Medication Treatments for Social Anxiety Disorder [CLINICAL SYNTHESIS]

Social anxiety disorder or social phobia (SP) is defined as “the intense fear of becoming humiliated in social situations, specifically of embarrassing yourself in front of other people” (National Institute of Mental Health, 2000). It affects between 6% and 15% of the general U.S. population (1), is the third most common psychiatric disorder, and is extremely debilitating to those who have it. Individuals with SP are extremely fearful and avoid social situations (APA, 2000). The fear is caused primarily by feelings that they will be humiliated or embarrassed. The onset of SP is usually in childhood or adolescence, and the disorder occurs more often in women than in men. Many people are so affected by it that they cannot work and cannot start or maintain personal or professional relationships; in addition, an unusually high rate of comorbid depression is seen in individuals with SP. More recently, interest has focused on the development course of SP, leading to a reconceptualization of the disorder as a chronic neurodevelopment illness rather than one manifesting for the first time in adulthood (2). In recent years, our knowledge of SP has included important advances in the understanding of the epidemiology, neurobiology, and neural circuitry of SP. In this clinical synthesis, we will review the diagnosis, psychopharmacological treatment, and recent questions and controversy regarding this debilitating, yet treatable, disorder. DSM-IV-TR criteria for social anxiety disorder are listed in Table 1.