Social anxiety disorder, a lifelong disorder? A review of the spontaneous remission and its predictors.

OBJECTIVE: Based on clinical observations, social anxiety disorder (SAD) is usually described as a chronic disorder. Its natural course in the community is less clear.

METHOD: The present review summarises prospective and retrospective spontaneous remission rates of SAD in the community and its predictors that were published after 1987. Remission rates were specified as partial, defined as still having social fears, but not fulfilling the diagnostic criteria, and full, defined as having no social fears anymore.

RESULTS: In prospective studies, remission rates of SAD varied between 36% and 93% and in retrospective studies between 3% and 80%. The estimated average remission rate in prospective studies was 50% for full remission and 79% when including partial remission. In retrospective studies, the average remission rate was 26% during the last year and 56% over the lifetime. Diverse predictors of remission of SAD have been found that can be clustered into less severe anxiety, less additional psychopathology, less stress, employment, and mental health.

CONCLUSION: The enormous variation in remission rates indicates that SAD might have different course types (short, fluctuating, and chronic) and is not necessarily a chronic disorder. Prevention and treatment should be focused on enhancing positive and reducing negative factors.