Social phobia: Etiology, neurobiology, and treatment

Social phobia is a common and often disabling condition, with an etiology t hat is not established. There is evidence at several levels for an interpla y of biological and psychological processes in social phobia. Genetic studi es show that both genetic and environmental factors are important, with evi dence pointing to associations with 2 genetic conditions, autism and fragil e X syndrome. Behavioral inhibition has emerged as an important precursor t o social phobia and possibly to other anxiety disorders. Epidemiologic and clinical studies have suggested that factors within the family environment, such as overprotection, overcontrol, modeling of anxiety, criticism, and i n some cases abuse, can play a role in the development of social phobia. Du ring childhood, complex interactions between brain system disturbances that mediate responses to negative social cues and factors in the social settin g may lead to the development of a distorted set of internal "blueprints" f or social behavior. The impact of severe social anxiety on brain systems th at mediate behavioral change may prevent patients from learning better "blu eprints." These can be taught through cognitive-behavioral therapies. The e ffective control of social anxiety with medications enables patients to rec over; whether recovery can last after discontinuation of medications may de pend on whether a new "blueprint" has been developed and whether stable cha nges in affected brain systems have occurred. Neuroimaging techniques are a t early stage of identifying abnormalities at the neurotransmitter and syst ems levels.