Article

Social phobia. Comorbidity and morbidity in an epidemiologic sample

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Abstract

Selected sociodemographic and clinical features of social phobia were assessed in four US communities among more than 13,000 adults from the Epidemiologic Catchment Area study. Rates of social phobia were highest among women and persons who were younger (age, 18 to 29 years), less educated, single, and of lower socioeconomic class. Mean age at onset was 15.5 years, and first onsets after the age of 25 years were uncommon. Lifetime major comorbid disorders were present in 69% of subjects with social phobia and usually had onset after social phobia. When compared with persons with no psychiatric disorder, uncomplicated social phobia was associated with increased rates of suicidal ideation, financial dependency, and having sought medical treatment, but was not associated with higher rates of having made a suicide attempt or having sought treatment from a mental health professional. An increase in suicide attempts was found among subjects with social phobia overall, but this increase was mainly attributable to comorbid cases. Social phobia, in the absence of comorbidity, was associated with distress and impairment, yet was rarely treated by mental health professionals. The findings are compared and contrasted with prior reports from clinical samples.

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... Specific symptoms of social phobia and sociodemographic factors were assessed among more than 13,000 adults in the United States; the results show that the mean age of onset was 15.5 years and that 1, 2 1 1 1 1 it is higher in females than in their male counterparts. SAD is more common among individuals who are less educated, single, younger, and from lower socioeconomic classes [3]. A cross-national study conducted in 1996 revealed that out of every 100 persons, 2.6 are socially phobic in the US, while this number was 0.5 in Korea. ...
... Concerning sociodemographic characteristics, our study demonstrates that age, gender, education level, and family income were statistically significant (P<0.05) factors in the prevalence and severity of SAD symptoms, consistent with the results of studies conducted outside of Saudi Arabia [3,21,24]. Moreover, our study found no significant association with marital status and employment, which does not match other studies [2,3]. ...
... factors in the prevalence and severity of SAD symptoms, consistent with the results of studies conducted outside of Saudi Arabia [3,21,24]. Moreover, our study found no significant association with marital status and employment, which does not match other studies [2,3]. Although most studies agree on the positive association between low family income and SAD, it is unclear whether low family income is a risk factor for SAD or if the relationship is the reverse [25]. ...
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Background Social anxiety disorder (SAD) is a subtype of anxiety characterized by avoidance, fear, and physical symptoms such as dry mouth, sweating, palpitations, and blushing. SAD is one of the most common mental disorders. Body dysmorphic disorder (BDD) is a mental disorder marked by a distressing or impairing preoccupation with imagined or minor flaws in one's physical appearance. Both disorders share similar symptoms. No satisfactory data have been provided about the prevalence of social anxiety symptoms in our region. In our study, we measured the prevalence and severity of SAD symptoms among adults in Riyadh City, as well as the sociodemographic factors associated with it. Additionally, the correlation between SAD and BDD was assessed. Methods Our study is quantitative, observational, and cross-sectional. It was conducted by administering a translated Arabic version of the Severity Measure for Social Anxiety Disorder scale and BDD scales in five locations in Riyadh, which include two general hospitals and three shopping malls. Data were analyzed using the SPSS version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistical data are presented through mean values, standard deviations, and percentages. Results A total of 752 responses were received, of which 509 (68.32%) were from females with a mean age of 30.12 years. The majority of the sample had a low to middle family income, with 64% earning less than $2555 monthly. The sample possessed a good educational level; 63% had a bachelor's degree or higher. Our study also shows that 233 subjects (30.98%) had scores indicating a moderate to severe form of SAD. Among these participants, 86 (36.9%) had scores indicating a moderate to severe form of BDD. There was a significant positive correlation between SAD and BDD (r = 0.496). Conclusion The prevalence of SAD was 30.98%, which is higher compared to Western countries. Low income, education, and female gender have roles in the disease condition. Moreover, there was a linear relationship between SAD and BDD.
... Social anxiety disorder, or social phobia, is one of the most frequent mental disorders in the world, after depression and alcohol abuse (Davidson, Hughes, George, & Blazer, 1993Kessler, et al., 1994;Kessler, Stang, Wittchen, Stein, & Walters, 1999;Lecrubier, Wittchen, Faravelli, Bobes, Patel, & Knapp, 2000;Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996;Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992;Stein, Walker, & Forde, 1994;Weinstock, 1999), with which, in turn, it has high comorbidity (Chartier, Walker, & Stein, 2003;Erwin, Heimberg, Juster, & Mindlin, 2002;Fehm, Beesdo, Jacobi, & Fiedler, 2008;Fogler, 2005;Ham, & Hope, 2005;Lampe, Slade, Issakidis, & Andrews, 2003;Merikangas, & Angst, 1995;Morris, Stewart, & Ham, 2005;Swinson, 2005;Weinstock, 1999;Yonkers, Dyck, & Keller, 2001). Social phobia is highly comorbid with other anxiety disorders (e.g., panic disorder, agoraphobia, specific phobia) or other mental disorders. ...
... Social phobia follows a chronic course and has a negative impact on the individual's satisfaction with, and quality of, life (Brunello, et al., 2000;Fehm, et al., 2008;Kessler, et al., 1999;Lecrubier, et al., 2000;Safren, Heimberg, Brown, & Holle, 1997;Schneier, et al., 1994;Weinstock, 1999;Wittchen, Fuetsch, Sonntag, Müller, & Liebowitz, 2000). Only few people seek treatment, and when they do it is often because of the comorbid disorders (Fehm, et al., 2008;Magee, et al., 1996;Merikangas, et al., 2002;Ruscio, Brown, Chiu, Sareen, Stein, & Kessler, 2008;Schneier, et al., 1992;Wittchen, et al., 1999). ...
... Furthermore, they often find it difficult to improve their level of education, hold a job, be productive, increase their income, and they have problems finding social support at a difficult time in their lives (Caballo, 1995;Fehm, et al., 2008;Wittchen, et al., 2000). Finally, individuals with social phobia often develop other mental disorders and are exposed to a greater risk of suicide (Caballo, & Turner, 1994;Davidson, et al., 1993;Nelson, et al., 2000;Schneier, et al., 1992;Yonkers, et al., 2001). Consequences of this nature can be observed especially in those who have multiple social fears (Ruscio, et al., 2008;Wittchen, et al., 1999). ...
... Extant research has also failed to evaluate the effects of comorbidity on the results. Comorbid depressive disorders and alcohol or drug dependence are common among anxious patients (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992;Weissman, 1990) and they have been linked to poor marital functioning in several studies (Billings, Kessler, & Gomberg 1979;Coyne etal., 1987;Dew &Bromet, 1991;Jacob & Krahn, 1988). Thus, the independent effects of phobic disorders on marital quality cannot be estimated accurately without explicitly controlling comorbidity for these disorders. ...
... The data for the analysis come from a general population survey of married couples. The use of a general population survey, including both treated and untreated persons, is particularly appropriate for evaluating questions about marital relationships because many persons with anxiety disorders do not enter treatment (Markowitz et al., 1989;Schneier et al., 1992). Persons in treatment may have the most severe cases, and their marriages may therefore differ from those of the majority of persons with anxiety disorders. ...
... In addition, the severity of the symptoms was not probed. These disorders were chosen because they are the most common comorbid conditions among persons with anxiety disorders (Schneier et al., 1992;Weissman, 1990). Diagnoses for all disorders were assigned without hierarchical exclusions because recent information casts doubts on the validity of such exclusions (Boyd et al., 1984). ...
Article
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This study compared perceived marital quality among couples in which neither, one, or both spouses met criteria for an anxiety disorder. Phobic husbands and their wives reported poorer marital quality than did other spouses. Husbands' panic disorders had similar but weaker effects on perceived marital quality, and wives' panic disorders predicted poor perceived marital quality by husbands. Wives with generalized anxiety disorder perceived their marriages to be less satisfying than did other wives. The effects of husbands' generalized anxiety disorders were strongest in the presence of comorbid depression or alcohol or drug dependence but the effects of husbands' phobias and of panic disorders did not vary with comorbidity. Spouse concordance for phobias was related to more favorable marital reports, but concordance for other anxiety disorders was unrelated to marital quality.
... The intense, or marked, fear or anxiety of one or more social situations in which the individual can be observed, judged, embarrassed, or humiliated by others can have many consequences, such as social and occupational impairment. SAD is associated with elevated school dropout rates, lack of autonomy, and decreased well-being, employment, workplace productivity, 2 of 17 socioeconomic status, and quality of life [4,[6][7][8]. SAD is also associated with a higher probability of being single, unmarried, or divorced, and with not having children, particularly among men [6,7]. ...
... SAD is associated with elevated school dropout rates, lack of autonomy, and decreased well-being, employment, workplace productivity, 2 of 17 socioeconomic status, and quality of life [4,[6][7][8]. SAD is also associated with a higher probability of being single, unmarried, or divorced, and with not having children, particularly among men [6,7]. Furthermore, SAD often leads to the development of other psychiatric complications such as alcohol dependence [9], depression, suicide attempts, and other anxiety disorders [4,10]. ...
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The effectiveness of in virtuo exposure-based treatment of performance-only social anxiety disorder (SAD) has been demonstrated in several studies. However, few studies have validated virtual environments with participants suffering from generalized SAD. The goal of this study is to confirm the potential of a virtual environment in inducing anxiety in adults suffering from generalized SAD, compared to adults without SAD, when engaged in awkward social interactions. Differences between participants from two different countries were also explored. The sample consisted of 15 participants with SAD from Canada, 17 participants without SAD from Canada, 16 participants with SAD from Spain, and 21 participants without SAD from Spain. All participants were immersed in a control virtual environment and in an experimental virtual environment considered potentially anxiety-inducing for individuals with generalized SAD. As hypothesized, results showed that the experimental virtual environment induced a higher level of anxiety than the control environment among participants with SAD compared to those without SAD. The impact on anxiety of each socially threatening task performed during the experimental immersion was statistically significant. In terms of anxiety responses, no significant differences were found between participants from Canada and Spain. However, spatial presence and ecological validity were higher in Canadians than in Spaniards. Unwanted negative side effects induced by immersions in virtual reality were higher in the SAD group. This study highlights the importance for therapists to engage people with SAD in clinically relevant tasks while immersed in VR psychotherapeutic applications.
... Community studies have shown that many people have social fears, which significantly affect their lives, but do not present for treatment (Schneier, Johnson, Hornig, Liebowitz & Weissman, 1992). Some of these individuals may meet criteria for social phobia if they presented to services, and those remaining are still likely to be suffering significant difficulty and distress. ...
