Psychological Medicine

Original Articles

Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication

A. M. Ruscioa1 c1, T. A. Browna2, W. T. Chiua3, J. Sareena4, M. B. Steina5 and R. C. Kesslera3

a1 Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA

a2 Department of Psychology, Boston University, Boston, MA, USA

a3 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

a4 Department of Psychiatry and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

a5 Department of Psychiatry, University of California, San Diego, CA, USA


Background Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R).

Method The NCS-R is a nationally representative household survey fielded in 2001–2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia.

Results The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose–response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment.

Conclusions Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.

(Received January 31 2007)

(Revised July 26 2007)

(Accepted July 30 2007)

(Online publication November 02 2007)


c1 Address for correspondence: Dr A. M. Ruscio, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104, USA. (Email: