Did You Know?

Factoids about Shyness

  • There’s almost a 50% chance a person will think of him- or herself as shy. That percentage holds across a large number of countries and cultures.
  • Many psychiatrists recognize that shyness overlaps with what they call Social Anxiety Disorder. They believe doctors can distinguish between the two. The DSM, in its fourth edition, cautions against their confusion; but many psychiatrists lack the ability to distinguish social anxiety disorder from ordinary shyness, because the two share so many traits.
  • Consider the following admission: “Interestingly, the central elements of social phobia, that is discomfort and anxiety in social situations and the associated behavioral responses … are also present in persons who are shy” (Samuel Turner with colleagues in Behaviour Research and Therapy, 1990).

Factoids about DSM-III

  • The third edition of the Diagnostic and Statistical Manual of Mental Disorders (1980, revised 1987) added 112 new disorders to the roster, almost doubling overnight the number of mental disorders on the books.
  • DSM-IV (1994) added 58 more. Were they all necessary? Were they also carefully and scientifically defined?
  • “The consensus was arranged by leaving out the dissenters” (Isaac Marks, University of London, 2005).
  • The chair of the task force (Robert Spitzer at Columbia) overseeing the creation of the new disorders accepted only “kindred spirits” as participants.
  • The task force met for 4 years before it occurred to them to include other voices and perspectives.
  • The person (John Frosch) added to the task force to correct this imbalance later resigned, complaining of an “Alice in Wonderland feeling.”
  • “There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, ambiguous” (Ted Millon, a consultant to DSM-III, quoted in the New Yorker, 2005).
  • Some of the patient sample sizes were extremely low, sometimes involving just one patient treated by the sponsor of the proposal.
  • The DSM includes “humorless or dull” as descriptors for Schizoid Personality Disorder.
  • The official symptoms of Passive-Aggressive Personality Disorder include “dawdling” and “procrastination” over things like shopping and doing the laundry.
  • Oppositional disorder was created for those who seem “negativistic, disobedient, and ineffective.”
  • One psychiatrist’s definition of “masochism”: “Oh, you know what I mean, a whiny individual . . . the Jewish-mother type.”
  • Social Phobia was included in 1980 largely on the basis of one article appearing two decades earlier, which had described roughly a dozen people experiencing social embarrassment. The authors of the article said that on no count should this be considered a separate disease. They were ignored.
  • In 1980, the “impairing” criteria for social phobia included
    • fear of eating alone in restaurants;
    • concern about hand-trembling while writing checks;
    • avoidance of public restrooms.
  • By 1987 (in DSM-III Revised), the stipulation about a “compelling desire to avoid” anxiety-inducing situations was deleted and replaced by “marked concern.” In addition, the anxiety no longer needed to be actual; anticipating it was enough.

Drug Treatments for Social Anxiety

  • In the 1970s, when it first developed Paxil as an antidepressant, GlaxoSmithKline (then SmithKline Beecham) was so unimpressed by the results it considered shelving the drug.
  • In 2000, the year after Paxil received FDA approval to treat social anxiety disorder, GSK spent $92 million pushing Paxil as the remedy—almost $3 million more on advertising than Pfizer spent that year on Viagra.
  • Paid consultants (some receiving fees from up to 17 different drug companies) were prepared to say that almost one American in five experiences social anxiety disorder in particular, and nearly one-third of the country suffers from some form of anxiety disorder.
  • The first figure was based on a study involving randomized telephone calls to 526 urban Canadians. Their self-reported levels of social anxiety resulted in percentages ranging from 1.9% to 18.7%. The higher figure was widely reported in subsequent literature, as a claim about the likely social anxiety prevalence rates in the U.S overall.
  • GSK has spent over $165 million in class action lawsuits since Paxil received FDA approval in March 1999 (Business News, March 28, 2006; Washington Drug Letter, April 3, 2006).
  • GSK continues to call the drug “safe and well-tolerated,” even after acknowledging, in a confidential memo quoted in Shyness and available on this website, that one-in-five patients suffers mild-to-serious side effects from Paxil.
  • Information about some of those side effects was withheld from the public.

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