Reply to Dr. Crippa's letter "Are there differences between early- and late-onset social anxiety disorder?"

Resposta à carta do Dr. Crippa "Existem diferenças entre transtorno de ansiedade social de início precoce e tardio?"

CARTA AOS EDITORES

Reply to Dr. Crippa's letter "Are there differences between early- and late-onset social anxiety disorder?"

Resposta à carta do Dr. Crippa "Existem diferenças entre transtorno de ansiedade social de início precoce e tardio?"

Dear Editor,

We appreciate the thoughtful letter from Dr. Crippa and colleagues, who raised some interesting issues based on the findings of our article entitled "Early-onset social anxiety disorder in adults: clinical and therapeutic features",¹ which was published in the Revista Brasileira de Psiquiatria. In our study, we evaluated the sociodemographic and clinical characteristics of a sample of adult patients diagnosed with social anxiety disorder (SAD). The objective of our analysis was the identification of differences between the subgroups presenting early- and late-onset forms of the disorder. We found that patients from the former group were more frequently economically unproductive, presented a higher frequency of the generalized subtype of SAD, and exhibited greater rates of multiple comorbid psychiatric disorders.

Despite Crippa et al.'s comments, our socioeconomic findings dovetail with the results previously described both in clinical and epidemiological studies of patients with SAD from the developed countries. For example, in an epidemiological study, Wells et al. found that early-onset SAD was associated with lower levels of education and low frequency of marriage.² Likewise, in a clinical study, Lecrubier found that patients with early-onset SAD (< 15 years) had lower levels of education than those from the late- onset group.³ In terms of clinical features, the finding that the generalized subtype of SAD was more common in the early-onset group was also observed in studies of both epidemiological and clinical samples conducted by Wittchen and Manuzza, respectively, in which a significant correlation was found between earlier age at onset and the generalized subtype.^4-5

We believe that the discrepant findings described by Crippa et al. in their letter might be ascribed to the particular sociodemographic characteristics of their sample, which was composed exclusively by undergraduate subjects. Although we acknowledge that our study has some limitations, including its small sample size and the fact that it has enrolled individuals who sought treatment at a research center, it certainly covers a wider age range than does the study by Crippa et al. This feature may have provided the required heterogeneity to unveil more clear-cut differences between early- and late-onset SAD. Moreover, since we have described our findings using a treatment-seeking sample, our results may be considered as more relevant for the daily clinical practice.

Gabriela Bezerra de Menezes

Program of Anxiety and Depression, Institute of Psychiatry,

Universidade Federal do Rio de Janeiro (UFRJ),

Rio de Janeiro (RJ), Brazil

Leonardo F Fontenelle; Márcio Versiani

Department of Forensic Psychiatry and Medicine,

Medical School, Universidade Federal do Rio de Janeiro (UFRJ),

Rio de Janeiro (RJ), Brazil

Program of Anxiety and Depression, Institute of Psychiatry,

Universidade Federal do Rio de Janeiro (UFRJ),

Rio de Janeiro (RJ), Brazil

References

1. Menezes GB, Fontenelle LF, Versiani M. Early-onset social anxiety disorder in adults: clinical and therapeutic features. Rev Bras Psiquiatr. 2005; 27(1):32-6.

2. Wells JC, Tien AY, Garrison R, Eaton WW. Risk factors for the incidence of social phobia as determined by Diagnostic Interview Schedule in a population-based study. Acta Psychiatr Scand. 1994; 90(2):84-90.

3. Lecrubier Y. Implications of early onset social phobia on outcome. Eur Neuropsychopharmacol. 1997;7(Suppl 2):S85.

4. Wittchen HU, Stein MB, Kessler RC. Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med. 1999;29(2):309-23.

5. Mannuzza S, Schneier FR, Chapman TF, Liebowitz MR, Klein DF, Fyer AJ. Generalized social phobia. Reliability and validity. Arch Gen Psychiatry. 1995;52(3):230-7.

Financing: None

Conflict of interests: None

Publication Dates

• Publication in this collection
  06 July 2007
• Date of issue
  June 2007