reduce negative thinking and live in the present. The practice of meditation has been shown to have a positive impact on many medical and mental health conditions, including social anxiety disorder (SAD).
How does meditation help? In a study at Manchester University, Chris Brown and colleagues found that people who practiced meditation had less negative reactions to pain. As part of the study, participants were administered pin pricks on their arms with a laser; brain scans showed that areas involved in anticipation were much less active in those who meditated.
Anticipatory anxiety plays a large role in SAD; worry about upcoming social or performance situations can cause significant impairment in daily functioning. If meditation helps to reduce anticipation of pain, it follows that it would also help to reduce anticipation of feared events.
Indeed, when researchers at Stanford University looked at brain scans of participants with SAD during meditation, they found changes in brain activity that suggested the potential for a reduction in social anxiety symptoms and reactions to negative self-beliefs.
Finally, meditation is believed to have some direct impact on the body’s nervous system. Breathing, heart rate, and other physiological mechanisms respond to this form of relaxation. Given the role of the fight-or-flight response in SAD, it is easy to see how meditation may also have a direct positive effect on symptoms.
What do you think? Have you practiced meditation and was it helpful for you?
Further Reading
=======================
Stay up to date:
=======================
Photo Microsoft
Filed under Anxiety by on Jun 14th, 2011.
In a post I wrote a year ago, I debated the merits of Facebook for those with social anxiety disorder (SAD). At the time I reported on an article that claimed Facebook helped kids with social anxiety, by allowing them to connect with friends, practice social skills, and build social success.
Since that time there have been a number of comments on that post from people with SAD indicating that Facebook can be a hindrance, rather than a help.
Many of the commenters had similar experiences with Facebook. Some of the things that they reported include:
- feeling like “friends” are strangers
- fearing that status updates will be judged negatively or ignored
- wasting time wording and rewording posts
- posting photos and then taking them down
- stalking people and then feeling bad about it
- feeling like everyone else is having a lot more fun
- deactivating and reactiviting accounts
- feeling afraid to send friend requests
In a nutshell, most people who commented felt as though their social lives on Facebook were an extension of their social lives outside of Facebook: filled with the same fears, anxiety, and feelings of not measuring up.
How then can Facebook be used in a positive way by those with SAD? If you suffer with feelings of social anxiety and have not received a diagnosis or professional treatment, it is likely that your anxiety will extend to Facebook. On the other hand, if you are making positive changes in your life, Facebook could be a tool to help build on successes.
What do you think? Have you found a way to make Facebook work for you?
Further Reading
=======================
Stay up to date:
=======================
Photo Microsoft
Filed under Anxiety by on Jun 6th, 2011.
Normally each week I take a standard topic about social anxiety and discuss it in a bit of detail. Not so this week. This week I am tackling a problem that keeps coming back, no matter how much I blog or write or try to help. People suffering with social anxiety are not getting help.
The typical scenario goes like this. Person A emails me saying that she thinks she might suffer with social anxiety disorder (SAD). She hasn’t told anyone and hasn’t asked for help. She needs to know what to do. My standard response is to speak with your doctor if you have not already. Failing that, I send along links to articles that may be of help.
I know that 80% of you will not do as I say. The treatment is worse than the disease. Go talk to my doctor? Tell my family? Are you crazy? Do you not understand me at all?
In trying to find answers to solve this dilemma I sometimes end up in forums.
So, I was looking around a social anxiety forum where people were discussing the best books to help with social anxiety. One person argued that reading books is not the answer; getting out around people and receiving compliments to boost self-esteem was a better course of action.
Someone else argued that being dependent on compliments puts you in the dangerous situation of also being vulnerable to criticism. Better not to care what anyone thinks. Finally, in one of the last posts, in response to the original query, someone asked “Is vodka a book?”.
It made me laugh. It also made me think.
If people are choosing vodka over self-help books, are they also choosing it over professional treatment?
I guess what I am trying to say is that we haven’t really found the answer yet. People with SAD are not asking for help, and although there are treatments available, they are not easily accessible. So if you are struggling, know that you are far from alone.
Not as positive a post as I would normally write, but it is hard to read the same thing over and over again. I will wait for someone to chime in and tell me that they have an answer. Other than vodka.
Further Reading
=======================
Stay up to date:
=======================
Photo Microsoft
Filed under Anxiety by on Jun 3rd, 2011.
Agoraphobia and social anxiety disorder (SAD) share some common symptoms but in other ways are very different. Agoraphobics fear being in places where escape would be difficult if they were to have a panic attack.
For example, an agoraphobic might fear being in an elevator or a crowd of people because if panic were to strike, there would be no way to leave.
People with SAD might also fear being in a crowd but for a different reason. They might feel like the people in the crowd are watching or judging them. They might worry that they will embarrass themselves somehow by behaving in an inappropriate way.
Most agoraphobics feel better when they are in the company of someone they know well. People with SAD may feel worse having a friend along, because that friend is just another set of eyes.
The disorders are both incapacitating but in different ways. Agoraphobics are prisoners in their own homes, while those with SAD often live in a prison of solitude.
What do you think? Do you live with agoraphobia or SAD?
Further Reading
=======================
Stay up to date:
=======================
Photo Microsoft
Filed under Anxiety by on May 27th, 2011.
Rancho Santa Fe psychologist releases new parenting book
Dr. Keith Kanner, clinical psychologist and a columnist for this newspaper, has just released a book titled “Your Family Matters” (through “Love Your Life Publishing”). Subtitled “Solutions to Common Parental Dilemmas,” the book aims to direct parents to address the most common issues with their children, from infancy through age 18.
Read more on Rancho Santa Fe Review
Filed under Anxiety by on May 19th, 2011.
If you suffer with social anxiety disorder (SAD), you probably feel inhibited in most social situations. Perhaps when you are with a “comfort person” you are able to be your true self. In general though, the world does not see the real you.
For some people, drinking alcohol becomes a way to release the inhibitions that prevent you from being relaxed in social settings. After a few drinks, you might care less what people think of you. You might be more outgoing and friendlier than you would normally be.
Why does alcohol have this effect? It is because alcohol works as a sedative on the central nervous system. Along with reduced inhibition, you might also experience impaired speech, coordination, concentration and vision.
In general, alcohol weakens your judgement. For those with SAD, whose judgement is generally on overdrive, being drunk can mean freedom from the voices inside your head that constantly tell you to stop.
The problem with using alcohol to cope, is that alcoholism is a serious problem that can develop over time. What might seem like a casual coping strategy during young adulthood can turn into a lifetime battle with alcohol. Soon you are not just drinking before parties, but before work.
The question then becomes: Is it possible for people with SAD to use alcohol responsibly? Is there a place for alcohol in the life of someone who has SAD? Is it really that bad to have a few drinks at a social gathering to relax? What do you think?
Further Reading
=======================
Stay up to date:
=======================
Photo Microsoft
Filed under Anxiety by on May 16th, 2011.