... Chapman, Manuzza & Fyer (1995) summarise these disparate findings by saying that social phobia may affect upward of 10% of the population, and more than 20% of the population may experience significant irrational fears of social situations that do not meet full diagnostic criteria for social phobia. Epidemiological studies show that social phobia is common in the general population, and social phobia could be considered as the extreme end of a The Observer Perspective 6 continuum of social anxiety or difficulty, which is also likely to be fairly widespread (Schneier et al, 1992). model of social phobia People with social phobia seem to have a strong desire to convey a favourable impression of themselves to others, but do not feel that they have the ability to achieve this. ...
Thesis
p>Social phobia is a common and disabling disorder. The cognitive model of social phobia by D.M. Clark and A. Wells (1995) proposes four maintenance factors for social anxiety. One of these factors involves the construction of an impression of the self as a social object using interoceptive information, which can be formed into a visual image of self, seen as if from another person's viewpoint. This image is usually negative, and thus maintains anxiety. Evidence exists that the observer perspective is used more by socially anxious individuals, but there is no clear evidence for its effects on thinking, anxiety, behaviour and social performance. Theory and evidence from the social psychological literature on self-focused attention suggest that the observer perspective, itself a form of self-focused attention, would impact negatively on these factors. The current study tested the effects of the observer perspective in an experimental situation. The results indicate that high socially anxious individuals were negatively affected by the observer perspective in comparison to its opposite, the field perspective, supporting the proposition of Clark and Wells (1995) that it contains distorted negative information. Low socially anxious individuals, contrary to the predictions of this study, were unaffected by the observer perspective. Clinical implications of these findings are discussed.</p
... with obsessive-compulsive disorder and 5% with panic disorder. In 77% of cases, social phobia preceded the co-morbid condition (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). The modal age of onset is 11-15 years of age, but social phobia has also been reported in children under the age often. ...
... The disorder is prevalent, with findings suggesting that between 7% and 13% of the population meet the criteria for diagnosis in a lifetime (Furmark, 2002). The consequences of experiencing social phobia can be pervasive, with a large proportion of people experiencing subsequent co-morbid difficulties such as depression and substance misuse (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). It has also been indicated that individuals with social phobia may have difficulty in fulfilling their potential academically or occupationally (Judd, 1994). ...
Thesis
p>This thesis addresses biases in appraisal that are thought to contribute to the development and maintenance of social anxiety. The literature review outlines several theories of anxiety, before focussing on cognitive theories of social anxiety which predict that individuals with social anxiety have a bias in threat appraisal. Contemporary cognitive-motivational and neurocognitive theories of anxiety are then detailed and their relevance to social anxiety is described. Recent theories make efforts to integrate cognitive theory of appraisal with functional neuroanatomy, proposing that the amygdala is involved in threat appraisal. Research has provided support for the presence of appraisal biases in social anxiety and recent neuroimaging evidence suggests that threat appraisal of social cues is associated with potentiation of the amygdala in social anxiety. The utility of the startle response, in further investigating the predictions of the neurocognitive theory is described. The empirical paper investigates the predictions of neurocognitive theory that sub-cortical appraisals of social cues are associated to potentiated amygdala response. The startle response, a behavioural index of sub-cortical appraisal, was used to investigate response to social cues (neutral and fear faces) and non-social fear cues (light and dark patches) in individuals high and low in social anxiety (HSA vs. LSA). It was found that both groups had a potentiated startle response to the dark condition compared to the light and face conditions and there were no group differences in the response to social cues contrary to theoretical predictions. The findings are discussed in relation to theory and previous research findings.</p
... Contrary to depression, there has been no research on the association between social anxiety and suicidal ideation among medical students. Previous epidemiological studies showed that social anxiety disorder (SAD) symptoms were associated with increased risk of suicidality [48,49]. This higher risk of suicidal ideation may be due to increased isolation and hopelessness, since research suggests social anxiety is associated with social skills deficits as well as social withdrawal [50]. ...
... This suggests that each symptom aspect of social anxiety may affect suicidal ideation. Given that the risk of suicide attempts in SAD mainly results from comorbid disorders such as MDD [48], medical students with both disorders may be at greater risk of suicide. This point should be considered in suicide prevention programs in medical colleges. ...
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Background Little is known about the role of protective factors in suicidal ideation among medical students. This study aimed to examine the association between suicidal ideation and protective (self-esteem/ego-resiliency/social support) and risk (depression/social anxiety) factors. Methods Data on sociodemographic factors, depression, social anxiety, self-esteem, ego-resiliency, social support, and current suicidal ideation were collected from 408 medical students. A logistic regression model was constructed to identify the independent impact of potential influencing factors on suicidal ideation. Potential moderating effects were also explored. Results Thirty-eight participants (9.3%) reported experiencing suicidal ideation. Younger age, higher levels of depression, social anxiety, and lower levels of self-esteem, ego-resiliency, and social support were found to be significantly correlated with suicidal ideation. In the final model, higher levels of depression and social anxiety were associated with an increased risk of suicidal ideation, while higher levels of self-esteem and social support were associated with a decreased risk of suicidal ideation. Although the independent effect was not significant, the interactions of ego-resiliency with both depression and social anxiety on suicidal ideation were significant. Higher levels of ego-resiliency acted as a buffer against suicidal ideation among those with higher levels of depression or social anxiety. Conclusions In addition to risk factors, this study revealed the underlying protective and moderating factors of suicidal ideation among medical students. Mental health programs focusing on enhancing ego-resiliency, self-esteem, and social support may contribute to suicide prevention in medical students.
... Additionally, a study that examined the predictors of financial anxiety among university students discovered that students who are from families with a difficult financial situation experience greater anxiety compared to their peers without financial difficulties (Potter at al., 2020). On the contrary, various research also discovered that students' family socioeconomic status has a negative correlation with their social anxiety (Cheng et al., 2015;Demir et al., 2013;Schneier et al., 1992). Based on this argument, the fifth hypothesis is generated: ...
Article
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University education is viewed as an honourable level of education as it enables personal development in different areas of expertise through scientific exposure. Over the last few years, there has been a significant increase on the issues of rising cost of education, as well as students’ emotional fragility within the higher education sector which may link to many negative outcomes. This article aims to examine the influence of financial difficulties and sociodemographic characteristics on new university students’ self-esteem using t-test and ANOVA analysis on 411 respondents. Results showed that a student's programme is the only factor that significantly influences a new student’s self-esteem. In light of these surprising findings, this study discussed the implication and strategies, particularly in maintaining students’ self-esteem during their study term.
... Significant gender differences have been found in many aspects of SAD (Asher et al., 2017). For instance, women have been found to have higher prevalence rates of SAD (Kessler et al., 1994;Schneier et al., 1992;Xu et al., 2012) and to report greater clinical severity (Crome et al., 2012;Turk et al., 1998) compared to men. Conversely, social anxiety has been found to result in greater subjective distress in men compared to women (Merikangas et al., 2002) and men with SAD were found to seek treatment to a greater extent compared to women with SAD (Asher et al., 2019;Schneier & Goldmark, 2015). ...
Article
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Background Shame is an important emotion in social anxiety disorder (SAD). However, gender differences in shame, as well as the temporal relationship between shame and anxiety in SAD have not been examined. The present study aimed to address these gaps. Methods Participants were 88 individuals (44 with SAD and 44 without SAD) who completed a 21-day experience sampling measurement (ESM). Specifically, participants reported on their emotions once a day at random times. Results Hierarchical Linear Modeling indicated that individuals with SAD reported significantly more shame compared to individuals without SAD. In addition, women reported significantly more shame compared to men. Importantly, gender differences in shame were more pronounced among individuals with SAD compared to those without SAD. Finally, we found that for individuals without SAD, shame on a given day significantly predicted anxiety on the following day among men but not among women, whereas for individuals with SAD, shame on a given day significantly predicted anxiety on the following day among both men and women. Conclusions Our findings suggest that shame may play a role in the maintenance of SAD. In addition, our findings suggest that social anxiety disorder may impact women’s experience of shame more than men’s.
... According to Turner, Beidel, Dancu, and Keys (1986), more than 90% of a group of social phobics reported that their anxiety interfered significantly with occupational functioning. In addition, Schneier, Johnson, Hornig, Liebowitz, and Weissman (1992) indicated that more than 82% of their sample acknowledged difficulties in occupational functioning, which, in some cases, was associated with greater financial hardship. However, the previous studies were based on survey data, and to date no research has attempted to assess specific occupational adjustment variables that might be impacted by social phobia. ...
Article
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This study examined whether social phobics differed from nonanxious controls in occupational adjustment. Results indicated that generalized and nongeneralized social phobics, in contrast to controls, were underemployed and believed that their supervisor would rate them as less dependable. Nongeneralized social phobics and controls believed their supervisor would rate them higher in work role conformance and likelihood of advancement than did generalized social phobics. Generalized socially phobic women, in contrast to nongeneralized and control group women, were more likely to be employed in noninterpersonally oriented jobs. Generalized social phobics were more anxious than controls when starting their current job but did not differ in job satisfaction. Results are discussed relative to the nature of social phobia, subtype differences, and counseling services.
... with a lifetime diagnosis of social anxiety disorder also had a history of mood disorders, compared with 14.5% of individuals without social anxiety disorder (Kessler, Stang, Wittchen, Stein, & Walters, 1999). The onset of social anxiety disorder also preceded the onset of depression in about 70% of comorbid cases in both the NCS and the Epidemiological Catchment Area Study (Schneier et al., 1992). In clinical samples of patients with social anxiety, rates of lifetime diagnoses of mood disorders range from 11% to 70%, with most reports converging at around 40% (T. A. Brown & Barlow, 1992;Stein, Tancer, Gelernter, Vittone, & Uhde, 1990;Van Ameringen, Mancini, Styan, & Donison, 1991). ...
Article
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Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxiety disorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety were best represented by anxious and secure attachment style clusters. Members of the anxious attachment cluster exhibited more severe social anxiety and avoidance, greater depression, greater impairment, and lower life satisfaction than members of the secure attachment cluster. This pattern was replicated in a separate sample of 56 patients and compared with the pattern found in 36 control participants. Social anxiety mediated the association between attachment insecurity and depression. Findings are discussed in the context of their relevance to the etiology, maintenance, and cognitive–behavioral treatment of social anxiety disorder.
... Common co-occurring disorders include generalized anxiety disorder, major depression, obsessive-compulsive personality disorder, and avoidant personality disorder (Klass, DiNardo, & Barlow, 1989;Sanderson, Rapee, & Barlow, 1987;Schneier et al., 1992;Turner et al., 1991). Two subtypes of social phobia currently are recognized: those with the generalized subtype experience distress across a broad range of social encounters, and those with the specific (circumscribed) subtype experience distress in only one or a few social encounters. ...
