Why Social Anxiety Disorder Is a "Real" Disorder

Cartoon of woman with list.
Be careful what you say to someone with social anxiety. Getty / Kristen Ulve

I am right in the middle of reading "Quiet" by Susan Cain. It's a very thought-provoking, insightful, and eye-opening book in many ways. On the other hand, from what I've read so far, it does a bit of a disservice to those legitimately suffering with an anxiety disorder related to social situations.

Cain talks about the "promotion" of drugs to treat social anxiety disorder—not saying it directly but hinting at the idea that this disorder is a fabrication (at worst) of the drug manufacturers or an exaggeration (at best) by those who claim to be afflicted with it.

While I am all for having an open mind about the benefits of introversion, and seeing how society has created an environment that makes it hard for introverts to thrive, that is a very different matter from what is happening for those with social anxiety disorder (SAD).

In fact, a person can be very much extroverted and at the same time suffering from social anxiety. One needn't think too hard to come up with examples (such as Jamie Blyth).

While I feel a little silly "defending" a disorder, I feel bad for those who genuinely suffer—and they face the double assault that perhaps what they are feeling is just the need for some quiet time alone and that if they could just have that, everything would be A-ok. 

I think of the book "Daffodil Dancing" by Jean Jardine Miller and how hard she tried to save her daughter from her anxiety.

I think of the Andrew Kukes Foundation and all they are doing in the name of someone who also could not fight his way out of the shadow social anxiety had cast on his life.

When I think of young people like these, I think of the need for more help, not less. The need for more understanding, not more casting of doubt.

As much as groupthink, brainstorming, open office plans, class participation, and the "extrovert ideal" may be the cause of much pain experienced by introverts, I just don't believe it is the same pain that is felt by those with SAD.

It's not so much a feeling of not measuring up to the extrovert ideal. It's panic, pure and simple. It's a fight-or-flight response so completely out of control that it can only be described as a "disorder." For those with generalized SAD, this may mean panic over the simplest social interactions.

So why is social anxiety a "real" disorder?

I guess we need to ask what a "real" disorder is. Something that interferes with your ability to function? A recognized set of symptoms that cluster together in predictable ways?

1. People are not clamoring to get on the phone and ask their doctor to diagnose them with social anxiety disorder. Most take a long time to get a diagnosis and some never do. Many people may suffer with this cluster of symptoms and not know what to call it or what is wrong with them. But they are in pain and do know that something is wrong.

2. You can't coddle yourself out of feeling this way. Holing up in an office isn't likely to reduce the panic you feel when you face strangers. It's not the same as introversion.

3. We have found ways to fix it. Yes medication is one way, but there is also CBT, and wonderful things being done with mindfulness therapy. It's all about working on the anxiety response that for some reason is so out-of-whack in certain people.

4. There is some heritability to SAD. Are blue eyes real? SAD reflects behavior, but its roots may be just as concrete as what determines your physical characteristics.

5. There is value in defining it. Just like there is value in defining depression as something other than "just the blues" there is value in defining social anxiety as something more than just "shyness." Hopefully someday the acceptance will be there like it has gradually come for other mental health issues.

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