Social Phobia: Are doctors too eager to drug us?

This week I ventured out into the blogosphere to see what other brain-related news people are talking about. Several blogs lead me to this op-ed in Friday’s New York Times on how psychiatrists are increasingly diagnosing social anxiety disorder in children, and consequently, prescribing anti-depressant medication as treatment. As the author points out, this is problematic because many anti-depressants have been linked to suicidal thoughts in children as well as other side effects. He then calls on psychiatrists to make the distinction between “social anxiety disorder” and “shyness” more clear cut in the upcoming edition of the Diagnostic and Statistical Manual (DSM V), which lists the standards by which mental disorders are diagnosed. I first saw this article linked to in a post titled “Shyness: Pathological or Normal Experience” in a blog authored by an anonymous academic in clinical psychology. Next, I looked at the post “Shy of a Phobia” by Jacob Sullum in Reason Magazine’s blog, Hit & Run. This blog is a little bit different in that it does not focus exclusively on neuroscience or psychology as it is part of a political magazine, but I thought Sullum’s comments on the Times piece were original and insightful.

Comment on “Shyness: Pathological or Normal Experience”

I would first like to say that I enjoyed your link to and commentary on Christopher Lane’s piece in the Times. I agree with your assertion that too many people are being diagnosed with social phobia if your figure of 13% is correct. In my opinion, a clinically significant psychiatric condition should, by definition, be something that occurs in a very small percentage of the population. Otherwise every single unfavorable aspect of human nature may one day be labeled as a disorder worthy of “treatment.” However, I partially disagree with your blaming the majority of the over diagnosis problem on drug companies. Also significant, in my view, is the fact that too many patients (and parents of patients) want something tangible to come of every doctor’s visit. The fact that these people are consulting with psychiatrists in the first place suggests that they are proactively looking for something to “cure” them. I imagine many would not be satisfied if their psychiatrist simply said there was nothing wrong with them. For many people, leaving the office with a diagnosis and a prescription makes the visit seem worthwhile. The same phenomenon can be seen in the over prescribing of antibiotics for viral illnesses that doctors know antibiotics won’t cure. Unfortunately, the side effects of psychoactive drugs are much more serious than those of common antibiotics.

Comment on “Shy of a Phobia”

I would first like to say that your take on Lane’s piece is original and insightful. It is true that in the case of psychological illnesses, there are no objective physical tests that can determine if a person has illness X or not. However, I do not think this fact excludes the DSM from being an invaluable resource for both patients and doctors. The truth is, right now the DSM is the closest thing mental health professionals have to x-rays and blood tests. Although I do think psychiatrists should have the freedom to prescribe drugs as they see fit, the DSM can help in determining if drugs are the best course of action, especially since so many psychoactive drugs have potentially harmful side effects that patients may not be aware of. The DSM has come a long way from it’s beginnings in Freudian theory of questionable scientific validity, and it would be of great value to everyone if it were to continue to be refined to reflect the growing scientific knowledge of mental illness and the brain. Maybe someday in the future a quick brain scan will tell doctors all they need to know about what mental illness a patient has, but until then the DSM is all we have.

Food Additives: Are they causing hyperactivity in children?

A recent study suggests there may be a link between common food additives and hyperactive behavior in children. The idea that food additives cause hyperactivity is not new. Dr. Ben F. Feingold first introduced a diet free of food additives as a cure for attention-deficit/hyperactivity disorder (ADHD) in the 1970s. However his method never gained widespread support in the medical community and was heavily criticized by food companies involved in making or distributing food additives. The new research, financed by Britain’s Food Standards Agency and published in The Lancet, is the first double-blind placebo-controlled study of the effect of food additives on behavior.

The three-week study of over 300 children involved two different age groups: 3-year olds and 8 and 9-year olds. Each child spent one week drinking one of three fruit drinks: one containing the amount of additives found in a typical British child’s diet, another without any additives, and the last containing a lower concentration of additives than the first. All three drinks were designed to taste the same. Researchers, ignorant of which children had received which drink, then observed the behavior of the children, paying close attention to the children’s’ attention spans, fidgetiness, restlessness, hyperactivity and other behaviors associated with ADHD. The study found that children were significantly more likely to display these ADHD-like behaviors when drinking the drinks with higher levels of additives. The effect was more pronounced in the 3-year olds than the 8 and 9-year olds. In addition, there were strong individual differences between the children, meaning some did not respond at all to the additives and others responded strongly.

One limitation of the study is that the additive-containing drinks contained a variety of different additives, making it impossible to determine specifically what compound is linked to the behavioral changes. The additive-containing drinks contained a variety of artificial food colorings as well as the compound pictured on the left, sodium benzoate, a common preservative. Sodium benzoate, however, is not only found artificially in foods as a preservative. It is also found naturally in cranberries and prunes.


One obvious question the results of the study bring up is whether these kinds of food additives are causing the high number of ADHD diagnoses in the United States. No other country diagnoses the disorder in children at anywhere near the rate that we do. In addition, the United States consumes 90% of the world’s methylphenidate, a common drug used to treat ADHD, also known by the brand name Ritalin. Some psychologists have questioned whether or not the high rate of diagnoses in the United States has more to do with cultural pressure on children to perform well in school rather than a real mental disorder. The results of the food-additive study, however, suggest that there may be other non-cultural reasons for the high rates of ADHD seen in the United States. Perhaps American children consume more food additives than children in other countries. Given the sheer number of colored and processed foods seen on a regular trip to an American grocery store, this is not hard to imagine. It would be interesting to see a study on the rate of food additive consumption compared to ADHD diagnosis across different countries.

Although it is easy and interesting to speculate on whether additives cause hyperactivity and ADHD in children, it is too early to jump to these kinds of conclusions. As mentioned earlier, there was a high degree of individual difference between children in the study with some children being much more sensitive to the presence of additives than others. It may be the case that the more sensitive children are already more hyperactive or predisposed to ADHD-like symptoms and the additives just exacerbate the problem rather than additives causing ADHD to appear in children who otherwise would be completely normal.

Some scientists in the United Kingdom are already calling for the government to take a more active role in regulating food additives. Although I think the results of this most recent study do call for individuals to be more careful about what foods they and their children consume, at this point I do not think there is enough evidence for governments to make any kind of strict regulations concerning additives. The fact that the study only focused on children leaves open the possibility that additives may not affect adults at all, especially since the younger children were more affected than the older ones. In addition, the high individual differences in sensitivity to the additives calls into question the wisdom of the government regulating foods that may be perfectly harmless even for some children. At this point, I think the only role the government should play is to make sure all additives are listed in food ingredients so that consumers can make informed choices and to fund more research on the subject.