Article
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Sixty-eight individuals with specific or generalized social phobia and 25 normal controls were assessed for presence of a family history of anxiety, childhood shyness, traumatic conditioning experiences, neuroticism, and extraversion. Subtype differences emerged, including significantly greater neuroticism and a more frequent history of shyness in the generalized subtype. Those with the generalized subtype also had significantly lower extraversion scores, and those with the specific subtype had a significantly higher frequency of traumatic conditioning episodes. Together, traumatic conditioning and childhood shyness predicted the presence of social phobia, although other unidentified factors also appeared to be relevant. The results are discussed in terms of potentially different modes of onset for the subtypes of social phobia and the role of neuroticism and introversion in the development of the disorder.
... Social phobia (SP) is a prevalent, chronic, and potentially disabling anxiety disorder that has only relatively recently been identified (Kessler et al., 1994;Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). Affected individuals are fearful and often avoidant of either circumscribed social situations (eating, writing, speaking in public) or more generally to all situations involving interpersonal contact. ...
Article
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Anxiety disorders are the most prevalent mental disorders in the United States. In the past 3 decades, substantial advances have been made in the ability to identify and treat anxiety disorders including panic disorder (PD), social phobia (SP), obsessive–compulsive disorder (OCD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). It is now known that these common, usually chronic disorders confer significant disability to untreated sufferers. This overview highlights some of the important advances in pharmacological treatment of anxiety disorders. Evidence for efficacy of the various pharmacological agents (including relevant oral dosing and plasma-level data) and of acute and long-term treatment, and the disadvantages of medication treatment are discussed. Finally, some important clinical questions remaining to be addressed by psychopharmacological research are reviewed.
... In contrast to the aforementioned mild anxiolytic MS effects, MS-Veh in contrast to noMS-Veh males did not prefer a wire-mesh cage containing a male social stimulus mouse over an empty cage during SPAT1, indicating a MS-induced lack of social preference (Slattery et al., 2012). Of note, both depression and anxiety disorders are often accompanied by social phobia (Schneier et al., 1992), and a decrease in social interest and lack of social preference have been reported to either reflect enhanced depression-related behavior (Berton et al., 2006;Krishnan et al., 2007) or signs of social anxiety (Kalueff et al., 2006). Importantly, this MS-induced lack of social preference was absent in MS males repeatedly administered s.c. with M. vaccae subsequent to MS exposure, indicating that M. vaccae is able to prevent or reverse development of MS-induced social deficits in male mice. ...
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Chronic psychosocial stress is a burden of modern society and poses a clear risk factor for a plethora of somatic and affective disorders, of which most are associated with an activated immune status and chronic low-grade inflammation. Preclinical and clinical studies further suggest that a failure in immunoregulation promotes an over-reaction of the inflammatory stress response and, thus, predisposes an individual to the development of stress-related disorders. Therefore, all genetic (i.e., sex) and environmental (i.e., early life adversity; ELA) factors facilitating an adult's inflammatory stress response are likely to increase their stress vulnerability. In the present study we investigated whether repeated subcutaneous (s.c.) administrations with a heat-killed preparation of Mycobacterium vaccae (M. vaccae; National Collection of Type Cultures (NCTC) 11659), an abundant soil saprophyte with immunoregulatory properties, are protective against negative behavioral, immunological and physiological consequences of ELA alone or of ELA followed by chronic psychosocial stress during adulthood (CAS) in male and female mice. ELA was induced by the maternal separation (MS) paradigm, CAS was induced by 19 days of chronic subordinate colony housing (CSC) in males and by a 7-week exposure to the social instability paradigm (SIP) in females. Our data indicate that ELA effects in both sexes, although relatively mild, were to a great extent prevented by subsequent s.c. M. vaccae administrations. Moreover, although the use of different paradigms for males and females impedes a direct comparison, male mice seemed to be more susceptible to CAS than females, with only females benefitting slightly from the stress protective effects of s.c. M. vaccae administrations when given prior to CAS alone. Finally, our data support the hypothesis that female mice are more vulnerable to the additive effects of ELA and CAS than male mice and that s.c. M. vaccae administrations subsequent to ELA but prior to CAS are protective in both sexes. Taken together and considering the limitation that CAS in males and females was induced by different paradigms, our findings are consistent with the hypotheses that murine stress vulnerability during different phases of life is strongly sex dependent and that developing immunoregulatory approaches, such as repeated s.c. administrations with immunoregulatory microorganisms, have potential for prevention/treatment of stress-related disorders.
... Previous studies have reported a 2%-19% comorbidity of OCD with SAD (Koyuncu et al., 2014;Schneier et al., 1992) and an 8%-42% comorbidity of SAD with OCD (Torres et al., 2006). In the present study, the percentage of OCD in SAD was 17%, and the percentage of SAD in OCD was 28.8%, which is consistent with previous studies. ...
Article
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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.
... Le trouble d'anxiété sociale et le trouble de l'usage d'alcool sont deux pathologies mentales parmi les plus prévalentes, toutes les deux associées à un grand handicap fonctionnel (3)(4)(5). Leur coexistence est également très fréquente (5)(6)(7)(8)(9), comme l'illustre une étude épidémiologique en population générale (10) : la prévalence du TUA sur l'ensemble de la vie chez les individus souffrant de TAS est de 48 %. Sur la même cohorte, la prévalence du TUA à un an chez les personnes présentant un TAS était de 13.1 %, comparé à 8.5 % en population générale. ...
Article
Alcohol use disorder and social anxiety disorder are two common and disabling conditions that share a frequent co-existence. If this co-existence is well documented in epidemiological studies, less is known about the nature of this relation and on a broader perspective, between social anxiety disorder and alcohol use. The aim of this article is to bring an update to the current literature concerning these topics in a way useful for the clinical practice. If there is no validated empirical model treating the comorbidity, we underline that alcohol use disorder is often a social bonds disorder. Personal and social factors have a moderating role in these bonds. All of these variables have a major clinical impact and should therefore be take into account for any prevention or treatment measure.
... SAD often involves negative evaluation and rejection by others and a constant fear of embarrassment or humiliation [3]. Therefore, individuals with SAD often avoid social interactions, which may have detrimental impacts on most areas of life, including their career, education, social relationships, and mental health [4]. Social anxiety usually emerges during performance situations (such as job interviews, public presentations, or attending a meeting) and interpersonal situations (such as greeting someone, drinking and eating in public, taking part in social gatherings, or shopping). ...
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Background Social anxiety disorder (SAD), also known as social phobia, is one of the most common mental disorders worldwide. In Hong Kong, the prevalence of SAD is high, but its treatment rate is low. SAD has immense impact on academic or work performance, social life, career development, and quality of life. One of the most effective treatments for SAD is cognitive behavioral therapy (CBT), with internet-based CBT (iCBT) and virtual reality exposure therapy (VRET) showing promise in treating SAD. However, internet interventions are underdeveloped in Chinese communities including Hong Kong. Objective This study aims to develop an iCBT program that includes VRET, called “Ease Anxiety in Social Event Online” (Ease Online), for Hong Kong adults with SAD in a randomized controlled trial. Methods The 14-week Ease Online program is a guided self-help iCBT program with a blended mode of service delivery. The program comprises 9 web-based modules and 5 individual counseling sessions (including 2 VRET sessions) conducted remotely or face-to-face with a therapist to provide therapist support, as guided iCBT shows superior effects than unguided iCBT. Other program components include therapist feedback on assignments, internal messages, forums, client portfolios, web-based questionnaires, reminders, and web-based bookings. The program can be accessed either through a mobile app or program website through a PC with an internet connection. The participants are openly recruited and screened using a questionnaire and through an intake interview. Eligible participants are randomized by placing them into a web-based iCBT group, app-based iCBT group, or a waitlist control (WLC) group. Participants in the WLC group are assigned to the app-based program upon completion of the service of the 2 experimental groups. Measurements of social anxiety, depression and anxiety symptoms, psychological distress, automatic thoughts, and quality of life are administered at pretest, posttest, and 3- and 6-month follow-ups. Multivariate ANOVA with repeated measures will be performed to determine the intervention effectiveness on the continuous variables over time. ResultsParticipant recruitment commenced in January 2021. As of February 2023, a total of 1811 individuals applied for the Ease Online program. In total, 401 intake interviews have been completed, and 329 eligible participants have joined the program, among whom 166 have completed the service. Data collection is still ongoing, which is expected to be completed in March 2024. Conclusions This study is the first of its kind in combining iCBT and VRET for the treatment of SAD in Hong Kong. At a theoretical level, this study contributes to the development and evaluation of internet-based psychological interventions in Hong Kong. At a practical level, the Ease Online program may serve as an alternative service option for SAD clients in Hong Kong if proven effective. Trial RegistrationClinicalTrials.gov NCT04995913; https://clinicaltrials.gov/study/NCT04995913 International Registered Report Identifier (IRRID)DERR1-10.2196/48437
... Meanwhile, this study demonstrated the highest bridge strength in social phobia in female patients with PD, which formed a bridge to depressive symptoms (cluster 4). Social phobia can easily lead to depressive disorders by causing functional degradation in social relations as well as interpersonal difficulties, and social anxiety exists at a significant level in the symptomatology of PD (Schneier et al., 1992). In particular, as social anxiety is a central bridging symptom that leads to depression in women, as reflected by our findings, it is necessary to pay more attention to the social anxiety of women with PD in clinical practice. ...
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Background: It has been suggested that gender differences in anxiety and depressive symptoms characterize panic disorder (PD) in terms of vulnerability to stressful life events, anxiety, depressive symptom patterns, and brain structure. However, few studies have investigated the gender differences in PD using a network approach. Methods: This study included 619 participants with PD (313 men). The Panic Disorder Severity Scale, Albany Panic and Phobia Questionnaire, and Beck Depression Inventory-II were used to evaluate symptomatology. To investigate the PD-related white matter (WM) neural correlates, tract-based spatial statistics were used. The PD-related clinical scales and WM neural correlates were included in the network analysis to identify associations between variables. To evaluate network differences between genders, network comparison tests were conducted. Results: Our findings revealed that agoraphobia in men was the strongest central symptom. In addition, loss of pleasure, and not anxiety or panic symptoms, was the strongest central symptom in women with PD. The network comparison test revealed that the bridge strength score was higher in agoraphobia and tiredness in men and in self-criticalness in women. Furthermore, in the network that includes neural correlates of WM, the bridge strength score was higher in the cingulate gyrus WM in men and the cingulum hippocampus in women. Limitations: Since this is a cross-sectional network study of PD patients, the causal relationship between interactions in this network analysis for both genders may not be accurately determined. Conclusion: Network structures of anxiety and depressive symptomatology and related WM neural correlates can differ according to gender in PD patients.
... SAD typically begins early in life and tends to run a chronic, often lifelong, course [4]. It is associated with serious functional disability and markedly reduced quality of life [5] with up to 69% of sufferers experiencing another lifetime major comorbid disorder [6]. In particular, SAD markedly increases the risk of subsequent depression [7] which is associated with a poorer prognosis and greater risk of suicide attempts [8]. ...
