206 Anxiety Disorders
Immigrant status is associated with significan tly lower rates of social anxiety disorder in
both Latino and non-Latino white groups. Prev alence rates of social anxiety disorder may
not be in line with self-reported social anxiety levels in the same cult ure—that is, societies
with strong collectivistic orientations may report high levels of social anxiety but low prev-
alence of social anxiety disorder.
Gender-Related Diagnostic Issues
Females with social anxiety disorder report a greater number of social fears and comorbid
depressive, bipolar, and anxiety disorders, wh ereas males are more likely to fear dating,
have oppositional defiant disorder or conduct disorder, and use alcohol and illicit drugs to
relieve symptoms of the disorder. Paruresis is more common in males.
Functional Consequences of  Social Anxiety Disorder
Social anxiety disorder is asso ciated with elevated rates of  school dropout and with de-
creased well-being, employment , workplace productivity, soci oeconomic status, and quality
of life. Social anxiety disorder  is also associated with being single, unmarried, or divorced
and with not having children, particularly amon g men. In older adults, there may be impair-
ment in caregiving duties and volunteer activi ties. Social anxiety disorder also impedes lei-
sure activities. Despite the extent of distress  and social impairment associated with social
anxiety disorder, only about half  of individuals with the diso rder in Western societies ever
seek treatment, and they tend to do so only after 15–20 years of experiencing symptoms. Not
being employed is a strong predictor for th e persistence of social anxiety disorder.
Differential Diagnosis
Normative shyness. Shyness (i.e., social reticence) is a common personality trait and is
not by itself pathological. In some societies, shyness is even evaluated positively. How-