Laura C . Bruce et al did a telephone survey of 806 residents of New York State. They gave people a brief description of someone who's uncomfortable in social situations and often avoids them. The question was: should they seek mental health treatment for this problem?
When the symptoms were labelled as "social anxiety disorder", 83% of people recommended treatment. But when the same description was deemed "social phobia", it dropped to 75%, a statistically significant difference.
OK, that's only an 8% gap. It's a small effect, but then the terminological difference was a small one. "Anxiety disorder" vs "Phobia" is about a subtle a distinction as I can think of actually. Imagine if one of the options had been a label that didn't imply anything pathological - "social anxiety" or "shyness". That would probably have had a much bigger impact.
This matters, especially in regards to current debates over the upcoming DSM-5 psychiatric diagnostic manual. Lots of terminological changes are planned. This study is a reminder that even small changes in wording can have an impact on how people think about mental illness. Last week I covered another recent piece of research showing that beliefs about other people's emotions affect how people rate their own mental health.
My point is: DSM-5 will not merely change how professionals talk about the mind. It will change how everyone thinks and behaves.
Bruce, L. (2012). Social Phobia and Social Anxiety Disorder: Effect of Disorder Name on Recommendation for Treatment American Journal of Psychiatry, 169 (5) DOI: 10.1176/appi.ajp.2012.11121808
26 comments:
'Disorder' and 'phobia' both come loaded with tons of cultural history. Disorders are what damaged people have, which is why autistics don't like the word, phobias are what your sister has about spiders or clowns. What people call reality is a nothing more than a narrative allowing apes to function in a post-ape society.
I’m very glad you wrote about this, as it’s relevant to current debates in my own field, where many people are concerned about how names affect how something is perceived. I don’t have hard data, but my guess is that “dyslexia” is seen as more serious than “specific reading disability”, though they refer to the same thing. I work on “specific language impairment”, which is a much less successful meme, so nobody has ever heard of it. There’s a real tension in the field between those who want labels that will make people sit up and take notice, and those who are concerned that we may be pathologising normal range behaviours with medical-sounding labels and talk of “disability” or “disorder”. There has been a shift from talking about “impairment” to “difficulties” or, more recently, “needs”, but the upshot is that it is likely to make it harder for children to get help. See http://deevybee.blogspot.co.uk/2010/12/whats-in-name.html
This reminds me of a two-year program development process for a large employer, when at the last meeting, someone got up and said, "Well, Disability is a *bad word*, and Management is a *bad word*, and that's why this program will never fly." He was wrong, in that it did fly, but he had the marketing idea down.
Cox et al (2004) reported that 26% of females and 19% of males self described themselves as being 'very shy' in childhhood.
Personality features in what has been described as ASC (autism spectrum conditions) is associated with social anxiety and social phobia. Why then do so many scatch their heads over the so-called autism epidemic?
http://www.sciencedirect.com/science/article/pii/S0005796704001792
Not that my vote counts to the makers of the DSM, but if they are choosing between these two terms to describe chronic social anxiety, I prefer "phobia" instead of "disorder". Disorder implies that the fundamental way a person perceives the world is in itself the culprit. It's harder to imagine will power as a factor in overcoming a disorder because their personhood itself is defective. Phobias have less of a stigma, they help describe someones personality rather than define them.
deevybee 12 May 2012 11:28
///my guess is that “dyslexia” is seen as more serious than “specific reading disability”, though they refer to the same thing.///
And guess why some people with high functionning autism want to remain "aspies" when the DSM 5 proposals want to suppress Asperger syndrome?
Plus, in France aspies I know who are in need of being helped on the work front in order to be able to find and keep a job in accordance to their diplomas and professionnal qualification will remain labeled by psychiatrists and French society as antisocial personality disorder persons or schizophrenia sufferers.
(without neglecting the research mess this suppression would cause-see the Yale professor Fred Volkmar educated and published take on that).
The many moral and academic failures of the APA masters of the DSMs should make one hopeful that researchers and indeed any other group will use the ICDs and forget about the DSMs.
http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems
I cite wikipedia :
///The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC).[1]
The ICD is revised periodically and is currently in its tenth edition. The ICD-10, as it is therefore known, was developed in 1992 to track mortality statistics. ICD-11[2] is planned for 2015[3] and will be revised using Web 2.0 principles.[4] Annual minor updates and triennial major updates are published by the WHO.[5] The ICD is part of a "family" of guides that can be used to complement each other, including also the International Classification of Functioning, Disability and Health which focuses on the domains of functioning (disability) associated with health conditions, from both medical and social perspectives.(...)
