Assessing the validity of social anxiety disorder subtypes using a nationally representative sample

The purpose of this study was to examine and validate social anxiety disorder subtypes using the nationally representative National Comorbidity Survey Replication (N = 9282). Generalized and non-generalized subtypes were defined as fearing at least 8 (i.e., most) and fewer than 7 of 14 possible social situations, respectively, following the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Results indicated that in those with social anxiety disorder, the odds of having comorbid major depression, a comorbid anxiety disorder, and suicidal ideation were significantly greater in the generalized subtype. However, differences were no longer significant when adjusting for the number of feared social situations. Results further indicated that the number of feared social situations was significantly associated with comorbid major depression, a comorbid anxiety disorder, and suicidal ideation. These findings call into question the validity of DSM-IV-defined subtypes and provide additional support for the notion that clinicians and researchers should consider viewing this disorder on a single continuum with greater number of feared situations associated with greater clinical severity.