community approximately 30% of individuals with social anxiety disorder experience re-
mission of symptoms within 1 year, and about 50% expe rience remission within a few
years. For approximately 60% of individuals wi thout a specific treatment for social anxiety
disorder, the course takes several years or longer.
Detection of social anxiety disorder in olde r adults may be challenging because of sev-
eral factors, including a focus on somatic symptoms, comorbid me dical illness, limited
insight, changes to social environment or roles that may obscure impairment in social
functioning, or reticence about de scribing psychological distress.
Risk and Prognostic Factors
Temperamental. Underlying traits that predispose individuals to social anxiety disor-
der include behavioral inhibition and fear of negative evaluation.
Environmental. There is no causative role of increa sed rates of childhood maltreatment or
other early-onset psychosocial adversity in th e development of social anxiety disorder. How-
ever, childhood maltreatment an d adversity are risk factors for social anxiety disorder. 
Genetic and physiological. Traits predisposing individual s to social anxiety disorder,
such as behavioral inhibition, are strongly genetically influenced. The genetic influence is
subject to gene-environment interaction; that is, children with high behavioral inhibition
are more susceptible to environmental influe nces, such as socially anxious modeling by
parents. Also, social anxiety disorder is heritable (but performance-only anxiety less so).
First-degree relatives have a two to six times greater chance of having social anxiety dis-
order, and liability to the disord er involves the interplay of di sorder-specific (e.g., fear of
negative evaluation) and nonspecific (e.g., neuroticism) genetic factors.
Culture-Related Diagnostic Issues