Clinical predictors of diagnostic status in individuals with social anxiety disorder.

Objective: In psychiatric patients, comorbidity tends to be the rule, rather than the exception. This is especially true for patients with social anxiety disorder (SAD), but research on the implications of diagnostic status has been limited. This study aimed to examine the frequency of SAD as: (1) the only diagnosis, (2) a principal diagnosis with comorbid conditions, or (3) a comorbid condition when another diagnosis is principal in a treatment-seeking population. The study also sought to identify clinical features that distinguish people in these diagnostic groups.

Method: Our sample included 684 adult participants presenting for treatment in a specialty clinic for anxiety disorders. We established diagnoses with semistructured clinical interviews, and participants completed self-report measures of social anxiety, associated transdiagnostic symptoms, general distress, and impairment due to psychological difficulties. We analyzed group differences and investigated predictors of principal SAD diagnosis.

Results: Over half of participants reported symptoms that met criteria for a SAD diagnosis (51.8%). Of these, 8.8% had SAD only (no comorbid psychiatric diagnoses), 48.6% had multiple conditions with SAD as the principal diagnosis, and 42.7% had multiple conditions with SAD as an additional diagnosis. SAD-only was associated with less severe impairment and transdiagnostic symptoms. Among participants with comorbid conditions, greater fear of negative evaluation, behavioral avoidance, and coping with substances predicted a principal SAD diagnosis, whereas SAD as an additional diagnosis was more likely when participants presented with greater anxiety sensitivity, intolerance of uncertainty, and thought avoidance.

Conclusions: Our findings suggest that principal diagnosis of SAD is common in a treatment-seeking population and is associated with more severe disorder-specific symptoms and less severe transdiagnostic features related to anxiety. Implications for assessment and treatment planning in clinical practice are discussed.