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  • Print publication year: 2010
  • Online publication date: November 2010

8 - Is there a spectrum of social anxiety disorder?

from Section 2 - Challenges in diagnosing pathological anxiety
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Anxiety Disorders
  • Online ISBN: 9780511777578
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Alnaes, S., & Torgersen, S. (1988). The relationship between DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population. Acta Psychiatrica Scandinavica, 78, 485–492.
Alpert, J. E., Uebelacker, L. A., McLean, N. E., et al. (1997). Social phobia, avoidant personality disorder and atypical depression: co-occurrence and clinical implications. Psychological Medicine, 27, 627–633.
Altamura, C., Paluello, M. M., Mundo, E., Medda, S., & Mannu, P. (2001). Clinical and subclinical body dysmorphic disorder. European Archives of Psychiatry and Clinical Neuroscience, 251, 105–108.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Argyropoulos, S. V., Bell, C. J., & Nutt, D. J. (2001). Brain function in social anxiety disorder. Psychiatric Clinics of North America, 24, 707–772.
Battaglia, M., Ogliari, A., Zanoni, A., et al. (2005). Influence of the serotonin transporter promoter gene and shyness on children’s cerebral responses to facial expressions. Archives of General Psychiatry, 62, 85–94.
Beesdo, K., Bittner, A., Pine, D. S., et al. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64, 903–912.
Berger, P., Sachs, G., Amering, M., et al. (2004). Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder. Journal of Affective Disorders, 80, 75–78.
Biederman, J., Hirshfeld-Becker, D. R., Rosenbaum, J. F., et al. (2001). Further evidence of association between behavioral inhibition and social anxiety in children. American Journal of Psychiatry, 158, 1673–1679.
Birchwood, M., Trower, P., Brunet, K., et al. (2006). Social anxiety and the shame of psychosis: a study in first episode psychosis. Behaviour Research and Therapy, 45, 1025–1027.
Black, B., & Uhde, T. (1995). Psychiatric characteristics of children with selective mutism: a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 847–856.
Book, S. W., Thomas, S. E., Randall, P. K., & Randall, C. L. (2008). Paroxetine reduces social anxiety in individuals with a co-occurring alcohol use disorder. Journal of Anxiety Disorders, 22, 310–318.
Broberg, A., Lamb, M., & Hwang, P. (1990). Inhibition: its stability and correlates in sixteen- to forty-month-old children. Child Development, 61, 1153–1163.
Cath, D. C., Ran, N., Smit, J. H., van Balkom, A. J., & Comijs, H. C. (2008). Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive–compulsive disorder in adults: a preliminary case-controlled study. Psychopathology, 41, 101–110.
Chambless, D. L., Fydrich, T., & Rodebaugh, T. L. (2008). Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication?Depression and Anxiety, 25, 8–19.
Chavira, D. A., Shipon-Blum, E., Hitchcock, C., Cohan, S., & Stein, M. B. (2007). Selective mutism and social anxiety disorder: all in the family?Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1464–1472.
Coles, M. E., Phillips, K. A., Menard, W., et al. (2006). Body dysmorphic disorder and social phobia: cross-sectional and prospective data. Depression and Anxiety, 23, 26–33.
Connor, K. M., Davidson, J. R., Chung, H., Yang, R., & Clary, C. M. (2006a). Multidimensional effects of sertraline in social anxiety disorder. Depression and Anxiety, 23, 6–10.
Connor, K. M., Cook, J. L., & Davidson, J. R. (2006b). Botulinum toxin treatment of social anxiety disorder with hyperhidrosis: a placebo-controlled double-blind trial. Journal of Clinical Psychiatry, 67, 30–36.
Cooper, P. J., & Eke, M. (1999). Childhood shyness and maternal social phobia: a community study. British Journal of Psychiatry, 174, 439–443.
Cornwell, B. R., Johnson, L., Berardi, L., & Grillon, C. (2006). Anticipation of public speaking in virtual reality reveals a relationship between trait social anxiety and startle reactivity. Biological Psychiatry, 59, 664–666.
Dalrymple, K. L., & Zimmerman, M. (2007). Does comorbid social anxiety disorder impact the clinical presentation of principal major depression disorder?Journal of Affective Disorders, 100, 241–247.
Davidson, R. T., Hughes, D. C., George, L. K., & Blazer, D. G. (1994). The boundary of social phobia: exploring the threshold. Archives of General Psychiatry, 51, 975–983.
