Social Anxiety Disorder (SAD) and Other Psychiatric Conditions

SAD can be associated with a number of other psychiatric conditions, such as specific phobia, depression, obsessive-compulsive disorder, and nicotine or alcohol dependence.[1] In fact, it is quite common for SAD to occur in conjunction with other psychiatric disorders.[2] One study of patients with SAD found that 60% had three or more comorbid conditions, and that SAD usually developed first.[2]

The fact that SAD can precede the development of other conditions emphasizes the need for early identification and treatment.[3][4] SAD may contribute to other physical conditions; a study of patients with coronary heart disease found that 21.3% had experienced SAD during their life.[5]

Not surprisingly, SAD is closely associated with depression, possibly because many people with SAD may stay at home most of the time for fear of meeting and interacting with others.[6] A large community study of SAD found that over 50% of people with SAD also experienced a depressive disorder, and that SAD occurred first in 59.3% of patients with both SAD and a depressive disorder.[7] Factors associated with a greater chance of developing depression included the presence of parental anxiety disorders or depression and the severity of SAD.[7]

SAD may contribute to the development of alcohol abuse as a form of "self-medication".[8][9][10] Since comorbid alcohol or drug abuse has been associated with greater distress and risk for self-harm in patients with anxiety disorders, a physician may suggest strategies to reduce alcohol consumption or abuse.[10]

Several medications are FDA approved to treat SAD and many are FDA approved to treat one or more psychiatric disorders. There are no medications approved specifically to treat SAD with other psychiatric disorders. Please discuss your treatment regimen with your doctor.

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References:

  1. ^ Grant BF, et al. 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. 2005;66:1351-61.
  2. ^ Fehm L, et al. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology. 2007;[Epub ahead of print]
  3. ^ Falk DE, et al. Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders. Drug and Alcohol Dependence. 2008;doi:10.1016/j.drugalcdep.2007.11.022.
  4. ^ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC: American Psychiatric Association; 2000.
  5. ^ Todaro JF, et al. Prevalence of anxiety disorders in men and women with established coronary heart disease. Journal of Cardiopulmonary Rehabilitation and Prevention. 2007;27:86-91.
  6. ^ Schneier FR, et al. Social phobia: comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry 1992;49:282-8.
  7. ^ Beesdo K, et al. Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry. 2007;64:903-12.
  8. ^ Grant BF, et al. 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. 2005;66:1351-61.
  9. ^ Falk DE, et al. Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders. Drug and Alcohol Dependence. 2008;doi:10.1016/j.drugalcdep.2007.11.022.
  10. ^ Bolton J, et al. Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample. Journal of Nervous and Mental Disorders. 2006;194:818-25.

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