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Social Anxiety Disorder
Reviewed by MARCIA WEBB , Ph.D.
Am J Psychiatry 2006;163:1845-1845.
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edited by Borwin Bandelow and Dan J. Stein. New York, Marcel Dekker, 2004, 366 pp. $169.95.

Social Anxiety Disorder is a recent contribution to the volume series entitled Medical Psychiatry, that includes other texts in this series. The text consists of three main sections, focusing upon the diagnosis, pathogenesis, and treatment of social anxiety disorder. Written by an impressive group of 38 contributors, chapters present the most recent theoretical and empirical information available regarding this challenging disorder.

The first section of the text, Psychopathology, includes a review of the symptom spectrum of social anxiety disorder, including its diagnostic history in various versions of the DSM. Issues regarding differential diagnosis and comorbidity are discussed. A review of epidemiological surveys is included, with consideration of the prevalence of social anxiety disorder in community and clinical settings, its incidence with regard to age of onset, its developmental course and pertinent risk factors, and various diagnostic subtypes. The psychosocial and economic burden of social anxiety disorder is further assessed, with an examination of the disorder’s impact upon interpersonal relationships, academic and occupational functioning, quality of life, and health care utilization. Psychometric information is provided regarding rating scales available for the assessment of social anxiety disorder, with data regarding each instrument’s reliability, validity, and sensitivity. The diagnosis of social anxiety disorder in children and in cross-cultural groups completes this first section of the text.

The second section, Pathogenesis, focuses upon models of the disorder’s etiology. Environmental influences, including childhood trauma, negative parenting styles, and observational learning, are considered. Cognitive models describing maintenance of the disorder are also evaluated, with emphasis upon the theories of Clark and Wells and of Rapee and Heimberg. Empirical support for these cognitive models and their impact upon treatment strategies is examined. An extensive review of the etiological contribution of neurobiological factors is further provided. The genetic basis of social anxiety disorder, as evidenced through twin and family studies, completes this section of the text.

Finally, the third section of the text, Management, focuses upon intervention. A review of cognitive-behavioral therapies, with descriptions of social skills training, relaxation training, cognitive restructuring, and exposure techniques, is presented. Meta-analytic studies supporting the efficacy of cognitive behavioral therapy in the alleviation of social anxiety disorder are examined. Psychodynamic models of intervention are also described. These treatment interventions include an examination of the emotional meaning of various social anxiety disorder symptoms, environmental stressors, developmental conflicts, and transference within the therapeutic setting. While the review of psychodynamic interventions provides scant empirical validation for any claims to efficacy, this is the only portion of the text that describes case examples of social anxiety disorder patients. The examples are engaging and informative, and provide an important contribution to the overall text, since they present the personal, very human challenge of social anxiety disorder. This section includes a detailed assessment of pharmacological interventions, including the potential for integration of psychotherapeutic and pharmacological treatment strategies.

In general, Social Anxiety Disorder is comprehensive, detailed, well-organized, clearly written, and highly informative. Its presentation of current theoretical models and empirical research regarding the multiple complex issues concerning social anxiety disorder makes it an important resource for both research and clinical practice.

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