Comorbid Social Anxiety Disorder Research Articles

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population.

Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms. Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-relatedsymptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms. Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity. Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

Olfactory Reference Syndrome: Its Relationship to Comorbidity of Social Anxiety Disorder and Obsessive-Compulsive Disorder.

Olfactory reference syndrome (ORS) is known to have the clinical features of both obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD). However, there has been no clear explanation as to why ORS has the characteristics of two different disorders. In the present study, the comorbidity rates of ORS in patients with SAD (without OCD, n = 83), ORS in patients with OCD (without SAD, n = 42), and patients with SAD and OCD comorbidity (n = 17) were compared. Of all 142 patients studied, 11 were diagnosed with ORS. The comorbidity rate of ORS in comorbid SAD/OCD group was significantly higher than those in both SAD and OCD groups. Logistic regression analysis of 100 cases of SAD and selected 69 cases of generalized SAD showed that the risk of ORS was significantly higher in patients with OCD and bulimia nervosa. Of 59 cases with OCD, the risk of ORS was significantly higher in patients with SAD. The results of the present study suggest that the comorbidity of SAD and OCD most likely explains the development of ORS.

Objective and Subjective Sleep Measures Are Related to Suicidal Ideation and Are Transdiagnostic Features of Major Depressive Disorder and Social Anxiety Disorder

Suicide is a major public health problem and previous studies in major depression and anxiety show problematic sleep is a risk factor for suicidal ideation (SI). However, less is known about sleep and SI in social anxiety disorder (SAD), despite the pervasiveness of SAD. Therefore, the current study comprised participants with major depressive disorder (MDD) (without comorbid SAD) (n = 26) and participants with SAD (without comorbid MDD) (n = 41). Wrist actigraphy was used to estimate sleep duration, wake after sleep onset, and sleep efficiency; sleep quality was evaluated with self-report. Self-report was also used to examine SI. These measures were submitted to independent t-tests and multiple regression analysis. t-test results revealed sleep and SI did not differ between MDD and SAD groups. Multiple regression results showed shorter sleep duration and worse sleep quality related to greater SI when taking symptom severity and age into account. Post-hoc partial correlational analysis showed these sleep-SI relationships remained significant after controlling for symptom severity and age. Preliminary findings indicate sleep and SI may be transdiagnostic features of MDD and SAD. Evidence of distinct sleep-SI relationships are consistent with previous reports showing that sleep difficulties contribute to SI. Altogether, improving sleep duration and sleep quality may reduce the risk of SI.

Social anxiety disorder in adolescents who stutter: A risk for school refusal.

Stuttering is a childhood-onset fluency disorder. Part of the counseling for middle and high school students with persistent stuttering is related to school refusal. Anxiety disorders are known to contribute to school refusal. However, it is not known whether social anxiety disorder (SAD) is a factor in school refusal among adolescents who stutter. In our first study, we examined the relationship between school refusal and SAD in 84 middle and high school students who stutter; 26% of the 84 students were in the school refusal group and the remaining 74% were in the school attendance group. The second study examined whether SAD was associated with 10 factors related to speech and stuttering frequency using the Japanese version of the Liebowitz Social Anxiety Scale for Children and Adolescents to determine the presence of SAD. Of the 84 students in the first study, 40 participated in the second study. The school refusal group of adolescents who stutter had significantly higher rates of SAD than the school attendance group. Fifty percent of adolescents who stutter met the criteria for SAD. Moreover, adolescents who stutter with SAD had significantly higher scores on the items "When speaking in public, do you experience tremors in your limbs?" and "After you stutter, do you have negative thoughts about yourself?" than the adolescents who stutter without SAD. When examining adolescents who stutter, checking for comorbid SAD may lead to better support. Moreover, noticing their repetitive negative thinking, nervousness, and trembling during speech may help to resolve SAD.

