Prefrontal Cortex Dysfunction in Social Anxiety Disorder: A Critical Review

Abstract

Social anxiety disorder (SAD) is characterized by the fear of negative evaluation and impairment in social functioning. Research has identified altered prefrontal cortex (PFC) activation and connectivity as possible biological correlates of SAD. This paper critically reviews five recent studies that examined PFC functioning during emotion regulation, self-appraisal, social feedback, or rest. The studies identified differences involving medial and lateral prefrontal regions. Altered connectivity was also observed within prefrontal and default mode networks. The direction of the findings varied according to the experimental condition and participant characteristics. Early-life adversity moderated resting-state connectivity, while short-term escitalopram treatment was associated with a change in the left inferior frontal gyrus activation. Methodological concerns included limited sample sizes and cross-sectional designs. The available evidence supports an association between SAD and alterations in PFC functioning. Longitudinal research and independent replication are needed to determine whether these neural differences contribute to the development of SAD or change in response to treatment.