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The microbiome-gut-brain axis plays a role in anxiety, the stress response and social development, and is of growing interest in neuropsychiatric conditions. The gut microbiota shows compositional alterations in a variety of psychiatric disorders including depression, generalised anxiety disorder (GAD), autism spectrum disorder (ASD) and schizophrenia but studies investigating the gut microbiome in social anxiety disorder (SAD) are very limited. Using whole-genome shotgun analysis of 49 faecal samples (31 cases and 18 sex- and age-matched controls), we analysed compositional and functional differences in the gut microbiome of patients with SAD in comparison to healthy controls. Overall microbiota composition, as measured by beta-diversity, was found to be different between the SAD and control groups and several taxonomic differences were seen at a genus- and species-level. The relative abundance of the genera Anaeromassillibacillus and Gordonibacter were elevated in SAD, while Parasuterella was enriched in healthy controls. At a species-level, Anaeromassilibacillus sp An250 was found to be more abundant in SAD patients while Parasutterella excrementihominis was higher in controls. No differences were seen in alpha diversity. In relation to functional differences, the gut metabolic module ‘aspartate degradation I’ was elevated in SAD patients. In conclusion, the gut microbiome of patients with SAD differs in composition and function to that of healthy controls. Larger, longitudinal studies are warranted to validate these preliminary results and explore the clinical implications of these microbiome changes.
... The association may be due to a lack of family interaction and the emotional toll that losing or separating from parents may have had on the family [45]. The other evidence might be due to the effect of the absence of social interaction, socio-economic, and psychological support which is exposed to social phobia [34,46]. ...
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Background Social anxiety disorder is defined as the fear of social situations, incorporating situations that involve contact with strangers. People highly fear embarrassing themselves which includes situations like social gatherings, oral presentations, and meeting new people. People with social phobia have nonspecific fears of practicing vague or, performing specific tasks like eating or speaking in front of others. In people with social anxiety disorder, worry can arise from both the circumstance itself and embarrassment from others, for students, social phobia is an overwhelming fear of speaking in front of others or giving presentations in class. The prevalence of social phobia among different studies in Ethiopia was inconsistent and inconclusive therefore, this study showed the cumulative burden of social phobia among students in Ethiopia. Method Observational studies published on social phobia and associated factors among students in Ethiopia were included in this study based on the criteria after independent selection by two authors. Data were extracted by Microsoft Excel spreadsheet to be exported to Stata version 11 for further analysis. The random-effect model was used to estimate the pooled effect size of social phobia and its effect on the previous studies with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to detect the presence of publication bias. Sub-group analysis and sensitivity analysis were done. Result A total of 2878 study participants from seven studies were included in this meta-analysis and systematic review. The pooled prevalence of social phobia among students in Ethiopia was 26.81% with a 95% CI (22.31–31.30). The pooled effect size of social phobia in Oromia, Amhara, and SNNPs regions was 24.76%, 24.76%, and 29.47%, respectively. According to the subgroup analysis, university, and college/high school students were 28.05% and 25.34% respectively. Being female [AOR = 2.11 (95% CI 1.72–2.60)], having poor social support [AOR = 2.38 (95% CI 1.54–3.70)], substance use [AOR = 2.25 (95% CI 1.54–3.30)], single parent [AOR = 5.18 (95% CI 3.30–8.12)], and rural residence [AOR = 2.29 (95% CI 1.91–2.75)] were significantly associated in this meta-analysis in Ethiopia. Conclusion The pooled prevalence of social phobia in this meta-analysis and systematic review was high (26.81%) among students therefore, the educational bureau needs to work on decreasing the burden of social phobia to raise the academic achievement and creativity of the students. In therapeutic advice like exposure to presentations, family members take the responsibility for the students’ therapy and expose them to various social interactions.
... Social anxiety increases during adolescence and is common among university students (Grant et al., 2007;Villarosa-Hurlocker et al., 2018). It is associated with adverse outcomes such as depression (Stein et al., 1990;Long et al., 2021), retardation in interpersonal communication development (Schneier et al., 1992;Spence & Rapee, 2016), decline in self-confidence and assertiveness (LeSure-Lester, 2001;Iancu et al., 2015), low academic functioning (Turner et al., 1986;Brook & Willoughby, 2015), increased risk of substance use (Anderson et al., 2011;Page & Andrews, 1996), risk of exposure to sexual bullying (Norris et al., 1996;Schry & White, 2013), an increase in suicidal tendencies (Arditte et al., 2016;Stein et al., 2001). Considering these adverse outcomes, we should take social anxiety seriously before it becomes severe or pathological. ...
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Social anxiety has an increasing pattern during adolescence and is common among university students. It is associated with many adverse outcomes. Although there is considerable progress in social anxiety literature, there are significant gaps, and more research is needed to clarify causal pathways and moderator and mediator effects. This study evaluated the mediating role of cognitive flexibility in the link between fear of negative evaluation and interaction anxiety, which are two main symptom clusters of social anxiety. The sample comprised 552 undergraduate university students, 453 (82.1%) female and 99 (17.9%) male and 4 (0.7%) unspecified, from various departments. The study used self-report measures. Results showed that the fear of negative evaluation is significantly related to interaction anxiety, and cognitive flexibility demonstrates a partial mediation effect in this relationship. These findings contribute to the current literature by revealing cognitive flexibility as a mediator between fear of negative evaluation and interaction anxiety. The results suggest that working on cognitive flexibility may help prevent the development of interaction anxiety in university students.
... In higher education institutions (HEI), those affected and untreated have poor autonomy and impaired college functioning (Park, Edmondson, & Lee, 2012) which often results in them quitting the university prematurely. Several epidemiological studies of social anxiety have determined that SAD usually begins in adolescence, often having a chronic course (Schneier et al., 1992). ...
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... Like our results, İzgiç et al. (4) reported that there was no significant difference between genders in social phobia. In different studies in the literature, it has been reported that the frequency of social phobia is higher in women (6)(7)(8)(9)(10)(11) . In another study, it was stated that although men face more social phobia disorders than women in treatment conditions, it is more prevalent in women in the general population sample (12) . ...
... In particular, while some researchers have found no significant differences in the relationship between parenting style and child social anxiety across genders [53,55], others have demonstrated results inconsistent with our own, finding that negative parental control behaviors were more strongly related to child anxiety in boys than in girls [57]. These findings may, therefore, suggest that although women have higher levels of social anxiety than men overall [44,45,115,116], parenting may be a stronger predictor of social anxiety in samples of boys rather than in samples of girls. ...
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Previous research on the relationship between parenting style and social anxiety in Chinese youth has been inconsistent, which has made it difficult to consider whether improving parenting may serve as a preventative intervention for social anxi- ety. The current study aimed to clarify these inconsistencies by examining the strength of the association between positive/ negative parenting style and social anxiety among Chinese students and the role of certain moderators in those associations. A meta-analysis was conducted on 53 studies with a total sample of 26,024 Chinese mainland students. Separate analyses were conducted for positive parenting style and social anxiety (N = 24,081), and negative parenting style and social anxiety (N = 24,933). Findings suggest a small negative association exists between positive parenting style and social anxiety, and a small positive association exists between negative parenting style and child social anxiety. Analyses suggested type of social anxiety measures, developmental stage, and gender all moderated the relationships between parenting style and social anxi- ety. Results clarify the direction of the relationship between parenting and social anxiety amongst Chinese youth and point to particular implications and future directions for policy, practice, and research.
... Általában serdülôkorban kezdôdik, és ha diagnosztizálatlan és kezeletlen marad, évekig vagy akár egy életen át fennmaradhat, mely komoly terhet jelent az érintetteknek, a családjuknak és a társadalomnak egyaránt. Nôk körében másfélszer gyakrabban fordul elô, mint férfiaknál (4). A SAD krónikus, az esetek 20%-ában tartós munkaképtelenséghez vezet, aluldiagnosztizált (5) és a súlyosság szempontjából olyan kontinuumként fogható fel (6), melyen a szorongás intenzitásától függôen jelentkeznek a különbözô állapotok a szubklinikus félénkségtôl kezdve a több helyzetben megnyilvánuló gátlásosságon keresztül az intenzív szorongással jellemezhetô szociális szorongásig. ...
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Objective Although elevated social anxiety in developmental prosopagnosia (DP) has been reported in anecdotal and qualitative studies, the current study sought to better quantify the prevalence, severity, and moderators of social anxiety in a large DP sample. Method A total of 88 DPs and 58 controls completed the validated Social Interaction Anxiety Scale and assessments of face recognition, autism traits, personality (Big Five Inventory), and coping strategies. Results DPs reported greater social anxiety symptoms (M = 30.25) than controls (M = 17.19), with 44% of DPs above a probable clinical cutoff compared with 14% of controls. Exploratory analyses revealed that DPs’ social anxiety was more specific to items pertaining to mixing socially or interacting with unfamiliar people. Notably, several DPs reported minimal social anxiety, which was associated with being more extraverted and having fewer autism traits. A follow-up survey revealed that extraverted DPs more openly disclosed face recognition inabilities than introverted DPs, which may be a factor in their reduced social anxiety. Conclusion These results better quantify the potential serious psychosocial consequences of DP and highlight the importance of individual differences as well as targeted intervention.
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Background Social Anxiety Disorder (SAD) is an anxiety disorder characterized by excessive fear of scrutiny in social situations. Health students are more susceptible to SAD due to academic demands. They may resort to self-medication, particularly beta-blockers (BBs) for managing physical symptoms of SAD. The study aims to investigate the prevalence of beta-blocker use and its relationship with social anxiety disorder among health students at Umm Al-Qura University. Methods In this cross-sectional study, 461 undergraduate health students participated in a questionnaire with 30 questions divided into three sections: The Social Phobia Inventory (SPIN), BBs usage behavior questionnaire, and demographic characteristics. Results The study found 56.2% had SAD. A total of 7.8% of the sample reported using BBs, and no significant correlation was found between the usage of BBs and the SAD score (P = 0.085). Conclusion The study revealed significant relationships between the presence of SAD with gender, history of mental conditions, and correlation between the use of BBs with history of mental conditions. Although BBs usage is low among health students, the prevalence of SAD is alarming. The results could raise awareness about the need for early detection of SAD among health students.
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Edvard Munch, a founder of Expressionism was pre-occupied with depicting his subjective experience and the most prolific painter of self-portraits since Rembrandt. Based on evidence that faces and self-related images are more salient than other objects it is plausible that self-portraits, in which the subject and object are the same, reflect the artist’s state of mind. Although he suffered from a variety of physical and psychological illness Munch was not diagnosed with any specificity in his lifetime. Posthumous diagnoses include schizophrenia, anxiety, bipolar and other disorders. Recent research has revealed altered visual perception in such patients. The present study empirically analysed three stylistic elements of Munch’s painted self-portraits and portraits: contrast, colour and fractal dimension and his painted productivity, to determine if variations correlate with critical life events and if so whether they indicate states of mind. It found significant increases in contrast and colour brightness and persistent high complexity during critical periods supporting the conclusion that Munch is diagnostically best described as suffering from early onset schizophrenia and comorbid social anxiety disorder.
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This study aimed to examine the mediating role of rumination in the relationship between adverse childhood experiences and social anxiety disorder symptoms. In this study, which was conducted with correlational design, one of the quantitative research methods, 878 participants were reached. 78.2% of the participants are women and 21.8% are men. In the study, self-report scales consisting of a personal information form, adverse childhood experiences scale, rumination scale, and Liebowitz social anxiety scale were administered to the participants. The analysis of the data regarding the research findings was carried out using the SPSS 25 package program. First of all, the relationship between adverse childhood experiences and social anxiety and rumination was examined; Then, parallel multi-agent analysis and serial intermediary analyses were performed using the Process V4.2 extension (Model 4). According to the findings, it was found that there was a significant positive relationship between adverse childhood experiences, social anxiety disorder symptoms, and rumination variables. It has also been observed that rumination has a mediating role in the relationship between adverse childhood experiences and social anxiety disorder symptoms. Examining the role of rumination in the relationship between childhood adverse events and social anxiety symptoms may help develop new interventions targeting SAD and expand the literature on the cognitive, behavioral, and affective vulnerabilities that early adverse events bring with them.
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Introduction Due to their similar behavioral presentation, it can sometimes be challenging to distinguish between a social anxiety disorder (SAD) and the social avoidance that is frequently described in autism spectrum disorder (ASD). Moreover, a growing body of evidences is reporting that a significant proportion of subjects with ASD also meet the requirements for SAD and, vice versa, subjects with SAD tend to exhibit a higher prevalence of autistic traits. Aim In this framework, the current study aims to evaluate prevalence and correlates of autistic traits in a sample of adult subjects diagnosed with SAD and healthy controls (HC), also evaluating which autism spectrum dimensions may statistically predict higher SAD symptoms. Methods 56 subjects with a clinical diagnosis of SAD and 56 gender and age matched HC were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, the Social Anxiety Spectrum – Short Version (SHY- SV) and the Adult Autism Subthreshold Spectrum (AdAS Spectrum). Results SAD group scored significantly higher in all AdAS Spectrum and SHY-SV domains and total score compared to the HC group with no significant gender difference. SHY-SV total and domain scores, were strongly and positively and strongly correlated with all AdAS Spectrum domains and total score. AdAS Spectrum total score and Childhood/Adolescence, Non-Verbal Communication, Empathy and Restricted interests and Rumination domain scores score were significant predictors of higher SHY-SV score. Conclusion Our results confirm the link between SAD and autistic traits also in adult population, describing not only high levels of autistic traits in SAD adults, but also significant correlations between many core features of the two disorders and a predictive role of autistic traits on higher SAD symptoms.
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The purposes of this brief integrative review are to identify and critically evaluate recent work in the area of Dialectical Behavior Therapy-Skills Group (DBT-SG) for Social Anxiety Disorder (SAD) with suicidal ideation (SI) and to suggest further how DBT-based skills may be applied to cognitive maintenance factors of SAD. Accordingly, we first evaluate the relevance of DBT in treating SI in other disorders. Second, we evaluate the relationship between SI and SAD, providing considerations for the complexity of comorbid disorders and presentations. Finally, we extend this knowledge to discuss considerations for the use of DBT-SG skills to target specific etiological and maintenance elements of SAD, with a focus on four themes (interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance). Overall, we conclude that DBT-SG may prove beneficial in reducing SI and symptoms in SAD that impact social and emotional functioning.
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Background Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs. Methods Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively. Results Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind–body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John’s wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as “unclear, unambiguous, or uncertain”. No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism. Conclusion Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694.
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Adolescence is a key developmental period for socio‐emotional skills, and companion animal relationships may be one potential source of emotional support and resilience during this time. This study used longitudinal data from 940 pet‐owning adolescents, collected over four‐time points, from youth in the Northeastern United States. We assessed whether pet relationship quality (indexed by relationship satisfaction, companionship, and emotional disclosure) predicted trajectories of loneliness, social anxiety, and depression. Results indicated that high satisfaction with a pet relationship was associated with more favorable trajectories, but companionship (i.e., regarding the frequency of interacting with the pet) was not related significantly to socio‐emotional functioning. High levels of disclosure to a pet were linked with less favorable trajectories for loneliness and depression, but not related to social anxiety. These results suggest that a pet relationship can, in some cases, be associated positively with socio‐emotional development, but that there is significant complexity in these associations. Families, educators, and practitioners should take a nuanced approach to understanding individual adolescent‐pet relationships as a contextual asset for specific youth.
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Background: Social anxiety disorder (SAD) and major depressive disorder (MDD) are characterized by behavioral abnormalities in motivational systems, namely, the behavioral inhibition system (BIS) and behavioral activation system (BAS). Limited studies indicate brain volume in regions that support emotion, learning/memory, reward, and cognitive functions relate to BIS/BAS. To increase understanding of BIS/BAS, the current study used a network approach. Methods: Patients with SAD (n=59), MDD (n=64) and healthy controls (n=36) completed a BIS/BAS questionnaire and structural MRI scans; volumetric regions of interest comprised cortical and limbic structures based on previous BIS/BAS studies. Bayesian Gaussian graphical model was used for each diagnostic group and groups were compared. Among network metrics, bridge centrality was of primary interest. Analysis of variance (ANOVA) evaluated BIS/BAS behaviors between groups. Results: Bridge centrality showed hippocampus positively related to BAS, but not BIS, in MDD; no findings were observed in SAD or control groups. Yet, network density (i.e., overall strength of relationships between variables) and degree centrality (i.e., overall relationship between one variable to all other variables) showed cortical (e.g., precuneus, medial orbitofrontal) and subcortical regions (e.g., amygdala, hippocampus) differed between diagnostic groups. ANOVA results showed BAS was lower in the MDD/SAD groups compared to controls, while BIS was higher in the SAD relative to MDD group, which in turn was higher than controls. Conclusions: Preliminary findings indicate network-level aberrations may underlie motivational abnormalities in MDD and SAD. Evidence of BIS/BAS differences builds on previous work that points to shared and distinct motivational differences in internalizing psychopathologies.
Chapter
The diagnosis and management of anxiety disorders have evolved greatly during the past 50 years. For the clinician, a careful assessment of the patient is critical in formulating an appropriate treatment plan. Once a diagnosis has been made, a range of psychological and medical treatments are available. The authors suggest a structured classification of anxiety disorders according to their symptoms, and of drug therapies according to their mechanism of action. The evidence for effectiveness of medications in each of the major anxiety disorders is reviewed and a series of treatment algorithms are proposed. Likely future developments are considered.
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Background Social anxiety disorder (SAD) is characterized by abnormal fear to social cues. Although unisensory processing to social stimuli associated with social anxiety (SA) has been well described, how multisensory processing relates to SA is still open to clarification. Using electroencephalography (EEG) measurement, we investigated the neural correlates of multisensory processing and related temporal dynamics in social anxiety disorder (SAD). Methods Twenty-five SAD participants and 23 healthy control (HC) participants were presented with angry and neutral faces, voices and their combinations with congruent emotions and they completed an emotional categorization task. Results We found that face-voice combinations facilitated auditory processing in multiple stages indicated by the acceleration of auditory N1 latency, attenuation of auditory N1 and P250 amplitudes, and decrease of theta power. In addition, bimodal inputs elicited cross-modal integrative activity which is indicated by the enhancement of visual P1, N170, and P3/LPP amplitudes and superadditive response of P1 and P3/LPP. More importantly, excessively greater integrative activity (at P3/LPP amplitude) was found in SAD participants, and this abnormal integrative activity in both early and late temporal stages was related to the larger interpretation bias of miscategorizing neutral face-voice combinations as angry. Conclusion The study revealed that neural correlates of multisensory processing was aberrant in SAD and it was related to the interpretation bias to multimodal social cues in multiple processing stages. Our findings suggest that deficit in multisensory processing might be an important factor in the psychopathology of SA.
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QUALITY CHANGES THROUGH RESEARCH– EXPERIENCES, EXPECTATIONS & ENHANCEMENT Editors DR.P.R.MUTHUSWAMY Conference Director & Principal Dr.N.G.P.Arts & Science College DR.V.RAMAKRISHNAN Conference Director & Principal Dr.N.G.P.College of Education DR.S.SARAVANAN Organising Secretary& Head, Commerce (IT) Dr.N.G.P.Arts & Science College DR.V.SHANMUGARAJU Organising Secretary& Head, Biotechnology Dr.N.G.P.Arts & Science College K.JAISHREE Joint Secretary& Assistant Professor Dr.N.G.P.College of Education K.PRABHU Joint Secretary& Assistant Professor Dr.N.G.P.College of Education
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Background: Social anxiety disorder (SAD) is associated with aberrant emotional information processing while little is known about non-emotional cognitive processing biases. The dorsal anterior cingulate cortex (dACC) has been implicated in SAD neuropathology and is activated both by emotional and non-affective cognitive challenges like the Multisource Interference Task (MSIT). Methods: Here, we used fMRI to compare dACC activity and test performance during MSIT in 69 SAD patients and 38 healthy controls. In addition to patient-control comparisons, we examined whether neural activity in the dACC correlated with social anxiety, trait anxiety or depression levels. Results: The MSIT activated the dACC as expected but with no differences in task performance or neural reactivity between SAD patients and controls. There were no significant correlations between dACC activity and social or trait anxiety symptom severity. In patients, there was a significant negative correlation between dACC activity and depressive symptoms. Conclusions: In absence of affective challenge, we found no disorder-related cognitive profile in SAD patients since neither MSIT task performance nor dACC neural activity deviated in patients relative to controls.