Influence of Comorbid Social Anxiety Disorder on Symptomatology and Social Functioning in Female Military Sexual Trauma Survivors with PTSD

Military sexual trauma (MST) is a common experience in veterans and associated with numerous negative outcomes, such as posttraumatic stress disorder (PTSD), diagnostic comorbidity, and impairments in multiple domains, including social functioning. Comorbid social anxiety disorder (SOC) may represent a particularly challenging presentation due to added difficulties with social functioning and treatment response. The present study investigated severity, emotion regulation, and perceived support and functioning of comorbid SOC in female MST survivors with PTSD. Participants were recruited for a randomized clinical trial that compared telehealth and in-person delivery of evidence-based psychotherapy for PTSD. Of the 112 participants with PTSD, 30 participants (27%) also met criteria for comorbid SOC on a diagnostic interview. Participants with comorbid PTSD-SOC endorsed poorer emotion regulation, less positive affect, and greater negative affect compared to participants with PTSD without SOC comorbidity. Participants with comorbid PTSD-SOC also were less likely to be involved in a romantic relationship and evidenced increased difficulties in sharing thoughts and feelings with family members and friends. Together, these findings suggest that SOC comorbidity in patients with MST-related PTSD is associated with increased impairments in emotion regulation and social functioning.

A Prospective Treatment for Selective Mutism through an Analysis of Social Anxiety Disorder

Selective mutism (SM) is a rare pediatric anxiety disorder in which a child fails to speak in specific social situations. Due to its classification as a rare disorder that affects less than 1% of the world’s population, research on this disorder is limited, inhibiting available treatment options for SM patients. Thus, it is critical to research more on this relatively unexplored disorder. Social anxiety disorder (SAD) is a prevalent anxiety disorder characterized by the fear, self-consciousness, and embarrassment in social situations in which a person may be judged or evaluated negatively. SM is known to present with other anxiety disorders, primarily SAD. The main treatment for SM is cognitive-behavioral therapy (CBT), followed by pharmacological interventions such as selective serotonin reuptake inhibitors (SSRIs). With limited knowledge of this rare disorder, this paper attempts to suggest a potential novel treatment for SM, serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are a class of antidepressants used to increase both an individual’s serotonin and norepinephrine levels in the brain. Previous case studies of SM and research on these specific antidepressants used commonly to treat comorbid SAD elucidate the antidepressant’s potential on SM. With its strong usage in the treatment of SAD, SNRIs may also be effective as a treatment for SM, a disorder that has similar clinical presentations and therapeutic approaches to SAD. In conclusion, this review paper calls to attention the lack of research on SM and identifies a novel alternative approach for its effective treatment.

Emotion regulation therapy for social anxiety disorder: a single case series study.

Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement. SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.

Emotional Dysregulation Symptoms Based on Sensitivity to Punishment and Reward and Intensity Mediated by Emotion Regulation

Objective: The emotion dysregulation model by Mennin and Fresco considers the high comorbidity of generalized anxiety disorder and major depressive disorder and pays special attention to their comorbidity. Additionally, due to the high comorbidity of social anxiety disorder as well as anxiety and mood disorders, this disorder was considered along with the last two disorders. This study aimed to assess a Conceptual Model of Emotional Dysregulation Symptoms Based on Sensitivity to Punishment and Reward and Intensity of Positive and Negative Emotions Mediated by Emotion Regulation Strategies in Students. Methods: In total, 189 students affiliated with the Sharif University were selected by random sampling method. Then, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7), the Social Interaction Anxiety Scale (SIAS), the Affect Intensity Measure (AIM), the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ), the Difficulties in Emotion Regulation Scale (DERS), the Attention Control Scale (ATTC), the Experiences Questionnaire (EQ), the Emotion Regulation Questionnaire (ERQ), and the Responses to Positive Affect questionnaire (RPA) were distributed among them to collect the necessary data. The obtained data were analyzed by LISREL using structural equation modeling. Results: Pearson correlation coefficient data indicated a significant relationship between motivation components, positive and negative emotion regulation strategies, and the symptoms of emotion dysregulation. The results showed that the conceptual model of the research fitted with the collected data; accordingly, the positive and negative strategies of emotion regulation mediated the relationship between motivation and the symptoms of emotion dysregulation. Conclusion: The present research results supported the main hypothesis of the study. Thus, positive and negative emotion regulation strategies mediated the relationship between sensitivity to punishment and reward and the intensity of positive and negative emotion with the symptoms of emotion dysregulation.

Vigilance-Avoidance Toward Negative Faces in Social Anxiety With and Without Comorbid Depression.

