The Pathophysiology of Social Anxiety

In this chapter, current knowledge about the pathophysiology of social anxiety is reviewed. Physiological studies reveal that social anxiety and its antecendent, a fearful temperament, are characterized by basal hyperarousal and enhanced reactivity to social stressors, suggesting a lower threshold of the limbic system. The blushing response appears enhanced in social anxiety disorder (SAD) compared to no anxiety disorder, although its specificity for SAD versus other anxiety disorders is unknown. Initial support is found for distinct physiological profiles associated with subtypes of SAD. Finally, cultural differences in the prevalence of SAD seem to be partially attributable to differences in predisposed hyperarousal, predisposed interoceptive awareness, and self-consciousness due to differences in visibility of blushing as a consequence of skin tone. To conclude, through further research on the pathophysiology of social anxiety, the development and maintaining mechanisms of SAD and cross-cultural differences in prevalence rates can be further illuminated.