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The natural course of social anxiety disorder among adolescents and young adults
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Beesdo‐Baum K, Knappe S, Fehm L, Höfler M, Lieb R, Hofmann SG, Wittchen H‐U. The natural course of social anxiety disorder among adolescents and young adults. Objective: To examine the natural course of social anxiety disorder (SAD) in the community and to explore predictors for adverse long‐term outcomes. Method: A community sample of N = 3021 subjects aged 14–24 was followed‐up over 10 years using the DSM‐IV/M‐CIDI. Persistence of SAD is based on a composite score reflecting the proportion of years affected since onset. Diagnostic stability is the proportion of SAD subjects still affected at follow‐up. Results: SAD reveals considerable persistence with more than half of the years observed since onset spent with symptoms. 56.7% of SAD cases revealed stability with at least symptomatic expressions at follow‐up; 15.5% met SAD threshold criteria again. 15.1% were completely remitted (no SAD symptoms and no other mental disorders during follow‐up). Several clinical features (early onset, generalized subtype, more anxiety cognitions, severe avoidance and impairment, co‐occurring panic) and vulnerability characteristics (parental SAD and depression, behavioural inhibition, harm avoidance) predicted higher SAD persistence and – less impressively – diagnostic stability. Conclusion: A persistent course with a considerable degree of fluctuations in symptom severity is characteristic for SAD. Both consistently meeting full threshold diagnostic criteria and complete remissions are rare. Vulnerability and clinical severity indicators predict poor prognosis and might be helpful markers for intervention needs.
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“and tend to have a chronic and unremitting course (Beesdo-Baum et al., 2012; Steinert et al., 2013)”
From Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample (2024) · cites this paper as Beesdo-Baum et al., 2012
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Self-citationNeurobiological candidate endophenotypes of social anxiety disorder
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Safety behaviours in social anxiety: An examination across adolescence
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“It has an average age of onset of 11-13 years (Asher et al., 2017; Kessler et al., 2005) and is very persistent in the absence of treatment (Beesdo-Baum et al., 2012; Bruce et al., 2005; Hale et al., 2008; Wittchen & Fehm, 2003).”
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“, 2005) and remitting course, swinging above and below the diagnostic threshold (Beesdo-Baum et al., 2012).”
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“This disorder shows a rather chronic course, with 57% of SAD cases revealed stability at 10-year follow-up (Beesdo-Baum et al., 2012).”
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“These rates are in line with previous findings (Ave - nevoli, 2012; Beesdo-Baum et al., 2012; Fehm et al., 2005; Kessler et al., 2005; Knappe et al., 2015; Merikangas et al., 2010; Ruscio et al., 2008) and corroborate that especially girls and young women are affected.”
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“In addition to increasing risk for internalizing disorders (anxiety, mood), and substance abuse disorders later in life (Beesdo-Baum et al., 2012; Grant et al., 2004; Shankman et al., 2009), anxiety may also interfere with an individual’s ability to form relationships (Nelson, Rubin, & Fox, 2005), to pursue academic a…”
BackgroundWhat can HPA axis-linked genes tell us about anxiety disorders in adolescents?
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Was wird aus Kindern und Jugendlichen mit psychischen Störungen?
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“Although social anxiety typically emerges in adolescence, research finds that a moderate percentage of individuals continue experiencing elevated social anxiety symptoms into young adulthood (Beesdo-Baum et al., 2012).”
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“Although social anxiety is a quite persistent disorder, fluctuations of symptom severity are common [17].”
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Schilstra, C. E., Fardell, J. E., Ellis, S. J., Jones, K. M., Anazodo, A. C., Trahair, T. N., Lah, S. S., Cohn, R. J., Wakefield, C. E., & Sansom‐Daly, U. M. (2021) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2021.0050 · Cited by 16
“15 Given that our survivors were an average of seven years post-diagnosis, the subset of AYAs reporting clinically significant SAD symptoms, as well as those scoring just below the cutoff for SAD, may face increased risk of developing more severe symptoms or enduring existing symptoms over time if…”
Clarkson, T., Eaton, N. R., Nelson, E. E., Fox, N. A., Leibenluft, E., Pine, D. S., Heckelman, A. C., Sequeira, S. L., & Jarcho, J. M. (2019) · Depression and Anxiety · doi:10.1002/da.22910 · Cited by 17
Predictors of treatment utilization among adolescents with social anxiety disorder
Zarger, M. M., & Rich, B. A. (2016) · Children and Youth Services Review · doi:10.1016/j.childyouth.2016.11.011 · Cited by 18
Bas‐Hoogendam, J. M., van Steenbergen, H., Kadosh, K. C., Westenberg, P. M., & van der Wee, N. J. A. (2021) · EBioMedicine · doi:10.1016/j.ebiom.2021.103445 · Cited by 14
“With its typical onset during childhood and early adolescence [7 9], followed by a chronic course [10], suboptimal treatment [11,12] and high rates of comorbid psychopathology [13 15], the disorder is very incapacitating.”
