The impairments caused by social phobia in the general population: implications for intervention

OBJECTIVE: Although social phobia is common, treatment remains low. In order to gauge public health implications of this low treatment, information is needed on the impairments caused by social phobia. METHOD: A computer literature review searched for the terms 'social anxiety disorder' and 'social phobia' in the MEDLINE and PsycLIT databases. New analyses were carried out in the US National Comorbidity Survey. RESULTS: The literature shows that social phobia has serious effects on role functioning and quality of life. These effects are least severe for pure non-generalized social phobia and most severe for comorbid generalized social phobia with avoidant personality disorder. The most direct impairments involve social interactions and information processing errors in these interactions. Indirect effects are even more important. Three indirect effects are highlighted: effects on secondary mental (e.g. depression), substance (e.g. alcoholism) and physical (e.g. cardiovascular disease) disorders; effects on normative role transitions (e.g. educational attainment); and effects on help-seeking. CONCLUSION: Given the early age of onset and impacts on secondary disorders and early adult life course transitions, the greatest public health impact of increasing treatment of social phobia is likely to be achieved by developing programs targeted at early identification and treatment through schools.