Body Shape Concern Research Articles

Assessment of Binge Eating Behavior, Body Shape Concerns, and Associated Factors among Female Adolescents of Northern Saudi Arabia: A Cross-Sectional Study.

Globally, binge eating behavior has emerged as a significant public health concern, especially among female adolescents. Body shape concerns in female adolescents can lead to body dissatisfaction and other mental health issues. Using a cross-sectional study design, we evaluated the frequency of binge eating behavior, body shape concerns, and associated factors among 400 female adolescents. We utilized a pretested Arabic binge eating scale (BES) and a body shape questionnaire-shorter version (BSQ-8C) to collect the required data. We performed Spearman's correlation analysis to find the strength and direction of the correlation between the BES and BSQ-8C scores. Finally, we applied binomial logistic regression analysis to identify the predictors of body shape concerns. Of the studied participants, 5.5% and 6.2% had medium and severe binge eating behavior. We found a significant positive correlation between the BES and BSQ-8C scores (rho = 0.434, p < 0.001). Also, we found that body shape concerns were significantly higher among the monthly family income category of 5000 to 7000 SAR (p = 0.005), the severe binge eating categories (p = 0.009), and obese adolescents (p = 0.001). The present study results can be applied to the development of focused interventions and strategies to address these concerns in this group.

RISK OF EATING DISORDER AND BODY SHAPE CONCERN AMONG UNDERGRADUATE NURSING STUDENTS

Background: Eating disorders (anorexia nervosa, bulimia nervosa and binge eating) are mental illness associated with severe disturbances in people’s eating behavior which results in both psychological and social impairments. Body image dissatisfaction might be an important predictor of increased incidence of eating disorder. This study aimed to assess the risk of eating disorder and body shape concern among undergraduate students at selected nursing colleges, Morang. Methods: A descriptive cross-sectional design was conducted among 288 undergraduate nursing students selected by non-probability convenient sampling technique. Data was collected through self-administered method using EAT-26 and BSQ-34 standard tool. The obtained data were analyzed by descriptive and inferential statistics using SPSS version 16 software. Results: Among 288 nursing students, majority (83%) of them had no risk while (17%) had risk of eating disorder. Similarly, majority (62.2%) of them had no concern with body shape, (19.8%) had mild concern, (12.2%) had moderate concern and (5.9%) had marked concern. There is a statistically significant association between the risk level and selected socio demographic variables like religion (P= 0.01*), weight (P=0.009*), BMI (P= 0.001*). Conclusions: Majority of the students had no risk while very few students had risk of eating disorder. Almost half of the nursing students had mild to marked concern about body shape which can entice eating disorder.

Major Dietary Patterns, Exercise Addiction, and Eating Disorders Among a Sample of Physically Active Young Adults.

Regular exercise has been widely acknowledged for its numerous health benefits, including improvements in physical fitness, body function, and mental well-being. However, excessive exercise and unhealthy dietary patterns can lead to adverse effects on individuals' physical and psychological well-being. This study aimed to examine the association of dietary patterns, exercise addiction, and eating disorders among physically active young adults. In this cross-sectional study, a total of 200 physically active young adults aged 18-35 years were included. The participants' dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ) consisting of 80 food items. To determine dietary patterns, factor analysis was employed. Exercise addiction was evaluated using The Exercise Addiction Inventory (EAI) and Exercise Dependence Questionnaire (EDQ), and eating disorders were assessed using The Eating Disorder Examination-Questionnaire Short (EDE-QS). Three main dietary patterns were identified: western, healthy, and traditional dietary patterns. The western dietary pattern was associated with increased waist-to-hip ratio (P = .01) that remained significant after adjustment for confounders (eg, age, gender, BMI, and physical activity P = .03), while the adherence to traditional dietary pattern was linked to higher waist circumference and body shape index (P < .05). Participants that followed the healthy dietary pattern showed a higher score of EAI and body shape concern (P = .04). Furthermore, in structural equation modelling (SEM), eating disorder was identified as a significant positive predictor of exercise addiction (r = .17, P < .05). According to our finding, those with the higher adherence to healthy dietary pattern had higher scores of exercise addiction and body shape concern. Also, eating disorder was a potential predictor of exercise addiction among young physically active individuals. Further research and targeted interventions are needed to better understand these complex relationships and develop effective strategies to promote healthy behaviors and mitigate the risk of adverse outcomes.

