Social Anxiety Disorder (Social Phobia) 205
Development and Course
Median age at onset of social anxiety disorder  in the United States is 13 years, and 75% of
individuals have an age at onset between 8 and 15 years. The disord er sometimes emerges
out of a childhood history of social inhibition or shyness in U.S. and European studies. On-
set can also occur in early childhood. Onset of  social anxiety disorder may follow a stress-
ful or humiliating experience (e.g., being bu llied, vomiting during a public speech), or it
may be insidious, developing slowly. First onse t in adulthood is relatively rare and is more
likely to occur after a stressful or humiliating event or after life changes that require new
social roles (e.g., marrying someone from a different social class, receiving a job promo-
tion). Social anxiety disorder may diminish after an individual with fear of dating marries
and may reemerge after divorce. Among individu als presenting to clinical care, the disor-
der tends to be particularly persistent. 
Adolescents endorse a broader pattern of fe ar and avoidance, including of dating,
compared with younger children . Older adults express social anxiety at lower levels but
across a broader range of situations, whereas younger adults express higher levels of so-
cial anxiety for specific situations. In older adults, social anxiet y may concern disability
due to declining sensory functioning (hearing , vision) or embarrassment about one’s ap-
pearance (e.g., tremor as a symptom of Parkin son’s disease) or functioning due to medical
conditions, incontinence, or cogn itive impairment (e.g., forgetting people’s names). In the
community approximately 30% of individuals with social anxiety disorder experience re-