Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication.
BACKGROUND
Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R).


METHODS
The NCS-R is a nationally representative household survey fielded in 2001-2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia.


RESULTS
The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose-response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment.


CONCLUSIONS
Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.
Ruscio
A M
AM
Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA. ruscio@psych.upenn.edu
Brown
T A
TA
Chiu
W T
WT
Sareen
J
J
Stein
M B
MB
Kessler
R C
RC
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005239:Fear / Q000523:psychology*; D006306:Health Surveys; D006801:Humans; D007398:Interpersonal Relations; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D010698:Phobic Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology