Background: Structural and functional brain imaging studies suggest abnormalities of the amygdala and hippocampus in posttraumatic stress disorder and major depressive disorder. However, structural brain imaging studies in social phobia are lacking. Methods: In total, 24 patients with generalized social phobia (GSP) and 24 healthy controls underwent 3-dimensional structural magnetic resonance imaging of the amygdala and hippocampus and a clinical investigation. Results: Compared with controls, GSP patients had significantly reduced amygdalar (13%) and hippocampal (8%) size. The reduction in the size of the amygdala was statistically significant for men but not women. Smaller right-sided hippocampal volumes of GSP patients were significantly related to stronger disorder severity. Limitations: Our sample included only patients with the generalized subtype of social phobia. Because we excluded patients with comorbid depression, our sample may not be representative. Conclusion: We report for the first time volumetric results in patients with GSP. Future assessment of these patients will clarify whether these changes are reversed after successful treatment and whether they predict treatment response.
Brief ReportReduced amygdalar and hippocampal size in adults with generalized social phobia
IntroductionPresent evidence from functional brain imaging studies suggests that patients with social phobia, posttraumatic stress disorder (PTSD) or specific phobia share a pattern of hyperactivity of the amygdala and surrounding cortices, including the hippocampus, linked to negative emotional responses. 1 The majority of studies including patients with social phobia suggest that these changes may be most pronounced in the generalized subtype of social phobia (GSP). 2-4 A recent study suggests that these changes may resolve after successful psychotherapeutic or psychopharmacologic treatment of social phobia. 5 There is now an extensive body of evidence suggesting that PTSD 6 and major depressive disorder 7,8 are related to abnormal amygdalar and hippocampal size. However, the mechanisms underlying these changes are not well understood. Research in nonhuman primates has suggested that stress and prolonged glucocorticoid exposure may damage the hippocampus, 9 thus raising the possibility that stress may also induce hippocampal degeneration in humans with anxiety or affective disorders. Another possibility is that preexisting small hippocampal size increases the risk for developing anxiety or affective disorders. 10,11 However, structural brain imaging studies in social phobia are lacking. Given the fact that patients with traumatic and nontraumatic anxiety disorders share a pattern of medial temporal hyperactivity during functional neuroimaging, 1 investigation into structural aspects of the amygdala and hippocampus in social phobia are warranted. Furthermore, because the more severe form of social phobia (i.e., GSP) is likely associated with continuous and extreme stress, the possibility of a reduction of the size of the amygdal...