Skip to main content
    • Aa
    • Aa

Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication

  • A. M. Ruscio (a1), T. A. Brown (a2), W. T. Chiu (a3), J. Sareen (a4), M. B. Stein (a5) and R. C. Kessler (a3)...

Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R).


The NCS-R is a nationally representative household survey fielded in 2001–2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia.


The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose–response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment.


Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.

Corresponding author
*Address for correspondence: Dr A. M. Ruscio, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G Andrews , S Henderson , W Hall (2001). Prevalence, comorbidity, disability and service utilization: overview of the Australian National Mental Health Survey. British Journal of Psychiatry 178, 145153.

SL Baker , N Heinrichs , H-J Kim , SG Hofmann (2002). The Liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis. Behaviour Research and Therapy 40, 701715.

RV Bijl , G van Zessen , A Ravelli (1998). Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 33, 587595.

A Bittner , RD Goodwin , H-U Wittchen , K Beesdo , M Höfler , R Lieb (2004). What characteristics of primary anxiety disorders predict subsequent major depressive disorder? Journal of Clinical Psychiatry 65, 618626.

TA Brown , LA Campbell , CL Lehman , JR Grisham , RB Mancill (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 4958.

TA Brown , BF Chorpita , DH Barlow (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology 107, 179192.

MA Bruch , RJ Hamer , RG Heimberg (1995). Shyness and public self-consciousness: additive or interactive relation with social interaction? Journal of Personality 63, 4763.

KP Burnham , D Anderson (1998). Model Selection and Inference. Springer: New York, NY.

BJ Cox , C Fleet , MB Stein (2004). Self-criticism and social phobia in the US national comorbidity survey. Journal of Affective Disorders 82, 227234.

JR Davidson , DC Hughes , LK George , DG Blazer (1994). The boundary of social phobia: exploring the threshold. Archives of General Psychiatry 51, 975983.

DJ DeWit , A Ogborne , DR Offord , K MacDonald (1999). Antecedents of the risk of recovery from DSM-III-R social phobia. Psychological Medicine 29, 569582.

T Furmark , M Tillfors , PO Everz , I Marteinsdottir , O Gefvret , M Fredrikson (1999). Social phobia in the general population, prevalence and sociodemographic profile. Social Psychiatry and Psychiatric Epidemiology 34, 416424.

T Furmark , M Tillfors , H Stattin , L Ekselius , M Fredrikson (2000). Social phobia subtypes in the general population revealed by cluster analysis. Psychological Medicine 30, 13351344.

BF Grant , DS Hasin , C Blanco , FS Stinson , SP Chou , RB Goldstein , DA Dawson , S Smith , TD Saha , B Huang (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 13511361.

SS Halli , VK Rao (1992). Advanced Techniques of Population Analysis. Plenum Press: New York, NY.

JM Haro , S Arbabzadeh-Bouchez , TS Brugha , G De Girolamo , ME Guyer , R Jin , JP Lepine , F Mazzi , B Reneses , G Vilagut , NA Sampson , RC Kessler (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 15, 167180.

C Hayward , JD Killen , HC Kraemer , CB Taylor (1998). Linking self-reported childhood behavioral inhibition to adolescent social phobia Journal of the American Academy of Child and Adolescent Psychiatry 37, 13081316.

RG Heimberg , CS Holt , FR Schneier , RL Spitzer , MR Liebowitz (1993). The issue of subtypes in the diagnosis of social phobia. Journal of Anxiety Disorders 7, 249269.

JM Hettema , MC Neale , JM Myers , CA Prescott , KS Kendler (2006). A population-based twin study of the relationship between neuroticism and internalizing disorders. American Journal of Psychiatry 163, 857864.

SG Hofmann , N Heinrichs , DA Moscovitch (2004). The nature and expression of social phobia: toward a new classification. Clinical Psychology Review 24, 769797.

J Kagan , JS Reznick , N Snidman (1988). Biological basis of childhood shyness. Science 240, 167171.

PC Kendall , RC Kessler (2002). The impact of childhood psychopathology interventions on subsequent substance abuse: policy implications, comments, and recommendations. Journal of Consulting and Clinical Psychology 70, 13031306.

KS Kendler , MC Neale , RC Kessler , AC Heath , LJ Eaves (1992). The genetic epidemiology of phobias in women: the interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of General Psychiatry 49, 273281.

