Gender differences in the presentation and management of social anxiety disorder.

Social anxiety disorder is associated with significant impairment in social and occupational functioning. Gender differences in social anxiety disorder are apparent for treatment seeking and symptom clusters, and hormonal influences may affect the natural course of illness. The lifetime prevalence rate is 13.3%, with rates of 15.5% in women and 11.1% in men. Although most studies indicate that more women suffer from social anxiety disorder, it appears that men are more likely to seek treatment. Gender differences in the presentation and management of social anxiety disorder may be influenced by fluctuations in levels of endogenous or exogenous reproductive hormones. Neurotransmitter systems implicated in the etiology of mood and anxiety disorders may be affected by both estrogen and progesterone. There are also issues with regard to pregnancy in women who have social anxiety disorder. It is not known if untreated social anxiety disorder represents a significant risk to the fetus. However, social anxiety disorder often is complicated by comorbid depression, panic disorder, or substance abuse, all of which may pose risks to the fetus if left untreated. Treatment strategies for patients with social anxiety disorder should consider gender differences in response to pharmacotherapy, psychiatric comorbidity, oral contraceptive use, pregnancy status, and the specific nature of symptoms in the individual patient.