Determinants of Higher Body Shape Concern Among Medical Students in Universiti Putra Malaysia

Introduction: Body shape concern can lead to eating disorders such as anorexia nervosa and bulimia. Our study aims to determine the determinant sociodemographic characteristics and mass media influences factors of body shape concern among medical undergraduate students of Universiti Putra Malaysia (UPM). Methods: This was a cross-sectional study design done among the first year to final year of undergraduate medical UPM students in 2019. A questionnaire consisting of sociodemographic data, mass media influences and body shape concern was used. Body Shape Questionnaire (BSQ), a validated questionnaire with good concurrent validity to other tools assessing body shape concerns, was used to assess body shape concern among the medical students in this study. Analysis was done using Chi-square, Fisher exact test and multivariate logistic regression. Results: A total of 316 respondents out of 502 (62.9%) participated in this study. 57.5% students showed varying degrees of concern about their body shape ranging from mild to marked concern. Greater odds of body shape concerns were noted with Malay ethnicity, preclinical years, hours using social media per day and number of Instagram® following. Conclusion: Significant determinant factors of higher body shape concerns among UPM undergraduate students were Malay ethnicity, preclinical year students, longer hours of using social media and having higher numbers of following on Instagram®. It is important to determine the non-modifiable and modifiable factors of higher body shape concerns to recognise high risk individuals of developing body shape concerns.

Assessment of Eating Habit and Body Shape Concern among Students of SGT University, Gurugram, Haryana

Assessment of Eating Habit and Body Shape Concern among Students of SGT University, Gurugram, Haryana

Eating behaviours and perception about body shape among adolescent girls of Panjab University, Chandigarh

Introduction: Indians are experiencing nutritional and lifestyle transitions due to globalization and westernization. The study aimed to find out the current eating patterns and body shape concerns and various factors that influence eating behaviors and body shape concerns of late-adolescent girls. Material and Methods: A cross-sectional study was conducted among 230 undergraduate adolescent girl university students from 12 departments in the age group of 17–19 years. Eating attitude and body shape concerns of adolescents were determined by using the standard eating attitude test-26 (EAT-26) and body shape questionnaire (BSQ-34). Results: The duration of the study was 6 months and participants were selected by simple random sampling. The mean age of the study subjects was 18.52 (±0.63) years. The majority of subjects had an urban background (85%). Less than half had an exercise routine (44%) which was followed daily. As per body mass index (BMI) distribution, 19.57% were underweight, 11.3% were overweight and only 2.17% were obese. An unfavorable eating attitude was found in 18% of subjects whereas 38.2% had mild to the marked concern of body shape. There was a significant positive correlation between BSQ with BMI (r = 0.387, P ≤ 0.01) and BSQ-34 with EAT-26 (r = 0.367, P ≤ 0.01). Conclusion: Current study shows that late adolescent urban females are susceptible to eating disorders and are body image conscious. Institutional mechanisms should be brought in place to address the need of improving their eating habits and modification of lifestyle.

A Cross-sectional Study on Body Image Dissatisfaction, Depression, Anxiety and Stress among Medical Students and Interns

Abstract Background: Body image dissatisfaction is hypothesized to be associated with depression, anxiety, psychological distress and low self-esteem. This study was conducted to assess body image concerns and weight control behaviors and the associations of body image concerns with depression, anxiety and stress among medical students in Central Karnataka. Methodology: A cross-sectional study among medical students was conducted at Basaveshwara Medical College and Hospital, Chitradurga. Each participant was asked to self-select the silhouette that best indicated his or her current body size and the silhouette that reflects his or her preferred ideal body size, from Stunkard Figure Rating Scale. Body Shape Questionnaire (to assess body shape concern) and Depression, Anxiety and Stress Scale-21 instrument (to assess depression, anxiety and stress) were utilized. Results: 66.9% students had normal body mass index. 74.6% students desired to change current weight, which was mainly influenced by family members, media icons and friends (47.9%, 40.8% and 31.7%). 42.3% reported that they did physical activity/exercises, 35.2% followed diet to control their weight. Higher proportions for depression, anxiety and stress were noted among those students who had body image misconception. Conclusions and recommendations: Counseling and if required treatment by psychologists and psychiatrists would be recommended to address wrong thoughts towards the ideal body image among college students and associated depression, anxiety, stress. Nutritional health education can be given about the importance of a healthy diet and provide free nutritional consultations and counseling.

Correlation of Body Shape Concern and Anxiety Severity among Sales Women in Medan

Introduction: Body image was recognized as one of the major concerns of emerging adults as well as adolescents. The resulting dissatisfaction with body image has become a more universal phenomenon. Past research in body image has generally focused on women interested in the achievement of thin ideas. Some findings suggest that problems with body image may underlie at least some social anxiety &#x0D; Methods: A Cross Sectional study using 135 sales women was conducted by self-reported measures (questionnaire). Body image dissatisfaction was measured using Body shape questionnaire-34, anxiety score using Hospital Anxiety and Depression Scale ( HADS). We use Kolmogorov Smirnov test to assess the normality of the data , and Pearson correlation test to assess the correlation between BSQ-34 and HADS. &#x0D; Results: The average age of our respondents were 23.57+5.657 and majority of them were graduated from high school (n=97, 72%) and are not married yet (n=109, 81%). Less than half admitted to have already worked for more than a year and we also found that most sales women in our study earned less than minimum standard wage a month (n=103, 76%). We found that all of our respondents showed BSQ-score of above 81 (82.14 + 4.530) indicating that all are slightly preoccupied with body shape concern. We also found that all respondents showed borderline anxiety score with average score of 8.20 + 3.256. Pearson correlation test showed that there is significant positive moderate strength correlation between body shape concern and anxiety severity (r = 0.413, p = 0.002). &#x0D; Discussion: This study revealed a significant positive relationship between the body shape concern and anxiety among saleswoman; our hypothesis was confirmed.

Relationship of eating behavior and self-esteem with body image perception and other factors among female college students of University of Delhi

BACKGROUND:Eating disorders (EDs) can lead to life-threatening nutritional deficiencies whereas self-esteem influences interpersonal relationships and academic performance. Excessive concerns about body image resulting in body dissatisfaction not only affect psychological well-being but also predisposes to disordered eating behaviors. The objective of this study is to assess the eating behavior and level of self-esteem, their relationship with body image perception and also identify factors associated with them among undergraduate female college students.MATERIALS AND METHODS:This cross-sectional study was conducted among 180 female undergraduate students of University of Delhi. Sociodemographic characteristics and anthropometric measurements were recorded. Eating Attitude Test-26, Rosenberg Self-esteem Scale, Contour Drawing Rating Scale and Body Shape Questionnaire 34 were used to assess eating behavior, self-esteem, body image dissatisfaction and body shape concerns, respectively. Both descriptive and inferential statistics were used and binary logistic regression was applied to identify the factors determining high risk eating behavior and low self-esteem.RESULTS:In this study, 27.8% of the study participants were overweight or obese, 30.6% had body shape concerns and 76.7% had body image dissatisfaction. Significant proportion (13.9%) of the participants was identified as high risk for the development of EDs and having low self-esteem (12.8%). Body shape concern and family influences were significant predictors of high risk eating behavior whereas type of college and family influences significantly predicted low self-esteem.CONCLUSIONS:The study concluded that factors such as nutritional status, family influences, type of college and body shape concerns lead to high risk eating behavior and low self-esteem. These findings will help in creating awareness on importance of concept of positive body image, healthy weight control behaviors and in developing future interventions.

Psychological and Physical Correlates of Body Image Dissatisfaction among High School Egyptian Students

Background: Body image is one of the most important psychological factors that affects adolescents’ personality and behavior. Body image can be defined as the person’s perceptions, thoughts, and feelings about his or her body.&#x0D; Objectives: to identify the prevalence of body image concerns among secondary school students and its relation to different factors.&#x0D; Subjects and methods: A cross-sectional study conducted in which 796 secondary school students participated and body shape concerns was investigated using the body shape questionnaire (BSQ-34).&#x0D; Results: The prevalence of moderate/marked concern was (21.6%). Moderate/ marked body shape concern was significantly associated with unemployed fathers and mothers, low level of maternal education, lower socioeconomic status, concern with body weight or problematic eating, increased BMI, increased anxiety and depression.&#x0D; Conclusions: The high prevalence of moderate/marked dissatisfaction with body shape and its possible relation to subsequent hazards such as eating disorders, depression, and anxiety should be of concern.

