Dr. Jonathan R.T. Davidson speaks out about SPIN

Dr. Jonathan Davidson is the creator of the Social Phobia Inventory (SPIN) and a leading expert on social anxiety disorder. He is currently at Duke University Medical Center, Department of Psychiatry, in Durham, North Carolina. Dr. Davidson had this to say about the diagnosis and treatment of social anxiety disorder:

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"Social anxiety disorder is among the most common of all psychiatric disorders, occurring in between 13 and 16% of the population, depending on the country which has been studied. It is also found in many different cultures, from both East and West. The rate of recognition by clinicians is extremely low, varying from 0.5 to 3% according to study. Several reasons can be given for this serious oversight: trivialization and dismissal of social anxiety disorder as being important, unawareness of the facts by professionals, shame/embarrassment/stigma on the part of the patient, and the symptoms of the disorder itself, which include avoidance of authority figures, such as doctors. In primary care practices, such as an HMO in the United States or a family practice in France, the current prevalence rates vary from 5 to 8%, indicating that it is a common condition in the context of clinical medicine.

"Because there are highly effective treatments, and also because social anxiety disorder is not generally difficult to diagnose, providing one thinks about it, we developed a patient self-rating scale, the Social Phobia Inventory (SPIN), which consists of 17 items, each rated on a 5-point scale, and covering the commonly found fears, avoidance and physical symptoms of the disorder. A maximum score of 68 can be obtained, and would obviously represent extreme social anxiety disorder. More typically, among people seeking help for treatment, scores would be in the 40 to 60 range. Separate work with the scale, however, has found that a score of 19 distinguishes with a fairly high level of accuracy (i.e., about 80%) between people with and without social anxiety disorder. While the full SPIN is simple to administer, taking about five to ten minutes at most, and is easy to score, we developed a shorter scale, known as the MINI-SPIN, which consists of 3 items that were found to be exceptionally sensitive to differentiating between the presence and absence of generalized social anxiety disorder. These three items are as follows: 'Fear of embarrassment causes me to avoid doing things or speaking to people; I avoid activities in which I am the center of attention; Being embarrassed or looking stupid are among my worst fears.' Each of these items, being scored to 0-4, is rated and the total score with this 3-item scale will range from 0-12. We examined the sensitivity of different score cut-offs across this range, and found that a score of 6 best distinguished between people with and without generalized social anxiety disorder to a 90% level of accuracy. Therefore, the MINI-SPIN can be used as a very quick and easy-to-administer self-rating to screen for the likelihood of generalized social anxiety disorder. On its own, it would not be sufficient to make a diagnosis, which needs to be based upon clinical assessment by a qualified professional."