In 1893, a French physician, Jacques Bertillon, introduced the Bertillon Classification of Causes of Death at a congress of the International Statistical Institute in Chicago.[6] Subsequent revisions represented a synthesis of English, German and Swiss classifications, expanding from the original 44 titles to 161 titles.
The ICD is currently the most widely used statistical classification system for diseases in the world. International health statistics using this system are available at the Global Health Observatory (GHO) ([7])
In addition, some countries—including Australia, Canada and the United States—have developed their own adaptations of ICD, with more procedure codes for classification of operative or diagnostic procedures.///
A rose will still be a rose by any other name but the bard wrote about a material vegetal living thing.
Here we stand and should protest about inventing a psychiatric illness by giving it a name when at the same time providing a very quick and easy way to diagnosed it using the DSM-5 proposals.
I cite "The Telegraph" on the topic Neuroskeptic post "Shyness By Any Other Name"
///Peter Kinderman, head of the Institute of Psychology at the University of Liverpool, said it was not "humane" to describe shy or bereaved people as "mentally ill".
The British Psychological Society has opposed the changes to the DSM while psychiatrists in the US have also spoken out against them.
A petition launched to try to stop the publication of the new edition was backed by 11,000 signatures from psychologists.
There are fears the new classifications are being driven by drug companies seeking to profit from a greater number of illnesses while the private health care system in the States requires a diagnosis recognised by the manual for a patient to be treated as ill.
"DSM5 will radically and recklessly expand the boundaries of psychiatry. Many millions will receive inaccurate diagnosis and inappropriate treatment.," said Allen Frances of Duke University, North Carolina.
http://www.telegraph.co.uk/health/healthnews/9073596/Shyness-could-be-defined-as-a-mental-illness.html///
nerkul: Yeah, I think that's it exactly. Phobias are nice and everyday. Maybe even desirable, it's 'weird' if you don't have a bit of a 'phobia' for spiders...
deevybee: Right. The tension between the "don't stigmatize" and "don't minimize" camps goes well beyond dyslexia, in one form or another you see that debate going on for every diagnosis...
Neuroskeptic 13 May 2012 08:40
You wrote:
///nerkul: Yeah, I think that's it exactly. Phobias are nice and everyday. Maybe even desirable, it's 'weird' if you don't have a bit of a 'phobia' for spiders...///
The DSMs maker have enough fault without being made into demons - dramatization it is called in cognitive therapy...
You just forget that to get a psychiatric diagnostic of phobia you need to have a significant suffering and incapacitation from a given aversive feeling-even using the DSMs!
You might be suffering of phobia if for example you can't travel by plane without getting drunk or heavily medicated (or both)in order to escape some of the incredible mental suffering with physical signs (intense perspiration, increase in cardiac pulse rate etc...) or if you have lost a good job you enjoyed in many ways because of your refusal to travel by plane
-idem if you refuse to attend your best friend American wedding because it will be an open air ceremony and you are so certain that you will get Lyme disease from the grass that you are sure to get a panic attack and make a fool of yourself and anyway you haven't been able to walk on grass without high rubber boots-an improper outfit for a September wedding in cape Cod (MA)- since you were raped on a grass lawn ten years ago.
I think you can argue that the term "social anxiety disorder" commands more authority than "social phobia" since it sounds like more of a technical term that would be spoken by an expert in the medical field. And authority alone can influece human behavior greatly (see the excellent "Influence: Science and Practice," Robert Cialdini). But it's a question of what the specific words are culturally linked to as well (the basic tenet of neuro-linguistic programming).
One wonders how the cultural context, down to the different language in other countries, can affect the perception of the severity of any illness relative to English-speaking countries.
Neuroskeptic ,
And be careful before you call somebody weird for not suffering spider phobia:
Here you can see a photograph of Field medal laureateCedric Villani proudly wearing a spider jewel as usual:
http://madame.lefigaro.fr/societe/avoir-recu-medaille-fields-confere-responsabilite-150412-228468
Cedric Villani who was Born French with Italian family origins is a remarquable public person known for arboring a spider on his dress as a habit. He is a very articulate kind and modest public speaker, a great European and pro-maths activist.
