Social Phobia: Etiology, Neurobiology, and Treatment
J Clin Psychiatry 2001;62(suppl 1):25-35
© Copyright 2015 Physicians Postgraduate Press, Inc.
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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 social
phobia. Genetic studies show that both genetic and environmental factors are important, with evidence
pointing to associations with 2 genetic conditions, autism and fragile X syndrome. Behavioral
inhibition 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 play
a role in the development of social phobia. During childhood, complex interactions between brain system
disturbances that mediate responses to negative social cues and factors in the social setting may
lead to the development of a distorted set of internal "blueprints" for social behavior. The impact of
severe social anxiety on brain systems that mediate behavioral change may prevent patients from
learning better “blueprints.” These can be taught through cognitive-behavioral therapies. The effective
control of social anxiety with medications enables patients to recover; whether recovery can last
after discontinuation of medications may depend on whether a new “blueprint” has been developed
and whether stable changes in affected brain systems have occurred. Neuroimaging techniques are at
the early stage of identifying abnormalities at the neurotransmitter and systems levels.