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Purpose: The purpose of this research is to study of the relationship between the social appearance anxiety levels and conscious awareness levels of the students studying at the university in terms of sports and different variables. The study was carried out on a total of 1000 individuals, 503 female and 497 male students studying at Atatürk University in 2018 – 2019 academic year. Method: İn this study , the scale of social appearance anxiety, a self report scale developed Hart and his friend(2008) was used to measure the emotional , cognitive and behavioral anxiety experienced by the individual. Used by Tayfun Doğan (2010).And the conscious awareness scale developed by Brown and Ryan(2003) was used to measure the level of awareness. For data analiysis, the data were transferred to the computer via the SPSS package program. Used by Zümra Özyeşil (2011). Frequency distiribution in the determination of propertion in data analysis, T test to examine the relationship between the two independent variables and the level of awareness of concscious with social appearance, Anova Waryans ana1ysis tests were used to examine the relationship between social appearance anxiety levels and conscious awareness levels with more than two variable. The difference between the variables was interpreted on the basis of P.0.05 significance level. Findings: According to findings, it was found that the students’ social anxiety levels were significantly different depending on the variables such as gender, age, personal monthly income, type of sports activity and the duration of performing weekly sport achvities. The level of conscious awareness was also found to be significantly different depending on variables such as the duration of weekly sporting activity and the aim of making sportive activitiess. A significant relationship was found between students’social appearance anxiety levels and conscious awareness levels. Result : In order to reduce the negative effects of social appearance anxiety in our daily lives, training based on conscious awareness can be extended. Key Words: Social Appearance Anxiety, Conscious Awareness, Sportive Activity, University Students
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Epidemiological studies show that anxiety disorders are highly prevalent and an important cause of functional impairment; they constitute the most frequent menial disorders in the community. Phobias are the most common with the highest rates for simple phobia and agoraphobia. Panic disorder (PD) and obsessive-compulsive disorder (OCD) are less frequent (2% lifetime prevalence), and there are discordant results for social phobia (SP) (2%-16%) and generalized anxiety disorder (GAD) (3%-30%). These studies underline the importance of an accurate definition of disorders using unambiguous diagnostic and assessment criteria. The boundaries between anxiety disorders are often ill defined and cases may vary widely according to the definition applied. Simple phobia, agoraphobia, and GAD are more common in vmrnen, while there is no gender différence for SP, PD, and OCD, Anxiety disorders are more common in separated, divorced, and widowed subjects; their prevalence is highest in subjects aged 25 to 44 years and lowest in subjects aged >65 years. The age of onset of the different types of anxiety disorders varies widely: phobic disorders begin early in life, whereas PD occurs in young adulthood. Clinical - rather than epidemiological - studies have examined risk factors such as life events, childhood experiences, and familial factors. Anxiety disorders have a chronic and persistent course, and are frequently comorbid with other anxiety disorders, depressive disorders, and substance abuse. Anxiety disorders most frequently precede depressive disorders or substance abuse, Comorbid diagnoses may influence risk factors like functional impairment and quality of life. It remains unclear whether certain anxiety disorders (eg, PD) are risk factors for suicide. The comorbidity of anxiety disorders has important implications for assessment and treatment and the risk factors should be explored. The etiology, natural history, and outcome of these disorders need to be further addressed in epidemiological studies.
Thesis
p>Social phobia is one of the most common anxiety disorders in childhood. However, there is currently no widely used and accepted model of social phobia for young people. In the literature reviews, the adult models of social phobia are discussed and researched based on them reviewed. Current models of anxiety and social anxiety in children are then considered and the research conducted on children is described. Comparisons between the adult and child models are made and suggestions for a more comprehensive model of social phobia for children, based on the Clark and Wells (1995) adult model of social phobia, are proposed. As part of their model, Clark and Wells (1995) propose that negative self-images, often visual images seen and recalled from the perspective of an observer (OP), are an important maintaining factor in social phobia. The OP can be contrasted with a field perspective (FP; where visual images are recalled from an individual’s perspective). The present empirical study explored the relevance of the OP to children. Fifty-eight children (aged 7 – 14 years) recalled memories of social and physical situations and were asked to label the perspective they used (OP or FP). Social anxiety, memory distress and memory age were also measured. Children did recall OP memories. OP was not related to child’s age, social anxiety or social memories. Interestingly, OP was related to older social memories, but not to memory distress. Possible reasons for the findings and the potential implications for the models of social phobia in child development are discussed.</p
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Social anxiety disorder (SAD) and major depressive disorder (MDD) are highly comorbid with each other, and comorbidity exacerbates distress and impairment. The prevalence of comorbid depression is higher in women with SAD than in men with SAD, but this is based on global depression scores and cannot speak to heterogeneous individual depression symptoms. The current study bridges this gap by examining gender differences in the relationship between social interaction anxiety and individual depression symptoms. 165 community adults (113 women, 52 men) were included in a series of bootstrapped moderation analyses to examine the main and interaction effects of social interaction anxiety and gender on total depression and individual depressive symptom scores while controlling for age and racial/ethnic background. Social interaction anxiety positively predicted total and individual depression scores. Greater social interaction anxiety predicted greater self-dislike and worthlessness in men than in women. Our findings replicate the finding that social anxiety and depression are highly comorbid with respect to total scores and extend this finding to individual symptoms. Our findings also demonstrate that the relationship between social interaction anxiety and depressive symptoms can be modulated by gender identities. Men with social interaction anxiety may be more prone to distress associated with self/identity. These findings elucidate the specific ways in which social interaction anxiety relates to the constellation of depression symptoms in men and women and highlights the need for more tailored assessment and intervention for socially anxious men and women to target individual dimensions of symptom presentations.
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Social norm transgressions are assumed to be at the root of numerous substantial negative outcomes for transgressors. There is a prevailing notion among lay people and scholars that transgressing social norms can negatively impact one’s mental health. The present research aimed to examine this assumption, focusing on clinically relevant outcomes such as anxiety and depression. The present research further aimed to examine a social cognitive process for these outcomes in the form of fear of negative evaluations as a result of one’s norm transgressing behavior. Specifically, it examined whether it is negative evaluations about ourselves or about those close to us that mediates the effect of social norm transgressions, and whether those may vary as a function of culture. Results of the present research, including a study with a community sample (N = 410), suggest a positive association between social norm transgressions and psychological distress. Results also suggest that increased fear of negative evaluation mediates that association but does so differently for people from more collectivistic cultures and people from less collectivistic cultures. For people from more collectivistic cultures increased fear of negative evaluation of close others may mediate the association between social norm transgressions and psychological distress. However, for people from less collectivistic cultures that association may be mediated by increased fear of negative evaluation of oneself. Implications for research on consequences of social norm transgressions and cross-cultural differences in perceptions of such consequences are discussed as are practical implications for motivating social norm adherence and the maintenance of constructive social norms.
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Parental verbal threat (vs. safety) information regarding the social world may impact a child's fear responses, evident in subjective, behavioral, cognitive, and physiological indices of fear. In this study, primary caregivers provided standardized verbal threat or safety information to their child (N = 68, M = 5.27 years; 34 girls) regarding two strangers in the lab. Following this manipulation, children reported fear beliefs for each stranger. Physiological and behavioral reactions were recorded as children engaged with the two strangers (who were blind to their characterization) in a social interaction task. Child attention to the strangers was measured in a visual search task. Parents also reported their own, and their child's, social anxiety symptoms. Children reported more fear for the stranger paired with threat information, but no significant differences were found in observed child fear, attention, or heart rate. Higher social anxiety symptoms on the side of the parents and the children exacerbated the effect of parental verbal threat on observed fear. Our findings reveal a causal influence of parental verbal threat information only for child‐reported fear and highlight the need to further refine the conditions under which acquired fear beliefs persist and generalize to behavior/physiology or get overruled by nonaversive real‐life encounters.
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Background Social Anxiety Disorder (SAD) is among the most common anxiety disorders worldwide with data largely emerging from the Euro-American and Pacific Rim populations. In contrast, there is a dearth of studies among the populations of Arabian Gulf countries including Oman. This study has two interrelated aims: (i) to explore the prevalence of SAD among Omani adults, and (ii) to tease out the links between socio-demographic factors and SAD in Oman. Methods A cross-sectional study via an online survey was conducted among 1019 adult Omani nationals residing in Oman. The presence of SAD was assessed using the Arabic version of the Liebowitz Social Anxiety Scale (LSAS). Results Nearly half the participants (45.9%, n = 468) exhibited “caseness” for SAD as defined by LSAS. In the multivariate logistic analysis, participants below 40 years of age were 1.6 times (OR = 1.568, p = .026) more likely to have caseness for SAD than those who were 40 and older. Women were 1.3 times (OR = 1.348, p = .038) more likely to exhibit caseness for SAD than men. Participants who had secondary or undergraduate education were respectively 1.5 times (OR = 1.45, p = .014) and 2.5 times (OR = 2.509, p < .001) to have caseness for SAD than those who were graduates. Conclusion The present data suggest that 45.9% of the participants reached the cut-off for caseness in LSAS, which is high compared to reports from other populations. The present accrued frequency is discussed within the context of the accrued response rate, socio-cultural factors as well as the tendency for self-reported measures to “produce” spurious results is also highlighted which, in turn, calls for studies that adopt more inclusive survey methods.
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According to cognitive models, preferential attention to social threat contributes to maintenance of social anxiety. Socially anxious individuals are known to show attention biases to threatening stimuli, although there is inconsistency in the literature with regards to the type of attentional biases they present. This study examines the effect of attention bias modification (ABM) for social anxiety in non-treatment-seeking college students meeting social anxiety disorder criteria, taking into consideration previous mixed results regarding its effectiveness. Attention bias levels and types (i.e. vigilance vs avoidance) at baseline were examined and considered as potential moderators of ABM effects. Sixty-eight socially anxious individuals were randomly allocated to ABM vs placebo groups. A structured interview and self-report assessment were completed at pre-treatment and post-treatment. Results showed half of the participants presented few attention biases at baseline, and the rest presented either vigilance or avoidance. Participants with low attention biases scored higher in social anxiety than those showing avoidance and there was no difference between those showing vigilance vs avoidance. No significant effects from pre to post treatment were observed in attention biases, self-report or structured interview of anxiety in the ABM group. Baseline attention biases did not moderate these effects. Results are discussed with regards to implications for future research towards the creation of more effective protocols, based on the needs of heterogeneous social anxiety sub-groups.
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Ninety-eight outpatients meeting DSM-III-R criteria for social phobia were evaluated for past history of RDC alcoholism using the SADS-LA structured interview. The resulting 16 subjects with a history of alcoholism were then compared to the 82 nonalcoholic social phobics. The alcoholic social phobics had more severe social phobia and tended to be less likely to be married. Both groups were similar in other measures of demographics. The mean age of onset of social phobia was significantly earlier than the mean age of onset of alcoholism, and social phobia preceded alcoholism in 15 of the 16 dual diagnosis subjects. Most of the dual diagnosis subjects reported using alcohol to self-medicate social phobic symptoms. These findings are consistent with the hypothesis that social phobia can be an important factor in the development of alcoholism.
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The Diagnostic and Statistical Manual (DSM-III) contains little specific information pertaining to the ages of onset of anxiety disorders. Such information is of clinical and research value in understanding the natural history of mental illnesses, in determining which of several possible etiologies for a given diagnosis may be relevant for a particular patient, and in testing theories of psychopathology or pathophysiology. Age-of-onset data is presented for 423 psychiatric outpatients seen at a University Hospital—based anxiety disorders program. All adult anxiety disorders are represented except posttraumatic stress disorder. The relevance of this information is discussed in terms of past research on ages of onset of the anxiety disorders, and in its bearing on the psychiatric diagnosis of these conditions.
