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Social anxiety disorder in the West and in the East

Dan J. Stein, MD, PhD

Department of Psychiatry, University of Cape Town, Cape Town, South Africa, Mt. Sinai School of Medicine, New York, NY, USA

BACKGROUND: Although social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in epidemiological surveys, concepts of social anxiety have varied from time to time and place to place. In recent years, however, similar assessments and treatments have been utilized across the world.

METHODS: In this paper, current concepts of SAD in the West and the partially related condition known as taijin kyofusho (TKS) in the East are summarized, and trials of selective serotonin reuptake inhibitors (SSRIs) that have been undertaken in both the United States/Europe and in Japan for social anxiety symptoms are reviewed.

RESULTS: Despite differences in the conceptualization of SAD and TKS, social anxiety is a prevalent symptom in many parts of the world. Fluvoxamine is more effective than placebo in randomized controlled trials of SAD in the West and the East.

CONCLUSIONS: Patients suffering from SAD in different parts of the world share many features in common, and certain SSRIs are an effective treatment for this condition globally.

KEYWORDS: social anxiety disorder, taijin kyofusho, cultural concepts, selective serotonin reuptake inhibitors


CORRESPONDENCE: Dan J. Stein, MD, PhD Department of Psychiatry University of Cape Town Groote Schuur Hospital (J-2) Anzio Rd., Observatory 7925 Cape Town, South Africa. E-MAIL:
Annals of Clinical Psychiatry ©2009 American Academy of Clinical Psychiatrists

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