Despite the growing evidence for the attentional bias toward emotional related stimuli in patients with social anxiety disorder (SAD), it remains unclear how the attentional bias manifests in normal individuals with SAD and/or depressive traits. To address this question, we recruited three groups of normal participants with different psychiatric traits—individuals with comorbid SAD and depression (SADd, N = 19), individuals with only SAD (SAD, N = 15), and healthy control individuals (HC, N = 19). In a dot-probe paradigm, participants view angry, disgusted, and sad face stimuli with durations ranging from very brief (i.e., 14ms) that renders stimuli completely intangible, to relatively long (i.e., 2000ms) that guarantees image visibility. We find significant early vigilance (i.e., on brief stimuli) and later avoidance (i.e., on long stimuli) toward angry faces in the SADd group. We also find vigilance toward angry and disgusted faces in the SAD group. To our best knowledge, this is the first study to unify both vigilance and avoidance within the same experimental paradigm, providing direct evidence for the “vigilance-avoidance” theory of comorbid SAD and depression. In sum, these results provide evidence for the potential behavioral differences induced by anxiety-depression comorbidity and a single trait in non-clinical populations, but the lack of a depression-only group cannot reveal the effects of high levels of depression on the results. The limitations are discussed.

Treatment Outcomes in a Partial Hospital Program for Patients with Social Anxiety Disorder: The Effects of Comorbid Major Depression

Although previous studies have examined the impact of comorbid major depressive disorder (MDD) on social anxiety disorder (SAD), the results have been somewhat mixed. Furthermore, most studies have been conducted in inpatient or outpatient settings. Given the large body of literature that suggests that this particular comorbidity can have negative effects on treatment efficacy and outcomes, it is important to continue to explore its impact. The present study aims to clarify contradictions in the literature and expands on previous studies by examining patients in a partial hospitalization setting. Patients at Rhode Island Hospital with a diagnosis of SAD were compared to those with comorbid SAD and MDD on pre-treatment and post-treatment measures of anxiety and depression. The results indicated that while the comorbid group showed significantly less improvement post-treatment on anxiety symptoms and constructs related to remission from depression, they did not show significantly less improvement on depression symptoms. The implications of these results for clinical practice are discussed. KEYWORDS: Social Anxiety Disorder; Major Depressive Disorder; Comorbid Anxiety Disorders; Comorbid Mood Disorders; Treatment Outcomes; Partial Hospitalization Program

Abnormal visual representations associated with confusion of perceived facial expression in schizophrenia with social anxiety disorder

Deficits in social functioning are especially severe amongst schizophrenia individuals with the prevalent comorbidity of social anxiety disorder (SZ&SAD). Yet, the mechanisms underlying the recognition of facial expression of emotions—a hallmark of social cognition—are practically unexplored in SZ&SAD. Here, we aim to reveal the visual representations SZ&SAD (n = 16) and controls (n = 14) rely on for facial expression recognition. We ran a total of 30,000 trials of a facial expression categorization task with Bubbles, a data-driven technique. Results showed that SZ&SAD’s ability to categorize facial expression was impared compared to controls. More severe negative symptoms (flat affect, apathy, reduced social drive) was associated with more impaired emotion recognition ability, and with more biases in attributing neutral affect to faces. Higher social anxiety symptoms, on the other hand, was found to enhance the reaction speed to neutral and angry faces. Most importantly, Bubbles showed that these abnormalities could be explained by inefficient visual representations of emotions: compared to controls, SZ&SAD subjects relied less on fine facial cues (high spatial frequencies) and more on coarse facial cues (low spatial frequencies). SZ&SAD participants also never relied on the eye regions (only on the mouth) to categorize facial expressions. We discuss how possible interactions between early (low sensitivity to coarse information) and late stages of the visual system (overreliance on these coarse features) might disrupt SZ&SAD’s recognition of facial expressions. Our findings offer perceptual mechanisms through which comorbid SZ&SAD impairs crucial aspects of social cognition, as well as functional psychopathology.

Caution When Screening for Autism among Socially Anxious Youth.