RC Kessler , J Abelson , O Demler , JI Escobar , M Gibbon , ME Guyer , MJ Howes , R Jin , WA Vega , EE Walters , P Wang , A Zaslavsky , H Zheng (2004). Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). International Journal of Methods in Psychiatric Research 13, 122139.

RC Kessler , WT Chiu , O Demler , EE Walters (2005 b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.

RC Kessler , CG Davis , KS Kendler (1997). Childhood adversity and adult psychiatric disorders in the US National Comorbidity Survey. Psychological Medicine 27, 11011119.

RC Kessler , KA McGonagle , S Zhao , CB Nelson , M Hughes , S Eshleman , HU Wittchen , KS Kendler (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 819.

RC Kessler , KR Merikangas (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research 13, 6068.

RC Kessler , P Stang , H-U Wittchen , MB Stein , EE Walters (1999). Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychological Medicine 29, 555567.

RC Kessler , MB Stein , PA Berglund (1998). Social phobia subtypes in the National Comorbidity Survey. American Journal of Psychiatry 155, 613619.

HC Kraemer , E Stice , A Kazdin , DR Offord , D Kupfer (2001). How do risk factors work together? Mediators, moderators, independent, overlapping, and proxy risk factors. American Journal of Psychiatry 158, 848856.

R Lieb , HU Wittchen , M Hofler , M Fuetsch , MB Stein , KR Merikangas (2000). Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study. Archives of General Psychiatry 57, 859866.

W Magee , W Eaton , H Wittchen , KA McGonagle , RC Kessler (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry 53, 159168.

S Mineka , D Watson , LA Clark (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology 49, 377412.

JF Rosenbaum , J Biederman , EA Bolduc-Murphy , SV Faraone , J Chaloff , DR Hirshfeld , J Kagan (1993). Behavioral inhibition in childhood: a risk factor for anxiety disorders. Harvard Review of Psychiatry 1, 216.

SA Safren , RG Heimberg , KJ Horner , HR Juster , FR Schneier , MR Liebowitz (1999). Factor structure of social fears: the Liebowitz Social Anxiety Scale. Journal of Anxiety Disorders 13, 253270.

J Sareen , MJ Chartier , MP Paulus , MB Stein (2006). Illicit drug use and anxiety disorders: findings from two community surveys. Psychiatry Research 142, 1117.

J Sareen , MB Stein , BJ Cox , ST Hassard (2004). Understanding comorbidity of anxiety disorders and antisocial behavior: findings from two large community surveys. Journal of Nervous and Mental Disease 192, 178186.

FR Schneier , J Johnson , CD Hornig , MR Liebowitz , MM Weissman (1992). Social phobia: comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry 49, 282288.

H Sonntag , HU Wittchen , M Hofler , RC Kessler , MB Stein (2000). Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults? European Psychiatry 15, 6774.

MB Stein (1998). Neurobiological perspectives on social phobia: from affiliation to zoology. Biological Psychiatry 44, 12771285.

MB Stein , MJ Chartier , AL Hazen , MV Kozak , ME Tancer , S Lander , P Furer , D Chubaty , JR Walker (1998). A direct-interview family study of generalized social phobia. American Journal of Psychiatry 155, 9097.

MB Stein , M Fuetsch , N Muller , M Hofler , R Lieb , HU Wittchen (2001). Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults. Archives of General Psychiatry 58, 251256.

MB Stein , LJ Torgrud , JR Walker (2000). Social phobia symptoms, subtypes, and severity: findings from a community survey. Archives of General Psychiatry 57, 10461052.

MB Stein , J Walker , D Forde (1996). Public-speaking fears in a community sample: prevalence, impact on functioning, and diagnostic classification. Archives of General Psychiatry 53, 169174.

SM Turner , DC Beidel , RM Townsley (1992). Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder. Journal of Abnormal Psychology 101, 326331.

SM Turner , DC Beidel , PL Wolff (1996). Is behavioral inhibition related to the anxiety disorders? Clinical Psychology Review 16, 157172.

MM Weissman , RC Bland , GJ Canino , S Greenwald , C-K Lee , SC Newman , M Rubio-Stipec , PJ Wickramaratne (1996). The cross-national epidemiology of social phobia: a preliminary report. International Clinical Psychopharmacology 11, 914.

H-U Wittchen , MB Stein , RC Kessler (1999). Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychological Medicine 29, 309323.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 36
Total number of PDF views: 294 *
Loading metrics...

Abstract views

Total abstract views: 1193 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th September 2017. This data will be updated every 24 hours.