Structural Equation Modeling to Evaluate the Effect of Body Shape Concern and Body Appreciation on Eating Behavior Pattern among University Students.

The article's abstract is not available.

How are body mass and body attitude impacted by a behaviour change intervention in primary care? A pragmatic randomised controlled trial.

Aims:This study evaluated the effect of behaviour change interventions at Norwegian Healthy Life Centres on change in body mass index (BMI) and body attitude, and explored the predictors for change after 6 months. Methods: We randomised 118 participants to either an intervention or a control group. Eligible participants: ⩾18 years and able to take part in group-based interventions. Body attitude, weight, and height were assessed at inclusion and after 6 months. We analysed the data using simple and multiple regression. Results: Eighty-six participants completed 6-month follow-up. The study found no intervention effect on BMI or body attitude across the two groups. However, an interaction effect indicated that the leaner participants in the intervention group reduced their weight significantly (b 0.94, p < 0.001). BMI reduction was predicted by self-efficacy for physical activity and autonomous motivation for change. Weight loss was associated with impaired body attitude, body shape concern, impaired weight-related self-esteem, weight cycling, and controlled motivation for change. Improvement in body attitude was positively impacted by self-rated health, the experience of childhood respect, life satisfaction, and self-efficacy for physical activity. Impaired body attitude was predicted by body shape concern, impaired weight-related self-esteem, and controlled motivation. Conclusions: The interventions did not affect body mass on average, but promoted weight loss among the leaner participants. Because weight reduction was associated body shape concern and impaired body attitude, the study supports the claim that interventions should be weight neutral and aim to improve body image and psychological well-being rather than weight reduction.

The effect of cognitive symptoms in binge eating disorder on depression and self-esteem: a cross-sectional study.

To compare individuals with class II and III obesity with and without binge eating disorder (BED) in terms of sociodemographic characteristics, depressive symptoms, self-esteem, eating behaviors, and cognitive variables thought to be involved in the pathophysiology of the disease. The participants were selected from volunteer patients with body mass index ≥ 35 applying to the Ondokuz Mayıs University Medical Faculty, Turkey, for bariatric surgery between 01.07.2016 and 31.05.2019. The Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to all participants. Binge eating disorder (BED) was determined in 95 (34%) of the 278 individuals applying for bariatric surgery. The frequency of previous psychiatric diseases was higher in the BED group than in the non-BED group. BDI, RSES, total EDE-Q, weight concern, shape concern, and eating concern EDE-Q subscale scores were also higher in the BED group. Correlation analysis revealed positive low correlation between depression scores and total EDE-Q scores and all subscales scores, with the exception of restraint. Positive low correlation was determined between decreased self-esteem and body weight and shape concern. At multivariate regression analysis, cognitive variables explained 28.6% of variance in depressive symptoms in the BED group, and 21.5% of variance in self-esteem. The study results showed elevation in cognitive factors in patients with BED compared to the controls. Among these variables, eating and weight concern were shown to be associated with depressive symptoms, while eating concern was linked to self-esteem. Level III, case-control analytic study.

Prediction of the Influential Factors on Eating Behaviors: A Hybrid Model of Structural Equation Modelling-Artificial Neural Networks.

