title: Neuroimaging in social anxiety disorder—a meta-analytic review resulting in a new neurofunctional model.
abstract: Social anxiety disorder (SAD) is one of the most frequent anxiety disorders. The landmark meta-analysis of functional neuroimaging studies by Etkin and Wager (2007) revealed primarily the typical fear circuit as overactive in SAD. Since then, new methodological developments such as functional connectivity and more standardized structural analyses of grey and white matter have been developed. We provide a comprehensive update and a meta-analysis of neuroimaging studies in SAD since 2007 and present a new model of the neurobiology of SAD. We confirmed the hyperactivation of the fear circuit (amygdala, insula, anterior cingulate and prefrontal cortex) in SAD. In addition, task-related functional studies revealed hyperactivation of medial parietal and occipital regions (posterior cingulate, precuneus, cuneus) in SAD and a reduced connectivity between parietal and limbic and executive network regions. Based on the result of this meta-analysis and review, we present an updated model of SAD adopting a network-based perspective. The disconnection of the medial parietal hub in SAD extends current frameworks for future research in anxiety disorders.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland; Behavioural and Cognitive Neuroscience Institute, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom. Electronic address: abb41@medschl.cam.ac.uk.
authors.forename: Annette Beatrix
authors.initials: AB
authors.lastname: Brühl
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Aba
authors.initials: A
authors.lastname: Delsignore
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Katja
authors.initials: K
authors.lastname: Komossa
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Steffi
authors.initials: S
authors.lastname: Weidt
mesh_terms: D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D006801:Humans; D008959:Models, Neurological; D059906:Neuroimaging; D010698:Phobic Disorders / Q000503:physiopathology*
keywords: Anxiety; Brain structure; Connectivity; MRI; Network; Neurobiology; Social anxiety disorder; Treatment