Description Of The Disorder

Social anxiety disorder, also referred to as social phobia (Liebowitz et al., 2000), has as its essential feature an extreme fear of appearing anxious or doing or saying something embarrassing in social or performance situations, accompanied by a fear of negative evaluation by others (American Psychiatric Association, 1994). For a diagnosis to be made in adults, the individual must recognize that the fear is excessive. Frequently feared situations include public speaking, going to parties, meeting strangers and talking to people in authority (Holt et al., 1992). The individual becomes anxious in anticipation of feared situations and often avoids them, leading to significant distress and interference in the person's life. When the person's anxiety is experienced in most social situations, he or she is further described as having the generalized subtype of social anxiety disorder. The majority of persons presenting for treatment for social anxiety disorder are of the generalized subtype.

Findings from the National Comorbidity Survey rank social anxiety disorder as the third most prevalent psychiatric disorder in the general population of the United States, with a lifetime prevalence rate of 13.3 % and a 1-year prevalence of 7.9 % (Kessler et al., 1994), and the prevalence of social anxiety disorder appears to be increasing (Heimberg et al., 2000). More recent analyses suggest that the lifetime prevalence rate of clinically significant social anxiety disorder is closer to 4 % (Narrow et al., 2002), a figure that is still substantial. This disorder is typically reported to begin in adolescence, with the mean onset age ranging from 13 to 20 years (Hazen & Stein, 1995). However, many patients report lifelong difficulties with social anxiety, and the distribution of age of onset of social anxiety disorder may actually be bimodal (Juster, Brown & Heimberg, 1996). While social anxiety disorder has been found to occur approximately 1.4 times more frequently in women than in men in epidemiological studies (Magee et al., 1996), a slight preponderance of males is typically reported in treatment settings (Chapman, Mannuzza & Fyer, 1995; Stein, 1997). This discrepancy perhaps reflects cultural intolerance of socially anxious

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men, who experience greater interference in negotiating social situations in which they are expected to be outgoing and assertive (Weinstock, 1999).

Social anxiety disorder can be extremely debilitating. The majority of socially anxious individuals presenting for treatment report numerous problems of social adjustment, including impairment in school, work, family and romantic relationships and friendships (Bruch, Fallon & Heimberg, 2003; Schneier et al., 1994). Persons with social anxiety disorder tend to be less educated, less likely to be married and of lower socioeconomic status compared to those without social anxiety (Katzelnick et al., 2001; Magee et al., 1996; Schneier et al., 1992). Social anxiety frequently co-occurs with other psychiatric conditions (such as the affective disorders), most often with an earlier age of onset than the comorbid disorder (Magee et al., 1996; Schneier et al., 1992; Wittchen & Fehm, 2003). Individuals with social anxiety disorder are also more likely than persons without the disorder to abuse alcohol in efforts to reduce their discomfort (Amies, Gelder & Shaw, 1983; Kushner, Sher & Beitman, 1990; Wittchen & Fehm, 2003). The generalized form of social anxiety is highly familial (Stein et al., 1998), associated with greater comorbidity (Mannuzza et al., 1995), and generally has a more chronic and disabling course than other forms of the disorder (Chartier, Hazen & Stein, 1998; Reich et al., 1994). Despite its prevalence and associated impairment, many persons suffering from social anxiety disorder do not recognize that they have a condition for which effective treatments are available, with only 5.4 % seeking care from a mental health practitioner during their lifetime (Davidson etal., 1993; Schneier etal., 1992). In one study, one of the most frequently cited barriers to treatment for individuals with social anxiety was a fear of what others might think or say (Olfson et al., 2000).

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