PS: I am not trolling although I have no hope that you would take my remarks into account- just procrastinating on a writing task of more difficulty...
Ivana.. lol.
You know what they should do ? Ship them all to Congo, shrinks, mentals, DSMIV manuals, make the whole sector live in abject poverty for a couple months. That could totally do wonders. Hunger Game mental camps without the real killing.
Speaking of Hunger Games they need to do something about Hollywood's mental health. Like broadcasting smoking to tubby pervs instead of James Dean. Even with Hunger Games the city fashion seemed a bit schizoid for my liking.
"nerkul: Yeah, I think that's it exactly. Phobias are nice and everyday. Maybe even desirable, it's 'weird' if you don't have a bit of a 'phobia' for spiders... "
I think you are confusing Phobias with common fear, I have a real phobia of insects and it's very different from people's fear of insects, I have panic attacks, I cry in fear, I avoid places where insects can appear, it's not what people do, someone with fear can scream, ask someone to kill it and move on with life, I don't scream, dissociate and walk away, have panic attacks and cry in despair most times, that is a real phobia. I'm actually a little offended by that comment, it's not nice and everyday, not at all, fear of insects and spiders is very different from phobia.
About the post, I am the opposite, I have this image as social phobia as more strong than social anxiety disorder. I am actually diagnosed with those and the terms are always changed and used combined, AvPD is used too.
What exactly is the difference between Social Phobia, Social Anxiety Disorder and Avoidant Personality Disorder?
"What exactly is the difference between Social Phobia, Social Anxiety Disorder and Avoidant Personality Disorder?"
Simple, a definition in a book. For the rest they are the same. Different aspects of the same thing.
I wonder if the coining of new DSM diagnoses can be linked to the development of pharmaceuticals that are then marketed as treatment for those diagnoses? Who would possibly fund such a study? The Bite the Hand that Feeds Me Foundation?
Shrinks come up with stuff anyway irrespective of being funded. It's like peeing in public in different directions but it's still considered inappropriate. I noticed shrinks spend their life writing about directions, dissecting every possible avenue to pee and reach the limits in their ability to help because the profession thickens the pee to see better.. makes more room for directional analysis.
P. "I'm actually a little offended by that comment, it's not nice and everyday, not at all, fear of insects and spiders is very different from phobia."
I didn't mean to offend. When I said "phobias are nice and everyday" what I meant was (in the context - but maybe it was unclear) that many people think they are.
i.e. many people will say they have a "phobia" about something, when actually they are just scared of it.
I wasn't saying I agree with that usage.
Neuroskeptic 14 May 2012 16:52,
/// i.e. many people will say they have a "phobia" about something, when actually they are just scared of it.
I wasn't saying I agree with that usage.///
Neuroskeptic 13 May 2012 08:40:
///nerkul: Yeah, I think that's it exactly. Phobias are nice and everyday. Maybe even desirable, it's 'weird' if you don't have a bit of a 'phobia' for spiders...///
Neuroskeptic,
I suspect that you must be a man to be able of such a bad faith!
Much will be forgiven though since you run such an interesting blog-with dedication to the world enlightment and a gift with words and in your choice of illustration.
No need to write:
"Ivana, Right" or "Ivana, Yeah, I think that's it exactly."
You were explicit enough in your "layman" feeling in the sanity of your own feelings abainst spiders or whatever.
It displeased me greatly because you accused of being weird Cedric Villani :
///it's 'weird' if you don't have a bit of a 'phobia' for spiders...///
And cedric Villani is a public man I greatly admire and respect who always wear a spider on his dress
-for reasons he does not offer to the public no matter how nicely he answered the journalists as usual-
You might be the greatest of the living neuroscientists and you are obviously very talented but you could take a lesson in modesty from Cedric Villani: in that link you can listyen to him telling a comedian -who had just complained that he was hopeless at math a school no matter how hard he tried- that not everybody has a sense of humor!
http://www.youtube.com/watch?v=5fdrDZmlpAM
I insist I am not trolling and you should be careful-because many people read and admire you for your blog - not to make blanta tpublicity for taking two antidepressant "for life" and careful not to insult people lightly: many people like insects and some keep at home a living specimen in a glass bowl like a fishtank. They do not desserved to be called weird by the authority of a British neuroscientist who probably do not like spiders.