BackgroundSchraeder, K. E., Brown, J. B., & Reid, G. J. (2017) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-017-9577-4 · Cited by 15
Detecting Anxiety via Machine Learning Algorithms: A Literature Review
Najaran, M. H. T., & Shahid, S. I. (2025) · IEEE Transactions on Emerging Topics in Computational Intelligence · doi:10.1109/tetci.2025.3543307 · Cited by 16
“…in the literature that clinical characteristics such as comorbidity [46] , increased triglyceride, decreased HDL cholesterol [47], lower birth weight, older age at first walking [48], pain intensity, duration and severity [49], young age of onset [50], and parental history [51] can affect anxiety.”
Burnham, C. M., & Kocovski, N. L. (2023) · Mindfulness · doi:10.1007/s12671-023-02268-4 · Cited by 16
“Social anxiety disorder is a prevalent and enduring condition characterized by fear and avoidance of social situations and worry about negative evaluations from others (Beedso-Baum et al., 2012; Kessler et al., 2012).”
Anxiety Regulation: A Developmental Psychopathology Perspective
Tone, E. B., Garn, C. L., & Pine, D. S. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy214 · Cited by 14
Figueiredo, D. V., Alves, F., & Vagos, P. (2024) · Current Psychology · doi:10.1007/s12144-023-04650-w · Cited by 13
“…associated with SAD usually start in adolescence (Stein et al., 2017; Knappe et al., 2015) and tend to have a chronic and unremitting course (Beesdo-Baum et al., 2012; Steinert et al., 2013), causing significant and persistent impairments in various life domains (e.g., Acquah et al., 2015;…”
InfluentialDaily-life reactivity and emotion regulation in children with social anxiety disorder
Hauffe, V., Vierrath, V., Tuschen‐Caffier, B., & Schmitz, J. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102907 · Cited by 14
Akün, E. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.05.002 · Cited by 12
Kırca, B., Saruhan, V., Aydoğdu, B. N., & Avcu, A. (2023) · Current Psychology · doi:10.1007/s12144-023-04495-3 · Cited by 12
“A study conducted with a ten-year follow-up reported that severe avoidance and behavior suppression predicted higher social anxiety persistence and diagnostic stability (Beesdo-Baum et al., 2012).”
Development and Preliminary Validation of the Child & Adolescent Social Cognitions Questionnaire
Leigh, E., & Clark, D. M. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01163-0 · Cited by 12
“SAD usually begins in childhood or adolescence, with a median age of onset of 13 years [11], and therefore there is theoretical and practical importance to understanding its persistence in youth.”
Social interaction anxiety and depression symptoms are differentially related in men and women
Kim, H., & Duval, E. R. (2022) · Current Psychology · doi:10.1007/s12144-022-03245-1 · Cited by 15
Epidemiology and Natural Course
Beesdo‐Baum, K., & Knappe, S. (2014) · Wiley eBooks · doi:10.1002/9781118775349.ch3 · Cited by 12
Self-citationMao, N., Li, T., Li, C., Ding, R., Zhang, Q., & Cui, L. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02619-8 · Cited by 10
“It is associated with a wide range of mental disorders, including other anxiety disorders, depression, and substance abuse (Beesdo-Baum et al., 2012; Burstein et al., 2011).”
BackgroundTseliou, F., Riglin, L., Thapar, A. K., Heron, J., Dennison, C. A., Armitage, J. M., Thapar, A., Rice, F. J., & Collishaw, S. (2024) · Psychological Medicine · doi:10.1017/s0033291724000631 · Cited by 17
Leigh, E., & Clark, D. M. (2019) · Trials · doi:10.1186/s13063-019-3651-6 · Cited by 11
“disorder is characterised by a persistent course [6, 7].”
BackgroundBos, D. J., Barnes, E. D., Silver, B., Ajodan, E. L., Clark-Whitney, E., Scult, M. A., Power, J. D., & Jones, R. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0249326 · Cited by 13
Factor Structure and Other Psychometric Properties of the Social Phobia Inventory in Korean Samples
Cho, Y., Choi, Y.-H., Kim, S., & Hong, S. (2018) · Measurement and Evaluation in Counseling and Development · doi:10.1080/07481756.2018.1435188 · Cited by 11
“…common mental disorders (Kessler et al., 2005; Kessler, Chiu, Demler, Merikangas, & Walters, 2005) and that it shows a largely persistent course with a considerable degree of fluctuations in symptom severity (American Psychiatric Association, 2013; Beesdo-Baum et al., 2012; Vriends et al., 2007).”
BackgroundMehrizi, S. H. A. A., Amani, O., Feyzabadi, A. M., & Kolae, Z. E. B. (2022) · Current Psychology · doi:10.1007/s12144-022-03225-5 · Cited by 10
Ahadianfard, P., Gharraee, B., Aghebati, A., & Habibi, M. (2023) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1578_22 · Cited by 10
“C group’s mean was the lowest in the follow‑up [Figure 2].”
