Situational panic attacks in social anxiety disorder

Abstract

Background: Panic attacks (PAs) are common in many psychiatric disorders other than panic disorder, especially social anxiety disorder (SAD). PAs have been associated with increased severity, comorbidity, and impairment in many disorders; therefore, PAs can now be used as a descriptive specifier across all DSM-5 disorders. However, the clinical implications of PAs in SAD remain unclear.

Methods: The aim of the present investigation was to examine demographic and clinical characteristics associated with SAD-related situational panic attacks in a large, representative epidemiological sample of individuals with SAD (N=1138). We compared individuals with SAD who did and did not endorse situational PAs in terms of demographic factors, fear/avoidance of social situations, distress, impairment, and diagnostic comorbidity.

Results: Being male, black, Asian, or over 65 years old was associated with a decreased likelihood of experiencing situational PAs, whereas being unemployed was associated with an increased likelihood. Individuals with situational PAs also exhibited greater fear and avoidance of social situations, impairment, coping-oriented substance use, treatment utilization, and concurrent and longitudinal psychiatric comorbidity.

Limitations: Consistent with most epidemiologic studies, the information collected relied on self-report, and not all participants were available for both waves of assessment.

Conclusions: The present findings suggest that SAD-related situational PAs are associated with more severe and complex presentations of SAD. Implications for the assessment and treatment of SAD, as well as for the use of PAs as a descriptive specifier for SAD, are discussed.

Keywords: Epidemiology; NESARC; Panic attacks; Social anxiety disorder; Social phobia.