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The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20,291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders.
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This article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size of n = 18.571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.
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Using data collected in the National Institute of Mental Health Epidemiologic Catchment Area Program, we examined the reported age at onset of selected mental disorders using life table survival methods. The examination of hazard rates suggests that adolescence and young adulthood are important periods for the development of unipolar major depression, bipolar illness, phobias, and drug and alcohol abuse/dependence. Although there are limitations in using cross-sectional data for this purpose, the findings suggest the need for more attention to the development of mental disorders in childhood and adolescence.
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In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.
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One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (less than age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.
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Studied the clinical manifestations of social phobia in a diagnosed sample of 21 social phobics (aged 21–53 yrs). Social phobia was found to be a chronic and pervasive condition affecting a variety of life areas and producing significant emotional distress. In a 2nd study, individuals with a diagnosis of social phobia or avoidant personality disorder were compared using a subsample of 10 socially phobic Ss and a sample of 8 Ss with avoidant personality disorder (aged 30–60 yrs). Although physiological reactivity and cognitive content were essentially the same for both groups in a number of situational tasks, those Ss with a diagnosis of avoidant personality disorder were found to be more sensitive interpersonally, and exhibited significantly poorer social skill than did the social phobic Ss. Results are discussed in relation to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for social phobia, the significance of social phobia as a clinical syndrome, and the research and treatment implications of the difference found between individuals with a diagnosis of social phobia and those with avoidant personality disorders. (19 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey. The ECA program is distinguished by its sample size of at least 3,500 subjects per site (about 20,000 total); the focus on Diagnostic Interview Schedule--defined DSM-III mental disorders; the one-year reinterview-based longitudinal design to obtain incidence and service use data; the linkage of epidemiologic and health service use data; and the replication of design and method in multiple sites. Demographic characteristics of community and sample populations are provided for New Haven, Conn, Baltimore, and St Louis.
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Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.
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The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DIS/DSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic Interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NIMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.
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Isaac Marks, Institute of Psychiatry, London Human emotion seems to have changed Westphal's perceptive label. Many factor analytic studies in Europe and the USA since DSM-III burst on the world in 1980. The mere fear or anxiety that people used showed that fears of public places are sali­ ent in this problem, and that such agora­ to feel has been transformed into dramatic phobic panic and avoidance was also fre­ panic attacks, and it has become vital to know whether 3 of these occurred over the quently accompanied by other nonphobic (nonsituational) features like tonic tension last 3 weeks. A rash of papers has appeared proving that 'panic disorder' is a disease and phasic panics independent of any with a specific genetic background, child­ special cue, depression and depersonal­ hood antecedents, biological markers, and ization. Unlike agoraphobia, panic is a pharmacological treatment. With alacrity rather nonspecific term. Spontaneous panic 'panic disorder' has been clutched to the is almost as frequent in anxious depression psychiatric bosom as proof of our medical as in panic disorder, while phobic panic is a identity. hallmark of nearly all severe phobias, be Alas, we have been here before. Did not they specific, social or agoraphobias.
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The age of onset, other background data, and measures from behavioral avoidance tests were studied in 370 phobic patients. They belonged to six different categories: agoraphobia (n = 100), social phobia (n = 80), claustrophobia (n = 40), animal phobia (n = 50), blood phobia (n = 40), and dental phobia (n = 60). Results showed that animal phobia had the earliest onset age (7 years), followed by blood phobia (9 years), dental phobia (12 years), social phobia (16 years), claustrophobia (20 years), and agoraphobia (28 years). The groups also differed in marital and occupational status, heart rate, anxiety experiences during the behavioral test, and general fearfulness. On the whole, agoraphobia and animal phobia stood out as the extremes on many measures.
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reviews studies that have assessed performance of the Diagnostic Interview Schedule (DIS) in assigning diagnoses to patients and community residents / by examining the nature of any discrepancies between the DIS and other assessment procedures, it may be possible to gain a clearer understanding of the problematic areas in diagnostic assessments in general / includes discussion questions and responses by Jack Burke] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Analyses of gender differences in phobias are presented based on Wave 1 of the five-site ECA community survey. A total of 18,572 respondents, aged 18 and over, were questioned about 15 phobic symptoms, yielding diagnoses based on DSM-III criteria for agoraphobia, social phobia, and simple phobia. Women had significantly higher prevalence rates of agoraphobia and simple phobia, but no gender differences were found for social phobia, the least prevalent of the phobic disorders. The most common phobias for both men and women involved “spiders, bugs, mice and snakes,” and “heights.” The largest differences between men and women were found on the agoraphobic symptoms of “going out of the house alone” and “being alone,” and on two simple phobia items, the fear of “any harmless or dangerous animal,” and “storms.” No sex differences were found in age of onset, reporting a fear on the phobic level, telling a doctor about symptoms, or recall of past symptomatology. Mean age of onset was significantly older for agoraphobia than for social or simple phobia, although all phobias evidenced onset at an early age.
Article
The lifetime prevalence of specific DSM-III-defined psychiatric disorders among 1243 Mexican-American and 1309 non-Hispanic white residents of two Los Angeles communities is reported from the Los Angeles site of the Epidemiologic Catchment Area (ECA) research study. Results from household interviews in response to the National Institute of Mental Health Diagnostic Interview Schedule revealed overall rates of disorders for the total Los Angeles sample and ethnic subsamples that were similar to rates reported from the initial three ECA sites. Non-Hispanic whites reported far more drug abuse/dependence and more major depressive episodes than Mexican Americans. Young non-Hispanic white women reported high rates of major depressive episodes and drug abuse/dependence. Alcohol abuse/dependence is highly prevalent among Mexican-American and non-Hispanic white men of any age. Mexican-American women infrequently abuse or become dependent on drugs or alcohol at any age. Dysthymia, panic disorder, and phobia are somewhat more prevalent among Mexican-American women over 40 years of age compared with both non-Hispanic white women over and Mexican-American women under 40 years of age. Antisocial personality is predominantly a disorder of young men of both ethnic groups.
Article
The current prevalence of DSM-III psychiatric disorders was assessed using the Diagnostic Interview Schedule (DIS) as part of a Los Angeles household population survey. The Los Angeles prevalence estimates were compared with sex- and age-adjusted estimates from four other US field sites, all of which were part of the Epidemiologic Catchment Area (ECA) program. Overall, few significant differences in household population rates were found between Los Angeles and the other ECA sites. Within the Los Angeles household sample, the current prevalence of disorder among Mexican Americans was compared with that among non-Hispanic whites. Non-Hispanic whites had higher rates of drug abuse/dependence than Mexican Americans; the rates among non-Hispanic whites in Los Angeles were also higher than those found at other ECA sites. Mexican Americans displayed higher rates of severe cognitive impairment, a finding that likely reflects ethnic and educational bias in the measurement of cognitive impairment. Another ethnic difference was found only for one specific age and sex group: Mexican-American women 40 years of age or older had strikingly high rates of phobia.
Article
The main aim of the present study was to examine whether the well-established association between depression and social dysfunction still remains when effects of a coexistent anxiety disorder are eliminated from the data. As these effects strongly depend on the proportion of depressed subjects suffering simultaneously from an anxiety disorder, we first examined the frequency of mixed and pure depressive disorders and that of pure anxiety disorders (control subjects) in a community sample (n = 483). Using DIS/DSM-III criteria (reference period 6 months), pure anxiety disorders were most frequent (6%), followed by pure depressive disorders (3%) and the coexistence of anxiety and depression (2%). Cases suffering from both disorders were most severely afflicted in terms of psychopathology (persistence of symptoms, comorbidity regarding other mental disorders). At the diagnostic level, the association between depression and social dysfunction was only slightly influenced by effects resulting from comorbidity; at the level of actual symptoms, however, we found that cases suffering simultaneously from severe depression and severe anxiety were significantly more handicapped in their social lives than depressive subjects with only mild anxiety symptoms.
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Seventy-four patients meeting DSM-III criteria for social phobia completed 4 or more weeks of double-blind, randomized treatment with the monoamine oxidase inhibitor phenelzine, the cardioselective beta-adrenergic blocker atenolol, or placebo. Sixty-four percent of the patients on phenelzine demonstrated moderate or marked improvement, compared to 30 percent on atenolol and 23 percent on placebo. Phenelzine was significantly more effective than atenolol or placebo, whereas the efficacy of atenolol and placebo did not differ significantly. Patients were also prospectively divided into generalized and discrete subtypes of social phobia. Phenelzine appeared to be a particularly effective treatment for the generalized form of social phobia. Atenolol may be useful for discrete forms of social phobia such as performance anxiety.
Article
In a general psychiatric outpatient sample (n = 1271) gathered through a cross-national French survey, anxiety and somatoform syndromes were assessed according to DSM-III and DMS-III-revised criteria. Lifetime and one-month prevalence rates in this population are provided and the high level of comorbidity between the anxiety syndromes is noted. The patient symptom profiles for panic syndrome, simple attacks, agoraphobia and generalized anxiety are displayed. The conspicuous consequences of the modifications brought in by the Revision-anticipatory anxiety in panic syndrome, and restricted period criteria for generalized anxiety- are discussed, with the conclusion that more field study assessment is required before further revision.
Article
Data from the Epidemiologic Catchment Area study showed that a lifetime Diagnostic Interview Schedule/DSM-III diagnosis of panic disorder was associated with pervasive social and health consequences similar to or greater than those associated with major depression. These consequences included subjective feelings of poor physical and emotional health, alcohol and other drug abuse, increased likelihood of suicide attempts, impaired social and marital functioning, financial dependency, and increased use of psychoactive medications, health services, and the hospital emergency department for emotional problems. Comorbidity of panic disorder with major depression, agoraphobia, and alcohol or other drug abuse did not explain these findings. The social and health consequences of panic disorder (quality of life) should be considered, as risks and benefits of currently available acute and maintenance treatments are evaluated. Clinical trials of panic disorder, whether of drugs or behavioral treatment, should include quality of life assessments as outcome measures. Long-term prospective studies based on clinical samples of patients with panic disorder are indicated to relate the illness more precisely to social morbidity.
