Social anxiety disorder/social phobia: Epidemiology, diagnosis, neurobiology, and treatment

Some anticipatory anxiety is expected on specific occasions such as giving a speech. However, some individuals have an excessive fear of such situatio ns when they are under scrutiny, believing that their performance will caus e them embarrassment or humiliation, frequently leading to deliberate avoid ance of these situations. This disabling condition has been termed social a nxiety disorder. Social anxiety disorder is common, with a lifetime prevale nce of 2% to 5%, but is probably underreported. The sufferer often avoids s eeking assistance, leading to comorbid mental disorders, greater disability , and an increased risk of suicide. Consequently, a high burden is placed o n the patient's caregivers and on society. The diagnosis of social anxiety disorder is aided by the patient's history together with DSM-IV criteria. R esearch into the neurobiology of social anxiety disorder suggests a dysfunc tion of postsynaptic serotonin receptors and a hypersensitivity to challeng e with caffeine, CO2, and pentagastrin. Neuroimaging studies suggest a dysf unction of the striatal presynaptic dopamine transporter in social anxiety disorder. Clear guidelines for the management of social anxiety disorder, i ncluding both pharmacotherapy and psychotherapy, are yet to be established. Selective serotonin reuptake inhibitors (SSRls) show the most promise for the future, while cognitive-behavioral therapy may also be helpful. In the meantime, physicians should treat social anxiety disorder promptly and aggr essively. Copyright (C) 2000 by W.B. Saunders Company.