Social Phobia 343
individuals with social phobia report a chronic course that can last for years, if not
decades (Chartier, Hazen, & Stein, 1998; Keller, 2003; see Vriends et al., 2007b, for
contrary findings). As with other disorders, it is likely that a greater preponderance of
those with the more chronic form of social phobia will be represented among treatment
seekers.
A number of variables predict chronicity in social phobia. Presence of a comorbid
personality disorder, especially APD, is associated with a lower probability of remission
(Massion et al., 2002), and the generalized subtype of social phobia is characterized by
greater chronicity. Consistent with other anxiety disorders, greater symptom severity
and psychopathology as well as increased functional impairment is associated with a
more enduring and stable course of social phobia (e.g., Chartier et al., 1998; Vriends et
al., 2007b).
Detrimental Effects of Social Phobia
Social phobia is associated with lower educational attainment, lost work productivity,
lack of career advancement, higher rates of financial dependency, and severe impair-
ment in social functioning (e.g., Keller, 2003; Schneier, Johnson, Hornig, Liebowitz,
& Weissman 1992; Simon et al., 2002; Turner, Beidel, Dancu, & Keys, 1986; Zhang,
Ross, & Davidson, 2004). In the NCS individuals with social phobia reported signifi-
cantly more role impairment than those with agoraphobia but fewer days absent from
work (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996). As with the other anxi-
ety disorders social phobia with comorbid anxiety (e.g., panic, GAD) or depression has
greater functional impairment (Magee et al., 1996).
Individuals with social phobia also judge their quality of life to be significantly
poorer than nonclinical individuals (Safren, Heimberg, Brown, & Holle, 1996–1997).
A meta- analysis of quality of life in the anxiety disorders revealed that social phobia had
similar negative effects on social, work, and family/home as panic disorder and OCD
(Olatunji et al., 2007). In sum, social phobia is a serious mental disorder that can have
enduring negative effects on life satisfaction and daily living.
Treatment Delay and Service Utilization
Despite many negative effects of the disorder, individuals with social phobia have some
of the lowest rates of treatment utilization of the anxiety disorders. The vast majority of
individuals with social phobia never seek treatment for their condition. In the NCS indi-
viduals with social phobia had lower rates of seeking professional help than those with
simple phobia or agoraphobia (Magee et al., 1996). Moreover, only 24.7% of individu-
als who met DSM-IV criteria for social phobia in the NCS-R made at least one visit to
a mental health specialist in a 12-month period (Wang, Lane, et al., 2005). In the same
study, the median duration of delay in first treatment contact was 16 years for social
phobia, a length of delay that was substantially longer than those for panic disorder,
GAD, PTSD, or major depression (Wang, Berglund, et al., 2005). They also make fewer
general medical visits than individuals with panic disorder (Deacon et al., 2008). In sum
individuals with social phobia are less likely to seek treatment and the minority who
do eventually make an initial contact only after many years with the disorder. Further-
more, social phobia tends to go undetected by physicians and other health professionals,