Secondly:
You were yourself quite sensitive in a previous post about people who could minimize your suffering of a real illness and not being lazy or whatever when you are suffering depression:
///Saturday, 5 May 2012
More Depressed Than Average?///
When it is about depression Neuroskeptic wants to be known that he is a sufferer and not a weak or lazy person or whatever.
NB: Of course I do not know you -and I will never discuss a client of mine giving his name or element to make him/her recognizable- in your blog or anywhere else.
I would advice you to consider cognitive therapy while tapering slowly your two antodepressants.
Ivana Fulli MD 15 May 2012 08:47
Reading what I just wrote I feel I should be more precise with my
"Secondly" and state that it is not fair for the 'real phobias" sufferers -in the psychiatrists and psychologists definition of the phobia complain- to make it a spectrum including fear or aversion for spider to reamain with your chosen example.
(Obviously some people like your good friend Dr Bishop did not realize-she on her blog used the DSMproposals on the autisms as an argument of authority against a feloww academic- that the spectrum of the DSM proposals are just that:
a dangerous way of making being human a mental illness insted of trying to reach a consensus on some metal illnesses
It is why I reminded you that:
You were yourself quite sensitive in a previous post about people who could minimize your suffering of a real illness and not being lazy or whatever when you are suffering depression:
///Saturday, 5 May 2012
More Depressed Than Average?///
When it is about depression Neuroskeptic wants to be known that he is a sufferer and not a weak or lazy person or whatever.
When it is about depression Neurosketoc want it ton be accepted as a mental suffering having nothing to do with the common sadness or whatever.
With phobias I want the same for my clients and so P. wants for himself or his "constituency".
PS: If you want me to stop commenting your post just write so.
Neuroskeptic,
I did some homework in order to convince you that I am not making up that insects or spiders might be respectful interests of some people who should not be called weird easily that :ty and cure you from assuming that///it's 'weird' if you don't have a bit of a 'phobia' for spiders...///
Many aspies see the natural world more vividly than neurotipicals and are enjoying the beauty of insects and of spiders 's way of life.
I cite "Life Behind Glass" from a very gifted person : Dr Wendy Lawson -a person with autism diagnosed at 42 who had been considered intellectually disabled in yer young and now is having a career in autism -Michelle Dawson like, if you wish, except Wendy went to university-
She wrotein chapter 15 :///(...) I noticed some movement at my feet and saw the last exist moment of a cicada crawling out of a hole in the ground.I watched the creature transform before my eyes(...) The process took only one and half hours.(...)
I have since heard that people thought my standing in the heat for one and half hours to watch an insect was a crazy thing to do.
I think it is them who are crazy.
By choosing not to stand and watch , they missed out of sharing an experience that was so beautiful and exhilarating.(...)///
From the blog post: "They gave people a brief description of someone who's uncomfortable in social situations and often avoids them."
This is a description of an introvert. Introverted traits are not very highly thought of in modern society, although they are perfectly normal.
The proportion of introverts is thought to be about 25% of the general population.
The other 75% (extroverts) matches pretty closely the proportion of people who would have the introverts seek psychiatric treatment.
The term "social anxiety disorder" was originally invented by Glaxo Smith Kline to sell Paxil. GSK had contracted for studies to show Paxil was specifically effective for SAD. It then blanketed TV with advertising for Paxil and "social anxiety disorder."
Now "social anxiety disorder" is about to be enshrined in the DSM-5, perhaps under a euphemism.
This is another example of how psychiatry, in partnership with pharma, is medicalizing normality, and how far this terrible misconception has penetrated into popular culture.
@iatrogenia: Introversion is normal, social anxiety is not, I am a introvert, I like being one and it doesn't harm me, I have social phobia, is terrible and I hate it, it's fear and terrible anxiety and forced isolation from the people I want to interact with. One thing is not the other, please don't say false information.
I hate what psychiatry does most times and hate the way money and pharma harms people like me but it doesn't mean that all is false.
Let's avoid being too radical.
P -- The study found 75%-83% willing to give a serious psychiatric diagnosis on the basis of vague symptoms:
"someone who's uncomfortable in social situations and often avoids them."
What's radical is the interpretation of this as a psychiatric disorder.
I did not say your own psychiatric disorder does not exist.
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