Higher- and lower-order personality traits and cluster subtypes in social anxiety disorder.

Mădălina Elena Costache,Örjan Frans,Olof Hjorth,Johanna M Hoppe,Andreas Frick,Jörgen Rosén,Clas Linnman,Johannes Björkstrand,Malin Gingnell,Vanda Faria,Mats Fredrikson,Kristoffer Månsson,Tomas Furmark,Ina Marteinsdottir,Jonas Engman,Iman Alaie,Fredrik Åhs,Maria Tillfors,Kurt Wahlstedt

doi:10.1371/journal.pone.0232187

Abstract

Social anxiety disorder (SAD) can come in different forms, presenting problems for diagnostic classification. Here, we examined personality traits in a large sample of patients (N = 265) diagnosed with SAD in comparison to healthy controls (N = 164) by use of the Revised NEO Personality Inventory (NEO-PI-R) and Karolinska Scales of Personality (KSP). In addition, we identified subtypes of SAD based on cluster analysis of the NEO-PI-R Big Five personality dimensions. Significant group differences in personality traits between patients and controls were noted on all Big Five dimensions except agreeableness. Group differences were further noted on most lower-order facets of NEO-PI-R, and nearly all KSP variables. A logistic regression analysis showed, however, that only neuroticism and extraversion remained significant independent predictors of patient/control group when controlling for the effects of the other Big Five dimensions. Also, only neuroticism and extraversion yielded large effect sizes when SAD patients were compared to Swedish normative data for the NEO-PI-R. A two-step cluster analysis resulted in three separate clusters labelled Prototypical (33%), Introvert-Conscientious (29%), and Instable-Open (38%) SAD. Individuals in the Prototypical cluster deviated most on the Big Five dimensions and they were at the most severe end in profile analyses of social anxiety, self-rated fear during public speaking, trait anxiety, and anxiety-related KSP variables. While additional studies are needed to determine if personality subtypes in SAD differ in etiological and treatment-related factors, the present results demonstrate considerable personality heterogeneity in socially anxious individuals, further underscoring that SAD is a multidimensional disorder.

Highlights

Social anxiety disorder (SAD) is one of the most common psychiatric disorders [1] characterized by a persistent and over-whelming fear of being negatively evaluated in one or more social or interactional situation [2]
As social anxiety may be conceptually intertwined with several personality components, the principal aim of the present study was to examine personality traits in a large sample of individuals diagnosed with social anxiety disorder (SAD) (N = 265), in comparison to healthy controls (N = 164) and Swedish normative data, by use of the NEO-PI-R and Karolinska Scales of Personality (KSP) instruments
There were no differences between the SAD patients and healthy controls with respect to gender distribution (χ2 = 1.394;p = .273)

Summary

Introduction

Social anxiety disorder (SAD) is one of the most common psychiatric disorders [1] characterized by a persistent and over-whelming fear of being negatively evaluated in one or more social or interactional situation [2]. It is associated with considerable individual suffering [3], large societal costs [4,5] and typically follows a chronic course if left untreated [6]. Cognitive behavioral therapy (CBT), serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are first-line treatment options for SAD [7,8]. Deciphering the complex relationships between basic personality traits and SAD is theoretically and clinically important

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Conclusion