Introversion Is Not Social Anxiety Disorder

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.

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