Social anxiety disorder: what are we losing with the current diagnostic criteria? Introduction Social anxiety disorder (SAD), according DSM-IV definition, is characterized by a marked and persis- tent fear of one or more social or performance situations in which the person is exposed to unfa- miliar people or possible scrutiny by others. Several epidemiologic studies suggest that SAD is among the most common anxiety disorders, with a 12- month prevalence ranging from 7% to 10% (1–4). Filho AS, Hetem LAB, Ferrari MCF, Trzesniak C, Martı´n-Santos R, Borduqui T, de Lima Oso´rio F, Loureiro SR, Busatto Filho G, Zuardi AW, Crippa JAS. Social anxiety disorder: what are we losing with the current diagnostic criteria? Objective: To assess the rate of comorbidities and the functional impairment associated with the social anxiety disorder (SAD), with an emphasis on the so-called subthreshold clinical signs and symptoms. Method: Psychiatric comorbidities and psychosocial functioning were evaluated in 355 volunteers (college students) who had been diagnosed as SAD (n = 141), Subthreshold SAD (n = 92) or Controls (n = 122). Results: The rate of comorbidities was 71.6% in the SAD group and 50% in subjects with Subthreshold SAD, both significantly greater than Controls (28.7%). Concerning psychosocial functioning, the SAD group had higher impairment than the other two groups in all domains evaluated, and subjects with Subthreshold SAD presented intermediate values. Conclusion: The rates of psychiatric comorbidities and the impairment of psychosocial functioning increase progressively along the spectrum of social anxiety. The fact that Subthreshold SAD causes considerable disability and suffering in comparison with control subjects justifies a review of the validity of the diagnostic criteria. A. S. Filho 1,2 , L. A. B. Hetem 1 , M. C. F. Ferrari 1,2 , C. Trzesniak 1,2 , R. Martín-Santos 2,3 , T. Borduqui 1,2 , F. de Lima Osório 1,2 , S. R. Loureiro 1,2 , G. Busatto Filho 2,4 , A. W. Zuardi 1,2 , J. A. S. Crippa 1,2 1 Department of Neuroscience and Behavior, Faculty of Medicine of Ribeir¼o Preto, University of S¼o Paulo, S¼o Paulo, 2 INCT Translational Medicine, Ribeir¼o Preto, Brazil, 3 Department of Psychiatry, Institut Clínic Neurociencies, IDIBAPS, CIBERSAM, Barcelona, Spain and 4 Department of Psychiatry, Faculty of Medicine, University of S¼o Paulo, Brazil Key words: social anxiety; diagnosis; psychosocial impairment; comorbidity; prevalence; college students Alaor Santos Filho, Hospital das Clínicas – Terceiro Andar, Av. Bandeirantes, 3900, Ribeir¼o Preto, S¼o Paulo, Brazil, CEP - 14049-900. E-mail: alaorsantos@hotmail.com The paper was presented at the Brazilian Congress of Psychiatry and was awarded the ÔProfessor Ulysses Vianna FilhoÕ prize, the highest award of the Brazilian Psychiatric Association. Accepted for publication July 14, 2009 Significant outcomes • The prevalence of comorbidities and the psychosocial impairment have Ôdose-dependentÕ values through the social anxiety disorder (SAD) spectrum. • The Subthreshold SAD demonstrates intermediate characteristics between the SAD and control group. • It is necessary to revise, in a judicious manner, the validity of the current criteria of suffering and of functional impairment of the DSM-IV. Limitations • Only DSM-IV axis I comorbidities were considered. • Premorbid psychiatric history of subjects was not taken into account. • Sample constituted only by young adults (college students). Acta Psychiatr Scand 2010: 121: 216–226 All rights reserved DOI: 10.1111/j.1600-0447.2009.01459.x Ó 2009 John Wiley & Sons A/S ACTA PSYCHIATRICA SCANDINAVICA 216