Social Phobia 339
indicate that shyness and social phobia, though significantly related, can not be consid-
ered synonymous.
Social Phobia Subtypes: Generalized versus Specific
DSM-IV-TR (APA, 2000) allows for the distinction between a generalized and a specific
or circumscribed subtype of social phobia. Unfortunately the criteria for making this
distinction are not at all clear. Generalized social phobia (GSP) can be specified when
individuals fear most social situations including both public performance and social
interaction situations. However, the number of feared situations needed to qualify for
GSP is not stated. The “specific subtype” of social phobia is even less clearly defined.
DSM-IV-TR states that this subtype may be quite heterogeneous including people who
fear just a single performance situation (i.e., public speaking) as well as those who fear
most performance situations but not social interaction situations. In their prospective
community study, Wittchen, Stein, and Kessler (1999) reported a lifetime prevalence of
5.1% for specific social phobia and 2.2% for GSP among 14- to 24-year-old, with the
specific subtype mostly characterized by fears of test performance and speaking in front
of people.
There is considerable debate in the literature on the validity of the generalized ver-
sus specific distinction in social phobia. Not only are the DSM-IV-TR descriptions of
generalized and specific social phobia ambiguous, but researchers employ different defi-
nitions of the specific subtype from reserving the term for fear of public speaking only
to a broader definition that includes fear of multiple situations within one social domain
such as social performance situations only (see Hofmann & Barlow, 2002). Further-
more, a more fundamental problem for subtyping is that social phobia appears to lie on
a continuum of severity with no clear-cut boundaries to delineate subtypes. Taxometric
analyses indicate that social anxiety favors a dimensional model of severity (Kollman,
Brown, Liverant, & Hofmann, 2006) and community-based studies have failed to find
a clear demarcation of subtypes based on the number of feared social situations (e.g.,
Stein, Torgrud, & Walker, 2000; Vriends, Becker, Meyer, Michael, & Margraf, 2007a).
These findings suggest that the generalized distinction may be confounded with symp-
tom severity so that the specifier may be arbitrarily selecting out the most severe on the
social anxiety continuum.
Others, however, have argued that specifying a generalized subtype is a clinically
useful distinction. The majority of individuals with social phobia who seek treatment
will meet criteria for the generalized subtype (see Beidel & Turner, 2007; e.g., Kollman
et al., 2006), whereas specific social phobia may be more prevalent in community sam-
ples (Wittchen et al., 1999). In addition GSP is associated with greater symptom sever-
ity, depression, avoidance, and fear of negative evaluation, as well as greater functional
impairment, earlier onset, greater chronicity, and increased rate of comorbid Axis I and
II diagnoses (e.g., Herbert, Hope, & Bellack, 1992; Holt, Heimberg, & Hope, 1992;
Kessler, Stein, & Berglund, 1998; Mannuzza et al., 1995; Turner, Beidel, & Townsley,
1992; Wittchen et al., 1999). Overall, the findings indicate that the generalized versus
specific subtype of social phobia is really capturing a severity distinction based on the
number of feared social situations, with GSP the more severe form of social phobia
that is most often seen in treatment settings. For this reason the cognitive perspective
described in this chapter is most relevant to GSP.