Subtyping social anxiety disorder in developed and developing countries

Dan J. Stein, Ayelet Meron Ruscio, Sing Lee, Maria Petukhova, Jordi Alonso, Laura Helena S.G. Andrade, Corina Benjet, Evelyn Bromet, Koen Demyttenaere, Silvia Florescu, Giovanni De Girolamo, Ron De Graaf, Oye Gureje, Yanling He, Hristo Hinkov, Chiyi Hu, Noboru Iwata, Elie G. Karam, Jean Pierre Lepine, Herbert MatschingerMark Oakley Browne, Jose Posada-Villa, Rajesh Sagar, David R. Williams, Ronald C. Kessler

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Background: Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful. Methods: The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. Results: Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. Conclusion: No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.

Original languageEnglish
Pages (from-to)390-403
Number of pages14
JournalDepression and Anxiety
Issue number4
StatePublished - Apr 2010
Externally publishedYes


  • Epidemiology
  • Social anxiety disorder
  • Social phobia
  • Subtype


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