BackgroundJohnston, C. R., Quarmley, M., Nelson, B. D., Helion, C., Murty, V. P., & Jarcho, J. M. (2023) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2308593120 · Cited by 11
Lassen, N. F., Hougaard, E., Arendt, K. B., & Thastum, M. (2019) · Trials · doi:10.1186/s13063-019-3885-3 · Cited by 10
Wiltink, J., Ruckes, C., Hoyer, J., Leichsenring, F., Joraschky, P., Leweke, F., Pöhlmann, K., & Beutel, M. E. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1257-7 · Cited by 12
Sunderland, M., Afzali, M. H., Batterham, P. J., Calear, A. L., Carragher, N., Hobbs, M. J., Mahoney, A., Peters, L., & Slade, T. N. (2019) · Assessment · doi:10.1177/1073191119832657 · Cited by 10
“If left untreated, SAD tends to be pervasive across the life span with severity fluctuating between subclinical and clinical levels (Beesdo-Baum et al., 2012; Blanco et al., 2011).”
BackgroundWolpert, M., Zamperoni, V., Napoleone, E., Patalay, P., Jacob, J., Fokkema, M., Promberger, M., da Silva, L. C., Patel, M. B., & Edbrooke-Childs, J. H. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01334-4 · Cited by 10
Mörtberg, E., Jansson‐Fröjmark, M., Zalk, N. V., & Tillfors, M. (2021) · Nordic Psychology · doi:10.1080/19012276.2021.1943498 · Cited by 10
“Our results are consistent with a previous longitudinal study (Beesdo-Baum et al., 2012) showing that elevated behavioral avoidance was the most important risk factor of both incidence and persistence of SAD and SSA.”
BackgroundMethodResultInfluentialGanho-Ávila, A., Vieira Figueiredo, D., & Vagos, P. (2022) · Clinical Case Studies · doi:10.1177/15346501221091519 · Cited by 9
“In Europe, SAD has a 2.4% lifetime prevalence (Alonso et al., 2004) and only a 40% natural remission rate (Beesdo-Baum et al., 2012).”
BackgroundInfluentialDapprich, A. L., Derks, L. M., Holtmann, M., Lange, W., Legenbauer, T., & Becker, E. S. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02227-3 · Cited by 9
“To be precise, a peak in social anxiety and CU-traits has been suggested as a normative part of puberty [49, 60, 61].”
BackgroundCognitive and behavioural processes in adolescents with social anxiety disorder
Leigh, E., Percy, R., Clark, D. M., Creswell, C., & Waite, P. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104416 · Cited by 14
Hammoud, R. A., Ammar, L., McCall, S., Shamseddeen, W., & Elbejjani, M. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05725-z · Cited by 9
Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors
McDougall, J., DeWit, D. J., & Wright, F. V. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1590742 · Cited by 9
Trait Impulsivity Impedes Maturing Out of Problem Drinking Among Socially Anxious Undergraduates
Bilevicius, E., Landeghem, C. V., Stewart, S. H., Sherry, S., & Keough, M. T. (2020) · Alcohol and Alcoholism · doi:10.1093/alcalc/agaa109 · Cited by 8
Social Anxiety Across Sexual and Gender Identity Subpopulations
Mahon, C. P., Pachankis, J. E., Kiernan, G., & Gallagher, P. (2023) · Annals of LGBTQ Public and Population Health · doi:10.1891/lgbtq-2020-0017 · Cited by 9
Metadata
- Authors
- Beesdo‐Baum, K., Knappe, S., Fehm, L., Höfler, M., Lieb, R., Hofmann, S. G., & Wittchen, H. ‐.
- Affiliations
- Technische Universität Dresden (DE)
- Humboldt-Universität zu Berlin (DE)
- University of Basel (CH)
- Boston University (US)
- Corresponding author
- Beesdo‐Baum, K.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2012-05-26
- Volume
- 126
- Issue
- 6
- Pages
- 411-425
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W1602079716
- Cited by
- 167
- References
- 69
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 14 · 2023: 20 · 2022: 14 · 2021: 15 · 2020: 16 · 2019: 15 · 2018: 11 · 2017: 11 · 2016: 13 · 2015: 6 · 2014: 9 · 2013: 5 · 2012: 1
- FWCI
- 9.00
- Type
- journal article
- Language
- en
- Open access
- green
- tud.qucosa.de
- Licence
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- social anxiety disorder, natural course, adolescents, young adults, symptom persistence, diagnostic stability, remission, early onset, generalized social anxiety, avoidance, impairment, parental depression, behavioral inhibition, harm avoidance, vulnerability factors, prognosis
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Phobic Disorders, Registries, Severity of Illness Index, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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