Subtyping social anxiety disorder in developed and developing countries.
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.
Stein
Dan J
DJ
Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
Ruscio
Ayelet Meron
AM
Lee
Sing
S
Petukhova
Maria
M
Alonso
Jordi
J
Andrade
Laura Helena S G
LH
Benjet
Corina
C
Bromet
Evelyn
E
Demyttenaere
Koen
K
Florescu
Silvia
S
de Girolamo
Giovanni
G
de Graaf
Ron
R
Gureje
Oye
O
He
Yanling
Y
Hinkov
Hristo
H
Hu
Chiyi
C
Iwata
Noboru
N
Karam
Elie G
EG
Lepine
Jean-Pierre
JP
Matschinger
Herbert
H
Oakley Browne
Mark
M
Posada-Villa
Jose
J
Sagar
Rajesh
R
Williams
David R
DR
Kessler
Ronald C
RC
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