Elsevier

Clinical Psychology Review

Volume 24, Issue 7, November 2004, Pages 737-767
Clinical Psychology Review

The etiology of social phobia: empirical evidence and an initial model

https://doi.org/10.1016/j.cpr.2004.06.004Get rights and content

Abstract

Research into the etiology of social phobia has lagged far behind that of descriptive and maintaining factors. The current paper reviews data from a variety of sources that have some bearing on questions of the origins of social fears. Areas examined include genetic factors, temperament, childrearing, negative life events, and adverse social experiences. Epidemiological data are examined in detail and factors associated with social phobia such as cognitive distortions and social skills are also covered. The paper concludes with an initial model that draws together some of the current findings and aims to provide a platform for future research directions.

Introduction

Social phobia is a debilitating disorder that affects a relatively large percentage of the population. While tremendous strides have been made in our understanding of potential maintaining factors in this disorder and consequently in its management, we are still a long way from knowing why one person develops the disorder and another does not. In turn, this information can be used to develop prevention efforts and ultimately reduce the incidence of the disorder (see Spence, 2001). Given that social phobia also precedes several other debilitating disorders such as depression and substance abuse for many individuals, understanding of the etiology of social phobia may help to improve understanding of these other disorders as well.

To date, there have been no single, landmark studies that comprehensively pull together a large part of the puzzle of the onset of social phobia. However, a wealth of empirical evidence provides insight and hints to a myriad of separate aspects that may be influential in the onset of social fears. These include epidemiological studies that point to unique features of social phobia that may be involved in its onset, as well as more descriptive and experimental studies in clinical and high-risk populations that focus on putative causal constructs. In this article, we attempt to draw together a wide variety of information relevant to social phobia that we believe may have bearing on questions of etiology. In some ways, these data raise more questions than they answer, but this is beneficial since it is important to provide guidance and direction to future investigations of causal mechanisms in social phobia. While it is impossible at this stage to provide a complete picture of the causes of social fears, in the final section we attempt to draw together some of this information and provide an initial model that will hopefully allow some concerted efforts for future research to better understand the onset of social phobia and ultimately produce far more comprehensive models.

Section snippets

Diagnostic threshold

An issue of major consideration for any theory of the etiology of social phobia is whether the disorder should be considered a qualitatively distinct category, or as simply a relatively arbitrary cut along a broader dimension or continuum. Evidence on this point can be examined from studies of the distribution of social fears in various samples. Such data generally indicate that fear and avoidance of social situations typically occur broadly and normally across the population Essau et al., 1999

Genetics

There is now a good deal of evidence to suggest that genetic factors play a modest but significant role in the development of social phobia and social anxiety, in both children and adults. Early studies identified elevated rates of social phobia among close family members of sufferers of social phobia (Fyer, 1993, Fyer et al., 1995). Children with social phobia were more likely than their non-affected peers to have parents with social phobia and similarly the children of parents with social

A model of the etiology of social phobia

It is clear that the principles of equifinality and multifinality are both relevant to the development of social phobia (Ollendick & Hirshfeld Becker, 2002). There are many possible pathways and risk factors that may eventuate in higher levels of social fears and none of these is likely to be necessary for social phobia to develop. In addition, few risk factors are likely to be specific to social anxiety and it is more likely to be the particular combination of risks or the combination of one

Uncited references

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Edelmann & Baker, 2002

Gelernter, Stein, Tancer, & Uhde, 1992

Henderson & Zimbardo, 2001

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Levin et al., 1993

Li, Chokka, & Tibbo, 2001

Peters, Clark, & Cooper, 1998

Skre et al., 1993

Stein & Deutsch, 2003

Veljaca & Rapee, 1998

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