Social anxiety disorder (SAD) is commonly comorbid with autism spectrum disorder (ASD). Here, in a sample of 86 children and adolescents (MAGE = 12.62years; 68.6% male), 28 of whom were diagnosed with ASD, 34 with SAD, and 24 with comorbid ASD and SAD, we compared parent-reported scores from the Social Responsiveness Scale-Second Edition (SRS-2; Constantino and Gruber in Social Responsiveness Scale (SRS; Constantino and Gruber 2012) to determine the sensitivity and specificity of the measure in cases of differential diagnosis between SAD and ASD. Results suggest that neither the subscales, nor the SRS-2 total score, consistently differed between ASD and SAD. Sensitivity and specificity analyses suggested that the SRS-2 total poorly discriminated ASD from SAD. When screening socially anxious youth for possible ASD, caution should be taken.

The Prevalence and Correlates of Social Anxiety Symptoms among People with Schizophrenia in Ethiopia: An Institution-Based Cross-Sectional Study.

Background The comorbidity of social anxiety disorder is very common in schizophrenia patients and affects almost all age groups. This social anxiety disorder negatively impacts the quality of life, medication adherence, and treatment outcomes of people with schizophrenia. It is not well recognized in clinical settings. Therefore, assessing social anxiety symptoms and its associated factors was significant to early intervention and management of schizophrenia patients in Ethiopia. Methods An institution-based cross-sectional study was conducted at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia. Data collectors randomly recruited 423 schizophrenic patients by using the systematic sampling technique. A face-to-face interviewer-administered questionnaire was used to collect data. The standardized Liebowitz Social Anxiety Scale (LSAS) was employed to assess individual social anxiety symptoms. We computed bivariate and multivariate binary logistic regressions to identify factors associated with social anxiety symptoms. Statistical significance was declared at p < 0.05. Results The prevalence of social anxiety symptoms was 36.2% (95% CI: 31.50, 40.80). Male sex (AOR = 2.03, 95% CI: 1.20, 3.44), age of onset of schizophrenia (AOR = 1.91, 95% CI:1.17, 3.12), positive symptoms (AOR = 0.75, 95% CI:0.67, 0.83), depression/anxiety symptoms (AOR = 1.29, 95% CI: 1.18, 1.41), number of hospitalizations (AOR = 2.80, 95% CI:1.32, 5.80), and suicidal ideation (AOR = 0.44, 95% CI: 0.26, 0.74) were factors significantly associated with social anxiety symptoms at p < 0.05. p < 0.05. Conclusion The prevalence of social anxiety symptoms among schizophrenia patients was found to be high. Timely treatment of positive and depression/anxiety symptoms and suicide risk assessments and interventions need to be done to manage the problems.

An overlooked combination in treatment: addiction and social anxiety disorder comorbidity

An overlooked combination in treatment: addiction and social anxiety disorder comorbidity

Prevalence rate of social anxiety disorder in individuals with a psychotic disorder: A systematic review and meta-analysis

Social anxiety disorder (SAD) is characterised as an excessive fear of negative judgment from others and is considered one of the most disabling of the mental ill health conditions. Research findings indicate that it is also a significant issue for individuals diagnosed with a psychotic disorder, with prevalence rates of social anxiety ranging from 8% to 36%. This study was conducted to address the variance of the reported prevalence rates of comorbid SAD amongst individuals with a psychotic disorder diagnosis. Via a systematic review, we collated all available literature on the prevalence of SAD in individuals with a psychotic disorder, and evaluated the prevalence results via meta-analysis. We also synthesised all psychosocial outcomes attributed to SAD comorbidity and conducted a narrative review of the relevant findings. Across 25 studies providing data from 1980 to May 2018 and spanning 13 countries (N = 92,522), we found a pooled prevalence rate of 21% (16%–26%). In outpatient samples, (17 studies), the prevalence was 25% (19%–31%), statistically significantly higher (z = 5.12, p < .001) than that of the inpatient studies six studies, which was 9% (7%–12%). We also found that SAD comorbidity is associated with increased depression, poorer social function, poorer subjective quality of life, greater negative self-evaluation, and greater insight. The results from this systematic review and meta-analysis suggest that SAD is prevalent amongst individuals with a psychotic disorder. More consistent screening for SAD and the development of theoretically driven and empirically supported tailored treatments are recommended.

Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder.

