Epidemiology of social phobia: a clinical approach

The recent epidemiologic studies report extremely varied rates for social p hobia (SP). One of the reasons for this may be the difficulty in diagnosing SP, the boundaries of which are uncertain. A community survey was carried out using doctors with experience in clinical psychiatry as interviewers, a nd a clinical diagnostic instrument. Two thousand three hundred and fifty-f ive people (out of the 2,500 randomly selected from the population) living in Sesto Fiorentino, a suburb of Florence, Italy, were interviewed by their own general practitioner, using the MINI plus six additional questions. Si x hundred and ten of the 623 subjects that were found positive for any form of psychopathology at the screening interview, and 57 negative subjects, w ere re-interviewed by residents in psychiatry using the Florence Psychiatri c Interview (FPI). The FPI is a validated composite instrument that has the format of a structured clinical research record. It was found that 6.58% o f subjects showed social anxiety not attributable to other psychiatric or m edical conditions during their life. Social or occupational impairments mee ting DSM-IV diagnostic requirements for SP was detected in 76 subjects (lif etime prevalence = 3.27%). Correction for age raises the lifetime expected prevalence to 4%. Sex ratio was approximately (F:M) 2:1. The most common fe ar was speaking in public (89.4%), followed by entering a room occupied by others (63.1%) and meeting with strangers (47.3%). Eighty-six point nine pe rcent of subjects with SP complained of more than one fear. The mean age of onset (when the subjects first fully met DSM-IV criteria for SP) was 28.8 years, but the first symptoms of SP usually occurred much earlier, with a m ean age of onset at 15.5 years. Ninety-two percent of cases with SP also sh owed at least one other co-morbid psychiatric disorder during their life. L ifetime prevalence of avoidant personality disorder (APD) was 3.6%. Forty-t wo point nine percent of cases with SP also had APD, whereas 37.9% of cases with APD developed SP. (C) 2000 Editions scientifiques et medicales Elsevi er SAS.