Journal of Anxiety Disorders 26 (2012) 393–400 Contents lists available at SciVerse ScienceDirect Journal of Anxiety Disorders Functional impairment in social anxiety disorder Idan M. Aderka a,b,* , Stefan G. Hofmann a , Angela Nickerson a,c , Haggai Hermesh d,e , Eva Gilboa-Schechtman b , Sofi Marom d a Department of Psychology, Boston University, Boston, MA, USA b Psychology Department & Gonda Brain Science Center, Bar-Ilan University, Ramat-Gan, Israel c School of Psychology, University of New South Wales, Sydney, Australia d Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Petach-Tikva, Israel e Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel a r t i c l e i n f o Article history: Received 22 April 2011 Received in revised form 5 January 2012 Accepted 7 January 2012 Keywords: Social anxiety disorder Impairment Comorbidity Subtypes a b s t r a c t The present study examined functional impairment among treatment seekers with social anxiety dis- order (SAD). We investigated the effects of diagnostic subtypes of SAD and comorbidity with mood and anxiety disorders on impairment. In addition, we used cluster analysis procedures to empirically identify subgroups of individuals with distinct patterns of impairment. Participants were 216 treatment-seeking individuals with SAD. Clinical interviews were undertaken to determine diagnoses of anxiety disorders and major depressive disorder, and a battery of self-report measures was administered to index symp- toms of social anxiety, depression and extent of impairment. Results indicated that individuals with the generalized subtype of SAD had greater impairment in all three life domains compared to individuals with the nongeneralized subtype. Comorbidity with mood disorders was associated with greater impair- ment than SAD alone, but comorbidity with anxiety disorders was not. Four distinct impairment profiles emerged from the cluster analysis: primary work/studies impairment, primary social life impairment, both work/studies and social impairment, and impairment in all domains. Findings from this study sug- gest that SAD is associated with substantial impairment across multiple domains, and that individuals with SAD present diverse impairment profiles. These profiles may inform subtyping of the disorder as well as therapeutic interventions. © 2012 Elsevier Ltd. All rights reserved. Social anxiety disorder (SAD) is associated with significant disability, impairment and reduced quality of life (Alonso et al., 2004; Kessler, 2003; Mendlowicz & Stein, 2000; Schneier et al., 1994; Stein, Torgrud, & Walker, 2000). Individuals with SAD have been found to be more financially dependent (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992), underemployed (Wittchen, Fuetsch, Sonntag, Müller, & Liebowitz, 2000), less productive at work (Wittchen et al., 2000), and underpaid (Stein et al., 2000), compared to those without the disorder. In addition, SAD is asso- ciated with educational impairment (Schneier et al., 1994), with individuals with SAD being more likely to fail a grade or drop out of school (Stein & Kean, 2000) compared to individuals without the disorder. Finally, individuals with SAD have been found to have impairment in close relationships (Davila & Beck, 2002), including romantic relations (Sparrevohn & Rapee, 2009), friendships (Davila & Beck, 2002; Schneier et al., 1994), and family relations (Schneier et al., 1994) compared to individuals without SAD. Even when * Corresponding author at: Department of Psychology, Boston University, 648 Beacon St., 6th floor, Boston, MA, USA. E-mail address: iaderka@bu.edu (I.M. Aderka). compared to other psychiatric disorders, the impairment caused by SAD is very high, with SAD being among the 5 most impairing psychiatric disorders (Alonso et al., 2004). Whereas evidence suggests that SAD is associated with impair- ment across numerous areas of functioning, certain life domains may be more strongly impaired by SAD than others (Wittchen et al., 2000). Specifically, there is evidence that SAD impairs work, studies, and social life, more than family life (Wittchen et al., 2000). 1 Simi- lar findings have emerged in studies comparing impairment across the anxiety disorders. For instance, SAD is associated with more educational and social life impairment and less family life impair- ment compared to other disorders (Lochner et al., 2003; Quilty, Ameringen, Mancini, Oakman, & Farvolden, 2003). The reduced impairment in family life is consistent with cog- nitive models of SAD (Clark, 2005; Hofmann, 2007; Rapee & Heimberg, 1997) which identify conditional beliefs about conse- quences of social behavior as pivotal in maintaining the disorder 1 In the Wittchen et al. (2000) study, different facets of impairment were com- pared among individuals with SAD (within-subjects), so no comparison group was used. 0887-6185/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2012.01.003