Dummit, E. S., Klein, R. G., Tancer, N. K., et al. (1997). Systematic assessment of 50 children with selective mutism. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 653–660.
Erickson, K., Gabry, K. E., Schulkin, J., et al. (2005). Social withdrawal behaviors in nonhuman primates and changes in neuroendocrine and monoamine concentrations during a separation paradigm. Developmental Psychobiology, 46, 331–339.
Fairbanks, L. A., Jorgensen, M. J., Huff, A., et al. (2004a). Adolescent impulsivity predicts adult dominance attainment in male vervet monkeys. American Journal of Primatology, 64, 1–17.
Fairbanks, L. A., Newman, T. K., Bailey, J. N., et al. (2004b). Genetic contributions to social impulsivity and aggressiveness in vervet monkeys. Biological Psychiatry, 55, 642–647.
Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43, 257–265.
Fox, N. A., Nichols, K. E., Henderson, H. A., et al. (2005). Evidence for a gene–environment interaction in predicting behavioral inhibition in middle childhood. Psychological Science, 16, 921–926.
Gilbert, N., & Meyer, C. (2003). Social anxiety and social comparison: differential links with restrictive and bulimic attitudes among nonclinical women. Eating Behavior, 4, 257–264.
Gilbert, P. (2001). Evolution and social anxiety: the role of attraction, social competition, and social hierarchies. Psychiatric Clinics of North America, 24, 723–752.
Godart, N. T., Flament, M. F., Lecrubier, Y., & Jeammet, P. (2000). Anxiety disorders in anorexia nervosa and bulimia nervosa: Comorbidity and chronology of appearance. European Psychiatry, 15, 38–45.
Golwyn, D. H., & Sevlie, C. P. (1999). Phenelzine treatment of selective mutism in four prepubertal children. Journal of Child and Adolescent Psychopharmacology, 9, 109–113.
Gundel, H., Wolf, A., Xidarra, V., Busch, R., & Ceballos-Baumann, A. O. (2001). Social phobia in spasmodic torticollis. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 499–504.
Hayward, C., Killen, J., Kraemer, K., & Taylor, C. (1998). Linking self-reported childhood behavioral inhibition to adolescent social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1308–1316.
Himmelhoch, J. M. (1998). Social anxiety, hypomania and the bipolar spectrum: data, theory and clinical issues. Journal of Affective Disorders, 50, 203–213.
Hinde, R. A. (1985). Expression and negotiation. In G. Zivin, ed., The Development of Expressive Behavior. San Diego, CA: Academic Press.
Hirshfeld-Becker, D. R., Biederman, J., Henin, A., et al. (2007). Behavioral inhibition in preschool children at risk is a specific predictor of middle childhood social anxiety: a five-year follow-up. Journal of Developmental and Behavioral Pediatrics, 28, 225–233.
Hirshfeld-Becker, D. R., Micco, J., Henin, A., et al. (2008). Behavioral inhibition. Depression and Anxiety, 25, 357–367.
Holma, K. M., Holma, I. A., Melartin, T. K., Rytsälä, H. J., & Isometsä, E. T. (2008). Long-term outcome of major depressive disorder in psychiatric patients is variable. Journal of Clinical Psychiatry, 69, 196–205.
Hummelen, B., Wilberg, T., Pedersen, G., & Karterud, S. (2007). The relationship between avoidant personality disorder and social phobia. Comprehensive Psychiatry, 48, 348–356.
Huppert, J. D., Strunk, D. R., Ledley, D. R., Davidson, J. R., & Foa, E. B. (2008). Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome. Depression and Anxiety, 25, 441–448.
Kagan, J., Reznick, J. S., & Snidman, N. (1988). Biological bases of childhood shyness. Science, 240, 167–171.
Kessler, R. C., Stang, P., Wittchen, H. U., Stein, M., & Walters, E. E. (1999). Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychological Medicine, 29, 555–567.
Kinoshita, Y., Chen, J., Rapee, R. M., et al. (2008). Cross-cultural study of conviction subtype Taijin Kyofu: proposal and reliability of Nagoya–Osaka diagnostic criteria for social anxiety disorder. Journal of Nervous and Mental Disease, 196, 307–313.
Kummer, A., Cardoso, F., & Teixeira, A. L. (2008). Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson’s disease. Movement Disorders, 23, 1739–1743.
Lissek, S., Levenson, J., Biggs, A. L., et al. (2008). Elevated fear conditioning to socially relevant unconditioned stimuli in social anxiety disorder. American Journal of Psychiatry, 165, 124–32.
