A Dual-System Model of Social Anxiety Disorder: The Interplay of the Social-Rank and Affiliation Biopsychosocial Systems

Social Anxiety Disorder (SAD) is a highly prevalent and debilitating condition. Although effective treatments exist, their success is limited. This narrative review seeks to advance a comprehensive understanding of the types of social threat affecting individuals with SAD from the perspective of two basic biobehavioral systems: affiliation and social-rank. We argue that SAD is associated with vulnerability to events signaling loss of affiliation (exclusion) and of social-rank (defeat). Specifically, we suggest that SAD is characterized by (a) hyper-reactivity to exclusion and defeat; (b) propensity to respond to exclusion by deploying distancing and withdrawal strategies; (c) propensity to respond to defeat by deploying conflict-reducing subordination strategies; and (d) enhanced linkage of the two systems. This dual-system account may help integrate clinically significant information about SAD and offer recommendations regarding novel theory-based directions for treatments.