Social anxiety disorder and the psychobiology of self-consciousness.

Dan J Stein

doi:10.3389/fnhum.2015.00489

Abstract

Individuals with social anxiety disorder (SAD) are characterized by fear or anxiety about social situations, but also by important alterations in self-referential processing. Given advances in our understanding of the neurocircuitry and neurochemistry of SAD, the question arises of the relationship between this research and an emergent literature on the psychobiology of self and self-consciousness. A number of investigations of SAD have highlighted altered activity in the medial prefrontal cortex (mPFC; involved in self-representation), insula (involved in interoceptive processing), and other structures that play a role in bodily self-consciousness, as well as the potential value of interventions such as selective serotonin reuptake inhibitors (SSRI) and self-focused reappraisal in normalizing such changes. Future studies to more closely investigate associations between psychobiological alterations and changes in self-related processing in SAD, may be useful in shedding additional light on both SAD and self-consciousness.

Highlights

A number of investigations of social anxiety disorder (SAD) have highlighted altered activity in the medial prefrontal cortex, insula, and other structures that play a role in bodily self-consciousness, as well as the potential value of interventions such as selective serotonin reuptake inhibitors (SSRI) and self-focused reappraisal in normalizing such changes
Social anxiety disorder (SAD or social phobia) is characterized in DSM-5 in terms of fear or anxiety about social situations in which the individual is exposed to possible scrutiny by others (American Psychiatric Association, 2013)
Social anxiety and SAD appear to be phenomena that are highly relevant to a consideration of the psychobiology of self-consciousness

Summary

Neurocircuitry of Sad

Multiple brain imaging studies of SAD have contributed to our understanding of the neurocircuitry of SAD (Stein and Stein, 2008). A recent meta-analysis of functional magnetic resonance imaging (fMRI) studies found that most significant areas of activation during emotional vs neutral stimuli in individuals with SAD compared to controls included bilateral amygdala, anterior cingulate, and globus pallidus (Hattingh et al, 2012). These findings are consistent with an animal literature emphasizing the involvement of the amygdala in fear conditioning (Davis, 1990). Given the growing literature on the neurocircuitry of self-related processes and self-focused attention (Stein, 2007; Northoff et al, 2011), additional work is needed to link alterations in structural and functional brain imaging in SAD with assessments of self-consciousness and related processes

Neurochemistry of Sad

Evolutionary Psychiatry and Sad

Conclusion