Low, N. C., Cui, L., & Merikangas, K. R. (2008). Specificity of familial transmission of anxiety and comorbid disorders. Journal of Psychiatric Research, 42, 596–604.
Manassis, K., Fung, D., Tannock, R., et al. (2003). Characterizing selective mutism: is it more than social anxiety?Depression and Anxiety, 218, 153–161.
Mannuzza, S., Schneier, F. R., Chapman, T. F., et al. (1995). Generalized social phobia. Reliability and validity. Archives of General Psychiatry, 52, 230–237.
Manuck, S. B., Kaplan, J. R., Rymeski, B. A., Fairbanks, L. A., & Wilson, M. E. (2003). Approach to a social stranger is associated with low central nervous system serotonergic responsivity in female cynomolgus monkeys (Macaca fascicularis). American Journal of Primatology, 61, 187–194.
Massion, A. O., Dyck, I. R., Shea, T., et al. (2002). Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Archives of General Psychiatry, 59, 434–440.
McClintock, J. M., & Evans, I. M. (2001). The underlying psychopathology of eating disorders and social phobia: a structural equation analysis. Eating Behavior, 2, 247–261.
Millon, T., ed. (1969). Modern Psychopathology: a Biosocial Approach to Maladaptive Learning and Functioning. Philadelphia, PA: Saunders.
Morris, E. P., Stewart, S. H., & Ham, L. S. (2005). The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clinical Psychology Review, 25, 734–760.
Moscovitch, D. A., Hofmann, S. G., Suvak, M. K., & In-Albon, T. (2005). Mediation of changes in anxiety and depression during treatment of social phobia. Journal of Clinical and Consulting Psychology, 73, 945–952.
Nelson, E. C., Grant, J. D., Bucholz, K. K., et al. (2000). Social phobia in a population-based female adolescent twin sample: co-morbidity and associated suicide-related symptoms. Psychological Medicine, 30, 797–804.
Newell, R., & Marks, I. (2000). Phobic nature of social difficulty in facially disfigured people. British Journal of Psychiatry, 176, 177–181.
Öhman, A. (1986). Face the beast and fear the face: animal and social fears as prototypes for evolutionary analyses of emotion. Psychophysiology, 23, 123–145.
Pallanti, S., Quercioli, L., & Pazagli, A. (2000). Social anxiety and premorbid personality disorders in paranoid schizophrenic patients treated with clozapine. CNS Spectrums, 5 (9), 29–43.
Pallanti, S., Quercioli, L., & Hollander, E. (2004). Social anxiety in outpatients with schizophrenia: a relevant cause of disability. American Journal of Psychiatry, 161, 53–58.
Parker, G., Wilhelm, K., Mitchell, P., et al. (1999). The influence of anxiety as a risk to early onset major depression. Journal of Affective Disorders, 52, 11–17.
Perez-Edgar, K., Roberson-Nay, R., Hardin, M. G., et al. (2007). Attention alters neural responses to evocative faces in behaviorally inhibited adolescents. Neuroimage, 35, 1538–1546.
Perugi, G., Akiskal, H. S., Toni, C., Simonini, E., & Gemignani, A. (2001). The temporal relationship between anxiety disorders and (hypo)mania: a retrospective examination of 63 panic, social phobic and obsessive–compulsive patients with comorbid bipolar disorder. Journal of Affective Disorders, 67, 199–206.
Perugi, G., Frare, F., Madaro, D., Maremmani, I., & Akiskal, H. S. (2002). Alcohol abuse in social phobic patients: is there a bipolar connection?Journal of Affective Disorders, 68, 33–39.
Phillips, K. A., & Stout, R. L. (2006). Associations in the longitudinal course of body dysmorphic disorder with major depression, obsessive–compulsive disorder and social phobia. Psychiatry Research, 40, 360–369.
Piven, J., & Palmer, P. (1999) Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families. American Journal of Psychiatry, 156, 557–563.
Randall, C. L., Thomas, S., & Thevos, A. K. (2001). Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcoholism, Clinical and Experimental Research, 25, 210–220.
Reichborn-Kjennerud, T., Czajkowski, N., Torgersen, S., et al. (2007). The relationship between avoidant personality disorder and social phobia: a population-based twin study. American Journal of Psychiatry, 164, 1631–1633.
Schmidt, L. A., Fox, N. A., Rubin, K. H., et al. (1997). Behavioral and neuroendocrine responses in shy children. Developmental Psychobiology, 30, 127–140.
Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia. Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282–288.
Schneier, F. R., Liebowitz, M. R., Abi-Dargham, A., et al. (2000). Low dopamine D2 receptor binding potential in social phobia. American Journal of Psychiatry, 157, 457–459.
Schneier, F. R., Barnes, L. F., Albert, S. M., & Louis, E. D. (2001). Characteristics of social phobia among persons with essential tremor. Journal of Clinical Psychiatry, 62, 367–372.
Schneier, F. R., Martinez, D., Abi-Dargham, A., et al. (2008). Striatal dopamine D2 receptor availability in OCD with and without comorbid social anxiety disorder: preliminary findings. Depression and Anxiety, 25, 1–7.
Schneier, F.R., Foose, T.E., Hasin, D.S., et al. (2010). Social anxiety disorder and alcohol use disorder comorbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 40(6), 977–988.
Schultz, L. T., & Heimberg, R. G. (2008). Attentional focus in social anxiety disorder: Potential for interactive processes. Clinical Psychology Review, 8, 1206–1221.
Schwartz, C., Snidman, N., & Kagan, J. (1999). Adolescent social anxiety as an outcome of inhibited temperament in childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1008–1015.
Schwartz, C.E., Wright, C.I., Shin, L.M., Kagan, J., & Rauch, S.L. (2003). Inhibited and uninhibited infants “grown up”: adult amygdalar response to novelty. Science, 300, 1952–1953.
Simonoff, E., Pickles, A., Charman, T., et al. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.
Stein, M. B., Walker, J. R., & Forde, D. R. (1994). Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety. American Journal of Psychiatry, 151, 408–412.
Stein, M. B., Baird, A., & Walker, J. R. (1996). Social phobia in adults with stuttering. American Journal of Psychiatry, 153, 278–280.
Stein, M. B., Chartier, M. J., Hazen, A. L., et al. (1998). A direct-interview family study of generalized social phobia. American Journal of Psychiatry, 155, 90–97.
Stein, M. B., Chavira, D. A., & Jang, K. L. (2001a). Bringing up bashful baby: developmental pathways to social phobia. Psychiatric Clinics of North America, 24, 661–675.
Stein, M. B., Fuetsch, M., Müller, N., et al. (2001b). Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults. Archives of General Psychiatry, 58, 251–256.
Stein, M. B., Goldin, P. R., Sareen, J., Zorrilla, L. T., & Brown, G. G. (2002). Increased amygdala activation to angry aand contemptuous faces in generalized social phobia. Archives of General Psychiatry, 59, 1027–1034.
Stemberger, R. T., Turner, S. M., Beidel, D. C., & Calhoun, K. S. (1995). Social phobia: an analysis of possible developmental factors. Journal of Abnormal Psychology, 104, 526–531.
Tamam, L., & Ozpoyraz, N. (2002). Comorbidity of anxiety disorder among patients with bipolar I disorder in remission. Psychopathology, 35, 203–209.
Thomas, S. E., Randall, P. K., Book, S. W., & Randall, C. L. (2008). A complex relationship between co-occurring social anxiety and alcohol use disorders: what effect does treating social anxiety have on drinking?Alcoholism, Clinical and Experimental Research, 32, 77–84.
Tien, A. Y., & Eaton, W. W. (1992). Psychopathologic precursors and sociodemographic risk factors for the schizophrenia syndrome. Archives of General Psychiatry, 49, 37–46.
Turner, S. M., Beidel, D. C., & Townsley, R. M. (1990). Social phobia: relationship to shyness. Behaviour Research and Therapy, 28, 497–505.
Turner, S. M., Beidel, D. C., & Townsley, R. M. (1992). Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder. Journal of Abnormal Psychology, 101, 326–331.
Williamson, D. E., Coleman, K., Bacanu, S. A., Devlin, B. J., Rogers, J., Ryan, N. D., & Cameron, J. L. (2003). Heritability of fearful-anxious endophenotypes in infant rhesus macaques: a preliminary report. Biological Psychiatry, 53, 284–291.
Yoon, K. L., Fitzgerald, D. A., Angstadt, M., McCarron, R. A., & Phan, K. L. (2007). Amygdala reactivity to emotional faces at high and low intensity in generalized social phobia: A 4-Tesla functional MRI study. Psychiatry Research: Neuroimaging, 154, 93–98.
Zimbardo, P. G. (1977). Shyness: What It is, What to Do About It. Reading, MA: Addison-Wesley.