تفاوت های جنسیتی در اختلال اضطراب اجتماعی: نتایج از نمونه اپیدمیولوژیک ملی درباره الکل و شرایط مرتبط

Abstract This study examined gender differences among persons with lifetime social anxiety disorder (SAD). Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093), a survey of a representative community sample of the United States adult population. Diagnoses of psychiatric disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version. The lifetime prevalence of SAD was 4.20% for men and 5.67% for women. Among respondents with lifetime SAD, women reported more lifetime social fears and internalizing disorders and were more likely to have received pharmacological treatment for SAD, whereas men were more likely to fear dating, have externalizing disorders, and use alcohol and illicit drugs to relieve symptoms of SAD. Recognizing these differences in clinical symptoms and treatment-seeking of men and women with SAD may be important for optimizing screening strategies and enhancing treatment efficacy for SAD.

1. Introduction Social anxiety disorder (SAD) is highly prevalent (Grant et al., 2005a, Kessler et al., 2005b, Kessler et al., 1994, Magee et al., 1996 and Stein et al., 1994), often co-occurs with other Axis I and Axis II disorders (Kessler et al., 2005a, Kessler et al., 2005b, Kessler et al., 1994, Magee et al., 1996 and Stein et al., 1994), and is associated with significant social, interpersonal and professional impairment (Davidson et al., 1993, Keller, 2003, Kessler, 2003 and Schneier et al., 1992). Research in other anxiety disorders, including generalized anxiety disorder (GAD) (Vesga-Lopez et al., 2008), obsessive-compulsive disorder (Bogetto, Venturello, Albert, Maina, & Ravizza, 1999), panic disorder (Barzega et al., 2001 and Sheikh et al., 2002), and post-traumatic stress disorder (Fullerton et al., 2001), has documented gender differences in their prevalence, symptoms, course, and patterns of comorbidity. However, whereas gender differences in prevalence of SAD have been well documented (Bourdon et al., 1988 and Kessler et al., 1994), knowledge of gender differences in specific features of SAD is scarce. Investigating gender differences in SAD is important because identifying those aspects of SAD which are most similar across genders may increase our understanding of the core features of SAD. On the other hand, isolating the aspects of SAD that differ across genders may guide identification of gender-specific target behaviors for therapeutic interventions (Turk et al., 1998). Furthermore, such examination may also help illuminate which features are disorder-specific and which reflect broader effects of gender on the phenomenology (and potentially the etiology) of anxiety disorders in general. A limited number of studies have primarily focused on gender differences in patterns of comorbidity and level of psychosocial functioning among individuals with SAD. For example, a report from the Harvard/Brown Anxiety Research Program (HARP), an observational study of individuals seeking treatment for anxiety disorders, found that lifetime SAD was associated with more comorbid anxiety disorders and greater functional impairment in women than in men (Yonkers, Dyck, & Keller, 2001). Although this study did not find gender differences in the probability of remission from SAD in the overall sample, women were less likely than men to remit among the subgroup with low scores on the Global Assessment of Functioning Scale (Yonkers et al., 2001). Symptom presentation has also been found to vary by gender. The Early Developmental Stages of Psychopathology Study (EDSP), an epidemiological study of a community sample of young adults, found that fear of embarrassment while eating or drinking in public, writing while someone was watching, talking to others, and participating in social events were more common among women than men with SAD (Wittchen, Stein, & Kessler, 1999), whereas another study in a treatment-seeking sample (Turk et al., 1998) found that women with lifetime SAD feared more social situations and had more intense fears than men with lifetime SAD. The goal of present study was to build on existing knowledge of gender differences in SAD by drawing on data from a large and nationally representative community sample of US adults, to yield more stable and generalizable results than can be derived from geographically localized or clinical samples. Specifically, we sought to compare men and women with lifetime SAD on: (1) lifetime prevalence and sociodemographic characteristics of DSM-IV SAD; (2) rates and patterns of psychiatric comorbidity; (3) course and clinical presentation; and (4) patterns of treatment-seeking (Wittchen & Jacobi, 2005).

5. Conclusions Despite these limitations, the NESARC constitutes the largest nationally representative survey to date to examine gender differences in SAD. While men and women share most features of SAD, our study indicates that, compared with men, women have a higher lifetime risk of SAD, a broader range of social fears, and lower psychosocial functioning. Recognizing the clinical differences and treatment-seeking pattern of men and women with SAD may be important for optimizing screening strategies and enhancing treatment efficacy for SAD.