Social anxiety disorder patients may be avoiding their doctor

May 16 2005

Patients with social anxiety disorder are less likely to visit their primary care doctors than people with other psychiatric disorders like depression, or patients without mental health disorders, according to new research in the journal General Hospital Psychiatry.

In the study of 207 patients at a New York City teaching hospital, patients with social anxiety disorder made only four visits per year to their primary care physician, compared with nearly seven visits a year for other psychiatric patients and six visits for well patients.

Patients with the disorder were also significantly more likely to abuse alcohol and drugs than other psychiatric patients, Dr. Raz Gross and colleagues at Columbia University found.

“Patients might be self-medicating…using alcohol as a social lubricant,” Gross says. She notes that certain components of substance abuse treatment such as Alcoholics Anonymous, with their emphasis on group discussion and public speaking, are unlikely to attract these patients.

Although their primary care doctors recognized emotional or mental health problems in 70 percent of the patients with social anxiety disorder, less than half of those patients reported any mental health treatment over the past year.

Social anxiety disorder or social phobia is one of the most common psychiatric disorders, say Gross and colleagues. Those affected have such severe fears or anxieties about social situations that the disorder causes significant distress and interferes with daily life.

The researchers thought that patients with social anxiety disorder might be less apt to seek health care, since it “involves exposure to situations that are typically feared and avoided by patients with [the disorder],” like crowded waiting rooms, examinations and questions from a stranger and discussions of private and possibly embarrassing medical conditions, Gross says.

“Physicians in primary care and general medical settings should be aware of the possibility that patients with SAD are avoiding regular medical care,” Gross says.

The finding is surprising in some ways because “most Americans with anxiety and depression are treated exclusively in primary care,” says Dr. Wayne Katon, a Washington State University psychiatry professor and editor of the journal’s special papers on psychiatry and primary care.

Katon says patients with anxiety and depression typically visit primary care doctors more often for “minor symptoms such as headaches, fatigue and abdominal discomfort, and often receive a lot of medical tests that increase medical costs.”

Gross and colleagues say their study provides important information about social anxiety disorder in low-income, urban populations that had been lacking from previous studies.

“Individuals with low incomes are less likely to receive mental health treatment from mental health specialists and tend to rely on primary care providers for that purpose,” Gross explains.

Gross and colleagues combined survey data with medical records to determine how patients with social anxiety disorder were using primary care physicians.

More than a third of the affected patients reported a substance abuse disorder, compared to 3 percent of patients with other mental or emotional disorders.

National studies estimate the prevalence of social anxiety disorder at 10 to 13 percent of the population. Nearly 6 percent of the 207 patients in the Gross study had the disorder.

The study was supported by Eli Lilly and Co., makers of Prozac, a drug used to treat anxiety; Upjohn (now Pfizer), makers of the anti-anxiety drugs Xanax and Zoloft; the National Institute of Mental Health and the National Institute of Aging.