Article
A structured interview designed to diagnose anxiety disorders according to DSM-III (plus infrequent panic attacks and generalized anxiety disorder using DSM-III-R criteria) was given to 1110 people registered with 6 general practitioners (GPs), whether they consulted the doctor or not. As each citizen in Italy has to be registered with a GP, the sample was representative of the population. The interviews were carried out by the GPs, who were also third- or fourth-year trainees in psychiatry. The lifetime prevalence and point prevalence were: 0.36% and 0.27% for agoraphobia; 0.90% and 0.72% for agoraphobia with panic; 1.35% and 0.27% for panic disorder; 0.63% and 0.45% for simple phobia; 0.49% and 45% for social phobia, 5.41% and 2.79% for generalized anxiety disorder; and 0.72% and 0.63% for obsessive-compulsive disorder. These figures are lower than those reported in other surveys; possible explanations may be the use of a hierarchical diagnostic model and the fact that diagnosticians were psychiatrists instead of lay interviewers as in most studies in the United States. On the whole, 62% of anxiety cases consult a GP, 50% consult a psychiatrist and 7% are hospitalized.
Article
The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DIS/DSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic Interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NIMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.
Article
Seventy-three agoraphobic and 31 social phobic women, all rated unsuitable for insight-oriented psychotherapy, were compared regarding family and personal history, intelligence, personality and factors pertaining to the disorder. The same patients, with 11 men included in the social phobic group, were also compared regarding response to four randomly assigned types of treatment given over a 3 month period, with a 9 months' follow-up. The following differences were revealed: 1) Social phobias were associated with a higher social class of the parental home, higher education, higher scores on verbal intelligence, and a higher social class of the patient. 2) Social phobics scored higher on the personality factor, aggressive non-conformance, otherwise there were no differences in the personality factor. 3) Agoraphobias were associated with mother working outside home during the patient's childhood, neurotic symptoms in childhood, and current economic difficulties. Agoraphobics more often gave experience of death as a cause of the disorder. 4) Social phobias started at an earlier age. 5) Target phobia and the global rating were of equal severity in the two syndromes, but the agoraphobics had higher ratings on free anxiety and depersonalization. 6) Social phobics responded better to prolonged exposure in vivo, while agoraphobics responded better to supportive therapy of dynamic type, or to a simple basal therapy. Social phobics more often wanted the therapists to give advice and guidance.
Article
While other anxiety disorders have recently become the subjects of increasing investigation, social phobia remains, except among behavior therapists, relatively unstudied. As a result, major uncertainties exist concerning classification, prevalence, severity, etiology, assessment, and treatment of social phobia. Existing findings do suggest that in its own right and as a comparison for other anxiety disorders, social phobia should prove a fertile area for psychobiological and clinical investigation.
Article
The Taiwan Psychiatric Epidemiological Project, conducted from 1982 to 1986, used the multistage random sampling method with 5005, 3004 and 2995 subjects selected respectively from metropolitan Taipei (MT), 2 small towns (ST) and 6 rural villages (RV). The case identification tool was the Chinese modified Diagnostic Interview Schedule (DIS-CM). This study presents the lifetime and one-year prevalence of 27 and of 17 specific psychiatric disorders respectively. The lifetime prevalence of any disorder defined by the DIS-CM -- excluding tobacco dependence -- was 16.3%, 28.0% and 21.5% in the MT, ST and RV samples respectively. The differences in lifetime prevalence between the sexes and between the 3 sampling areas were significant for 15 and 8 disorders respectively. The ST sample seemed to have the most disorders, with the highest prevalence among 3 sampling areas. The mean ratio of one-year to lifetime prevalence was 0.67. The differences in prevalence rates between the 3 sampling areas and between the international studies are discussed from methodological, social and cultural points of view.
Article
3,258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Six-month prevalence figures for DIS/DSM III diagnoses are given, and selected figures for the one-month and one-year prevalence, and the one-year symptom-free rates. The six-month prevalence for any diagnosis is 17.1%, comparable to findings from other population studies using DSM III derived diagnoses, but lower than studies using the PSE. The prevalence rates for most disorders tended to be lowest in the elderly, but this was not as marked as the drop in lifetime prevalence. Men had higher prevalence for substance use disorders than women, but women had higher rates for affective disorders and anxiety/somatoform disorders. Prevalences for all disorders were either similar or lower in those who were married or living as though married, than in those who were not cohabiting. One-year symptom-free rates were highest for those with substance use disorders and lowest for those with anxiety/somatoform disorders - largely due to the persistence of phobias.
Article
3,258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Lifetime prevalence for 16 DIS/DSM III diagnoses are given. Overall 33.8% of the population had one or more diagnoses and, excluding substance use disorders, one fifth of the population had a diagnosis. The most common lifetime diagnosis was alcohol abuse/dependence, followed by phobia and major depressive episode. Men were more likely to have had substance use disorders and antisocial personality disorder and women more likely to have had major depressive episode, dysthymia, agoraphobia and simple phobia. Those who were married had generally lower lifetime prevalences. Those over age 65 had the lowest prevalence of any age groups.
Article
The delivery of ambulatory mental health and general health services to persons with phobias (unweighted n = 1,689) and without phobias during a 6-month period are examined. The phobics were part of a larger study of 18,572 subjects, drawn as a representative sample of the population in five locations, as part of the Epidemiologic Catchment Area Program (ECA). Among phobic conditions, agoraphobia most often leads to use of services related to emotional problems, especially in the specialty mental health sector. There were no significant differences between male and female subjects in their use of the various sectors for a mental health reason. The highest age group of agoraphobics that used health services most often was 25-44 years old, and the group that used them least often was 65 years and older. Agoraphobics with four or more symptoms of panic use services in higher proportions than agoraphobics with zero to three panic symptoms. The authors observe that a very large proportion of phobics report seeking no help from any source.
Article
Data from the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program, an epidemiologic survey of five communities, showed that four major disorders commonly begin in late adolescence or young adulthood. The median age at onset for anxiety disorders is 15 years; for major depressive episode, 24 years; for drug abuse or dependence, 19 years; and for alcohol abuse or dependence, 21 years. Findings also suggest that for respondents 18-30 years old, having a major depressive episode or anxiety disorder doubles the risk for later drug abuse or dependence.
Article
Point prevalence rates and demographic characteristics associated with four specific forms of social phobia (public speaking/performing, writing in front of others, eating in restaurants, and use of public restrooms) were examined in a sample of adult residents of the greater St. Louis area. Diagnoses were determined by structured interview in accordance with DSM-III criteria. An unadjusted prevalence rate of 22.6% was found for all four social phobias combined. Application of DSM-III significant distress criteria resulted in a prevalence rate of 2.0%. Public speaking/performing phobias were by far the most common (20.6%). Prevalence rates of 2.8%, 1.2%, and 0.2% were found for phobias related to writing, eating, and use of public restrooms, respectively. Social phobias were more common among women than men. No other demographic differences were found between social phobics and the rest of the sample. Results of this study suggest a higher prevalence of social phobia than has been indicated by prior research. Explanations for and implications of these findings are discussed.
Article
An epidemiologic survey of the lifetime and six-month prevalence rates of several psychiatric disorders was conducted in Puerto Rico. This study, carried out in 1984, applied selected schedules of a Spanish translation of the Diagnostic Interview Schedule to a stratified, island-wide probability sample of the population. With few exceptions, prevalence rates in this study were similar to those obtained in the US communities studied in the Epidemiologic Catchment Area program. The demographic correlates of the disorders are reviewed, and differences between the results of this study and those of previous studies suggesting a higher rate of mental disorder among Puerto Rican populations are discussed.
Article
The authors used symptom profiles, demographic data, and other variables to compare 316 patients representing all specific DSM-III anxiety disorders except posttraumatic stress disorder to each other and to published norms for both an unselected psychiatric outpatient population and normal subjects. The results support the grouping of these disorders, with the possible exception of obsessive-compulsive disorder, into one general diagnostic category of "anxiety disorders." The distinction between the specific diagnoses of simple phobia and social phobia was also supported; however, the differentiation between panic disorder, agoraphobia, and generalized anxiety was only weakly supported.
Article
For many years, there has been a gap between clinical psychiatry and psychiatric epidemiology.1-3 Immediately after World War II, a number of community epidemiologic surveys were undertaken in North America in which clinical diagnoses of psychiatric conditions were not directly made. For the most part, these surveys relied heavily on measures of mental impairment rather than clinical diagnoses. The focus on mental impairment was based on theoretical and practical grounds. Theoretically, there was serious questioning of the validity of the concept of mental illness; instead, the concept of a continuum of mental health and mental illness became widely accepted. An indication of this conceptual difference was the congressional decision in 1947 to create the National Institute of Mental Health, rather than a National Institute of Mental Illness. On practical grounds, the low reliability of psychiatric diagnoses and the high cost of clinical interviewers made the use of self-report and
Six-month prevalence of psychiatric disorders in three communities: 1980-1982
  • Anthony Jc Boyd
  • J H Burke
  • J D Kramer
  • M Stoltzman
H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stoltzman R. Six-month prevalence of psychiatric disorders in three communities: 1980-1982. Arch Gen Psychiatry. 1984;41:959-967.
Marks IM. The classification of phobic disorders
  • P L Amies
  • M G Gelder
  • P M Shaw
Amies PL, Gelder MG, Shaw PM. Social phobia: a comparative clinical study. Br J Psychiatry. 1983;142:174-179. 27. Solyom L, Ledwidge B, Solyom C. Delineating social phobia. Br J Psychiatry. 1986;149:464-470. 28. Marks IM. The classification of phobic disorders. Br J Psychiatry. 1970;116:377-386.
Results of the St Louis ECA physician re-examination study of the DIS interview
  • J E Helzer
  • L T Mcevoy
  • L N Robins
  • E Spitznagel
  • R K Stoltsman
  • A Farmer
  • I F Brockington
Helzer JE, McEvoy LT, Robins LN, Spitznagel E, Stoltsman RK, Farmer A, Brockington IF. Results of the St Louis ECA physician re-examination study of the DIS interview. Arch Gen Psychiatry. 1985;42:657-666.
Comparison of lay DIS and a standardized psychiatric diagnosis: experience in eastern Baltimore
  • J C Anthony
  • M Folstein
  • A J Romanoski
  • M R Van Korff
  • G R Nestadt
  • R Chahal
  • A Merchant
  • C H Brown
  • S Shapiro
  • M Kramer
  • E M Gruenberg
Anthony JC, Folstein M, Romanoski AJ, van Korff MR, Nestadt GR, Chahal R, Merchant A, Brown CH, Shapiro S, Kramer M, Gruenberg EM. Comparison of lay DIS and a standardized psychiatric diagnosis: experience in eastern Baltimore. Arch Gen Psychiatry. 1985;42:667-675.
Comparing ICD diagnoses with DSM-III and RDC using the Diagnostic Interview Schedule (version II)
  • H U Wittchen
  • G Semler
  • D Von Zerssen
Wittchen HU, Semler G, von Zerssen D. Comparing ICD diagnoses with DSM-III and RDC using the Diagnostic Interview Schedule (version II). Arch Gen Psychiatry. 1985;42:677-684.