Bipolar II and unipolar comorbidity in 153 outpatients with social phobia

Previous studies on social phobia (SP) have focused largely on comorbidity between SP and major depression. Less attention has been devoted to the com orbidity between SP and bipolar disorder. In this retrospective study, we i nvestigated family history, lifetime comorbidity, and demographic and clini cal characteristics among 153 outpatients who met DSM-III-R diagnostic crit eria for SP. Information regarding axis I diagnoses was obtained using the Structured Clinical Interview for DSM III-R (SCID-UP-R). Social phobic symp toms and the severity of the illness were assessed by the Liebowitz Social Anxiety Scale (LSAS) and the Liebowitz Social Phobic Disorders Rating Scale , Severity (LSPDRS). Patients completed the Hopkins Symptom Checklist (HSCL 90). Fourteen patients (9.1%) satisfied DSM-III-R criteria for lifetime bi polar disorder not otherwise specified (NOS) (bipolar II), while 71 (46.4%) had unipolar major depression and 68 (44.4%) had no lifetime history of ma jor mood disorders. Comorbid panic disorder/agoraphobia (PDA), obsessive-co mpulsive disorder (OCD), and alcohol abuse were reported more frequently in the bipolar group than in the other two subgroups. Unipolar patients showe d higher rates of comordid PDA and OCD compared with SP patients without mo od disorders. Severity and generalization of the SP symptoms, prevalent int eractional anxiety, multiple comorbidity, and alcohol abuse appeared to be the most relevant consequences of SP-bipolar coexistence. In a significant minority of cases, protracted social anxiety may hypothetically have repres ented, along with inhibited depression, the dimensional opposite of gregari ous hypomania. Copyright (C) 2001 by WB. Saunders Company.