The association between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is poorly established. In fact, increasing and converging evidences suggest that there is a close relationship between the two disorders. High comorbidity rate between these two disorders, follow-up studies showing high rates of later development of SAD in ADHD and treatment studies in which ADHD medications have been helpful for both conditions all indicate this relationship. Recently, we have published a hypothesis regarding the development of SAD secondary to ADHD. In this hypothesis, we recognized that patients with SAD seem to go through a prodromal period that we labeled as "pre-social anxiety." Detecting patients in this period before meeting full-blown SAD criteria provides early intervention and prevention of SAD. New, comprehensive follow-up studies which will investigate whether ADHD causes later SAD secondarily are needed. In the current review, taken into account our developmental hypothesis, we will discuss whether high comorbidity of SAD and ADHD is a chance finding (i.e., the two disorders are found in cases with no causal relationship between them) or can SAD develop secondarily due to childhood ADHD. Is there a prodrom period in patients with SAD as in cancer or psychosis patients? We are going to summarize the overlapping features of SAD and ADHD in terms of child/parents interaction and family issues, aversive childhood experiences, social skill deficits, and development of cognitive distortions.

Prevalence of seasonal depression in a prospective cohort study

The prevalence of autumn/winter seasonality in depression has been documented in the longitudinal Zurich cohort study by five comprehensive diagnostic interviews at intervals over more than 20years (N = 499). Repeated winter major depressive episodes (MDE-unipolar + bipolar) showed a prevalence of 3.44% (5× more women than men), whereas MDE with a single winter episode was much higher (9.96%). A total of 7.52% suffered from autumn/winter seasonality in major and minor depressive mood states. The clinical interviews revealed novel findings: high comorbidity of Social Anxiety Disorder and Agoraphobia within the repeated seasonal MDE group, high incidence of classic diurnal variation of mood (with evening improvement), as well as a high rate of oversensitivity to light, noise, or smell. Nearly twice as many of these individuals as in the other MDE groups manifested the syndrome of atypical depression (DSM-V), which supports the prior description of seasonal affective disorder (SAD) as presenting primarily atypical symptoms (which include hypersomnia and increase in appetite and weight). This long-term database of regular structured interviews provides important confirmation of SAD as a valid diagnosis, predominantly found in women, and with atypical vegetative symptoms.

An Overview of Recent Findings on Social Anxiety Disorder in Adolescents and Young Adults at Clinical High Risk for Psychosis.

Background: Some studies have shown that anxiety is particularly frequent in the Clinical High Risk (CHR) for psychosis population. Notably, social anxiety disorder is identified as one of the most common anxiety disorders in CHR adolescents and young adults. Despite this, the frequency and the clinical significance of social anxiety in this population have been underestimated. Methods: A selective review of literature published between 2011 and 2017 on social anxiety disorder in CHR adolescents and young adults. Results: Five studies are included. In particular, three studies demonstrated that CHR adolescents and young adults have higher levels of anxiety compared to controls. Furthermore, anxiety, including social anxiety, is related to the severity of psychotic symptoms. The other studies included show inconsistent results regarding the possible relationship between social anxiety and social functioning. Conclusions: To date, the eidence concerning the comorbidity of social anxiety disorder and CHR in adolescents and young adults is not sufficient to provide clear guidelines for clinical practice. Future longitudinal studies on larger samples of the CHR adolescents and young adults are required to examine the relationship between social anxiety disorder and the presence of attenuated psychotic symptomatology.

The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative

BackgroundThere is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis.MethodsData from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates.ResultsSAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries.ConclusionsWhile differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.

Extended-release methylphenidate monotherapy in patients with comorbid social anxiety disorder and adult attention-deficit/hyperactivity disorder: retrospective case series.

The relationship between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is a subject which has recently become a topic of interest for research. In this study, 20 patients with comorbid SAD and adult ADHD who were treated with extended-release methylphenidate monotherapy were evaluated retrospectively. Clinical response for both ADHD and SAD symptoms was observed in 17 of 20 patients. Overall, one patient did not respond to treatment and two patients dropped out of treatment at the beginning due to adverse effects. Extended-release methylphenidate improved both SAD and ADHD symptoms and was generally well tolerated. Further studies are required to investigate the relationship between SAD and ADHD.