An epidemiologic perspective on social anxiety disorder.

Social anxiety disorder (SAD) is among the most common mental disorders on a lifetime basis, ranging from 12% to 14%. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, categorizes SAD as either generalized (fear/avoidance of multiple social situations) or nongeneralized (fearing only a limited number of social situations), with some overlap between the 2 subtypes. Generalized SAD is associated with more comorbid mental disorders, greater functional impairment, and lower health-related quality of life. Half of SAD patients have onset by age 13 years and 90% by age 23 years; however, SAD is rarely diagnosed or treated by the pediatrician, highlighting the low awareness level of SAD and the need to increase attention among physicians. Social anxiety disorder is associated with an increased risk for depression and a more malignant course, characterized by increased likelihood of suicide attempts and greater disease chronicity. SAD has an adverse impact on outcomes in patients with other comorbid mental conditions such as bipolar disorder, eating disorders, and personality disorders.