Comorbidity, Neurobiology, and Pharmacotherapy of Social Anxiety Disorder

Social anxiety disorder is a common psychiatric illness that imposes persistent functional impairmentand disability on persons who have the disorder. The disorder is characterized by a marked andpersistent fear of social or performance situations in which embarrassment may occur. It is the mostprevalent of any anxiety disorder and is the third most common psychiatric disorder after depressionand alcohol abuse. Social anxiety disorder typically begins during childhood with a mean age at onsetbetween 14 and 16 years and is sometimes preceded by a history of social inhibition or shyness. Personswho have social anxiety disorder either endure or avoid social situations altogether because thefear of embarrassment causes such intense anxiety; such avoidance may ultimately interfere withoccupational and/or social functioning and lead to significant disability. The duration of social anxietydisorder is frequently lifelong, and there is a high degree of comorbidity with other psychiatric disorders.Social anxiety disorder is a serious illness that frequently runs a chronic course and is associatedwith significant morbidity. Patients should be treated aggressively using pharmacotherapeutic agentsthat can be tolerated over the long term. Cognitive-behavioral therapy should also be considered intreatment planning. Efforts to increase the recognition of social anxiety disorder as a common, distressing,and disabling condition are critical. This article discusses the comorbidity, neurobiology, andpharmacotherapy of social anxiety disorder.