Social Phobia: Etiology, Neurobiology, and Treatment

Social phobia is a common and often disabling condition, with an etiology that is not established.There is evidence at several levels for an interplay of biological and psychological processes in socialphobia. Genetic studies show that both genetic and environmental factors are important, with evidencepointing to associations with 2 genetic conditions, autism and fragile X syndrome. Behavioralinhibition has emerged as an important precursor to social phobia and possibly to other anxiety disorders.Epidemiologic and clinical studies have suggested that factors within the family environment,such as overprotection, overcontrol, modeling of anxiety, criticism, and in some cases abuse, can playa role in the development of social phobia. During childhood, complex interactions between brain systemdisturbances that mediate responses to negative social cues and factors in the social setting maylead to the development of a distorted set of internal “blueprints” for social behavior. The impact ofsevere social anxiety on brain systems that mediate behavioral change may prevent patients fromlearning better "blueprints." These can be taught through cognitive-behavioral therapies. The effectivecontrol of social anxiety with medications enables patients to recover; whether recovery can lastafter discontinuation of medications may depend on whether a new "blueprint" has been developedand whether stable changes in affected brain systems have occurred. Neuroimaging techniques are atthe early stage of identifying abnormalities at the neurotransmitter and systems levels.