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Depress Anxiety. 2010 Apr;27(4):390-403. doi: 10.1002/da.20639.

Subtyping social anxiety disorder in developed and developing countries.

Author information

1
Department of Psychiatry, University of Cape Town, Cape Town, South Africa.

Abstract

BACKGROUND:

Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful.

METHODS:

The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears.

RESULTS:

Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes.

CONCLUSION:

No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.

PMID:
20037919
PMCID:
PMC2851829
DOI:
10.1002/da.20639
[Indexed for MEDLINE]
Free PMC Article

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