The lifelong course of social anxiety disorder: a clinical perspective

Social anxiety disorder (SAD) is among the most frequently observed psychiatric disorders, with estimates of approximately 10% of people likely to suffer from the disorder during their lifetime. However, despite causing significant impairment of normal functioning, this disorder is often mistaken as shyness and remains under-recognized and under-treated. Following onset in adolescence, patients with generalized SAD often experience a lifelong and unremitting mental disorder characterized by severe anxiety and disability. Typical duration of the illness is far in excess of that seen in panic disorder, and prospective, long-term, naturalistic studies have indicated that only one-third of individuals attain remission from SAD within 8 years, compared with over two-thirds of those with panic disorder. Comorbidity of other anxiety disorders, depression and personality disorders are common in SAD and associated with more pronounced impairment and a poorer long-term outcome. Effective treatment for SAD is available but use is low and may remain suboptimal, despite the development of pharmacotherapeutic agents with anxiolytic and antidepressant properties and the efficacy of psychotherapeutic approaches. Increased knowledge of the course of SAD highlights the need to examine the role of available treatments, administered individually or in combination, as acute, continuation or maintenance therapy to maximize the chances of remission and long-term benefit for patients.