Social anxiety disorder in review: two decades of progress

Social anxiety disorder (SAD) is among the most common of all psychiatric disorders. It presents with a lifetime prevalence rate of up to 16% in the general population and, like other anxiety disorders, is more frequent in women. Patients with SAD suffer from considerable psychiatric comorbidity that is often preceded by social anxiety. Social anxiety affects people early in life and provokes a great deal of impairment and cost, much being related to the under-recognition and/or under-treatment of this disorder, which occurs frequently with GPs and others specialists. There is a clear need among GPs for training and awareness about the existence of this disorder, its assessment, differential diagnosis and available treatments. In this paper we review the development of the concept of SAD and its epidemiology, and discuss the available information regarding cost and how SAD presents in primary-care settings. Potential aetiologies and studies concerning possible neurobiological mechanisms are also reviewed. Pharmacological and psychosocial treatments for SAD are examined and effect sizes calculated for placebo-controlled pharmacological studies of five medication categories.