The spectrum of social phobia in the Zurich cohort study of young adults

Background: The goals of the present study are to describe the prevalence, risk factors, course, and impact of social phobia in a 15-year prospective longitudinal community study; and to examine an expanded conceptualization of social phobia with respect to clinical indicators of severity, as well as gender differences, personality traits, and stability over 15 years. Methods: The sample is a cohort of 591 young adults aged 18-19 from the general population of Zurich, Switzerland at study entry who have been followed to age 35. Results: Six percent of participants met lifetime criteria for social phobia at the diagnostic level, 12% at the subthreshold level, and 24% had social phobia symptoms alone. Women had higher lifetime rates of diagnostic and subthreshold-level social phobia, whereas there was an equal gender ratio of social phobia symptoms. There was a direct association between strictness of the diagnostic threshold and severity, such that work impairment, social impairment, treatment rate, medication use, and subjective distress decreased from the diagnostic to the symptom level. Similarly, family history of phobias, autonomic lability, and comorbidity decreased across the spectrum. Although there was a substantial degree of longitudinal stability at each level of the spectrum, significant oscillation across levels suggests that the spectrum concept better characterizes the longitudinal course of social phobia. Conclusions: These findings demonstrate the utility of the social phobia spectrum. Application of the spectrum concept provides coverage of treated but undiagnosed cases of social phobia as well as those who vacillate across the diagnostic threshold over time. (C) 2002 Society of Biological Psychiatry.