title: Subtyping social anxiety disorder in developed and developing countries.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.forename: Ayelet Meron
authors.initials: AM
authors.lastname: Ruscio
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Laura Helena S G
authors.initials: LH
authors.lastname: Andrade
authors.forename: Corina
authors.initials: C
authors.lastname: Benjet
authors.forename: Evelyn
authors.initials: E
authors.lastname: Bromet
authors.forename: Koen
authors.initials: K
authors.lastname: Demyttenaere
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Oye
authors.initials: O
authors.lastname: Gureje
authors.forename: Yanling
authors.initials: Y
authors.lastname: He
authors.forename: Hristo
authors.initials: H
authors.lastname: Hinkov
authors.forename: Chiyi
authors.initials: C
authors.lastname: Hu
authors.forename: Noboru
authors.initials: N
authors.lastname: Iwata
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lepine
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.forename: Mark
authors.initials: M
authors.lastname: Oakley Browne
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sagar
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000328:Adult; D017668:Age of Onset; D002908:Chronic Disease; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D019049:Developed Countries; D003906:Developing Countries; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005239:Fear; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D007406:Interview, Psychological; D008016:Life Change Events; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D010698:Phobic Disorders / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011594:Psychometrics; D012307:Risk Factors; D012931:Social Environment; D014944:World Health Organization; D055815:Young Adult