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Subtyping social anxiety disorder in developed and developing countries
Dan J Stein1, Ayelet Meron Ruscio, Sing Lee
1Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
Depression and Anxiety
|December 29, 2009
Summary
This study found no evidence to support subtypes of social anxiety disorder (SAD) based on the number of fears or by differentiating performance versus interactional fears. Current classifications may not accurately reflect SAD
Area of Science:
- Psychiatry
- Epidemiology
- Mental Health Research
Background:
- Social anxiety disorder (SAD) is classified into generalized and non-generalized subtypes in DSM-IV.
- Previous Western surveys found no evidence to support these SAD subtypes.
- This study investigated SAD subtyping across diverse global settings.
Purpose of the Study:
- To determine if SAD subtyping holds across developed and developing countries.
- To evaluate the utility of subtyping SAD based on performance versus interactional fears.
- To examine the relationship between the number of social fears and SAD outcomes.
Main Methods:
- Population epidemiological surveys conducted in 19 countries (11 developing, 9 developed) by the WHO World Mental Health Survey Initiative.
- The Composite International Diagnostic Interview was used to assess DSM-IV disorders.
- Fourteen performance and interactional fears were assessed, and associations with SAD outcomes were analyzed.
Main Results:
- Lifetime social fears are common globally; SAD is more prevalent in developed countries.
- Dose-response relationships exist between the number of social fears and SAD outcomes (persistence, severity, comorbidity, treatment).
- No evidence supports generalized vs. non-generalized SAD, nor is performance vs. interactional fear distinction useful for predicting outcomes.
Conclusions:
- Current evidence does not support subtyping social anxiety disorder based on the number of fears.
- Distinguishing between performance and interactional fears does not improve outcome prediction in SAD.
- Further research may be needed to refine SAD classification.
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