The importance of eating behavior risk factors in the primary prevention of obesity has been established. Researchers mostly use the linear model to determine associations among these risk factors. However, in reality, the presence of nonlinearity among these factors causes a bias in the prediction models. The aim of this study was to explore the potential of a hybrid model to predict the eating behaviors. The hybrid model of structural equation modelling (SEM) and artificial neural networks (ANN) was applied to evaluate the prediction model. The SEM analysis was used to check the relationship of the emotional eating scale (EES), body shape concern (BSC), and body appreciation scale (BAS) and their effect on different categories of eating behavior patterns (EBP). In the second step, the input and output required for ANN analysis were obtained from SEM analysis and were applied in the neural network model. 340 university students participated in this study. The hybrid model (SEM-ANN) was conducted using multilayer perceptron (MLP) with feed-forward network topology. Moreover, Levenberg–Marquardt, which is a supervised learning model, was applied as a learning method for MLP training. The tangent/sigmoid function was used for the input layer, while the linear function was applied for the output layer. The coefficient of determination (R2) and mean square error (MSE) were calculated. Using the hybrid model, the optimal network happened at MLP 3-17-8. It was proved that the hybrid model was superior to SEM methods because the R2 of the model was increased by 27%, while the MSE was decreased by 9.6%. Moreover, it was found that BSC, BAS, and EES significantly affected healthy and unhealthy eating behavior patterns. Thus, a hybrid approach could be suggested as a significant methodological contribution from a machine learning standpoint, and it can be implemented as software to predict models with the highest accuracy.

Pilot trial of a group cognitive behavioural therapy program for comorbid depression and obesity

BackgroundDepression and obesity are significant global health concerns that commonly occur together. An integrated group cognitive behavioural therapy program was therefore developed to simultaneously address comorbid depression and obesity.MethodsTwenty-four participants (63% women, mean age 46 years) who screened positively for depression with a body mass index ≥25 were recruited from a self-referred general population sample. The group therapy program (10 two-hour weekly sessions) was examined in a single-arm, before-after pilot trial, conducted in a behavioural health clinic in Adelaide, Australia. Primary outcomes included survey and assessment-based analyses of depression, anxiety, body image, self-esteem, and weight (kg), assessed at four time-points: baseline, post-intervention, three-months and 12-months post program. Eighteen participants (75%) completed the program and all assessments.ResultsSignificant improvements in depression, anxiety, self-esteem and body shape concern scores, several quality of life domains, eating behaviours and total physical activity (among others) – but not weight – were observed over the course of the trial.ConclusionsResults from this pilot trial suggest that combining interventions for depression and obesity may be useful. Further development of the program, particularly regarding the potential for physical health benefits, and a randomised controlled trial, are warranted.Trial registrationTrial registration: ANZCTR, ACTRN12617001079336, 13 July 2017. Retrospectively registered after date of the first consent (6 July 2017), but before the date of the first intervention session (20 July 2017).

Increased risk of eating disorders in women with polycystic ovary syndrome: a case-control study

Data on eating disorders in women with PCOS is insufficient. The objective of this case study was to examine the hypothesis that women with PCOS exhibit more impaired eating than healthy women. Women diagnosed with PCOS under the 2003 Rotterdam Diagnostic Criteria (n = 40) were compared with a healthy control group (n = 40). The groups also were divided into two as normal body weight and overweight/obese. The Eating Disorders Assessment Questionnaire (EDE-Q) and the Three Factor Eating Questionnaire (TFEQ-R21), were completed by all participants in order to evaluate eating behaviors in addition to eating disorders. Among the overweight/obese group, the average total and subscale scores of the EDE-Q as well as the total and sub-factor scores of the TFEQ-R21 were higher in women with PCOS compared to controls (p < .05). However, this statistically significant result was not shown among the women with normal weight (p > .05). In comparison to the controls, the PCOS women displayed higher values of the tool scores indicating abnormal restraint eating, body shape concern and weight concern subscale scores (p < .05). This result suggests that the evaluation of eating disorders should be added to routine screening and the monitoring of women with PCOS.

Mental Health Symptoms Related to Body Shape Idealization in Female Fitness Physique Athletes.

Physical activity relates to optimal health, still the prevalence of mental health issues is high among athletes. Being young, female, and competing in aesthetic sports is a high-risk combination for mental health symptoms. Fitness physique athletes (FA) match this profile but are understudied. We aimed to study the intensity of mental health symptoms (i.e., body image, eating behaviour, relation to and routines for exercise, and perfectionism) in FA and in female references (FR), and to evaluate how preparing for fitness sport competitions affects these mental health symptoms. Before competition, FA had higher levels of drive for leanness (DFL) and eating restraint compared to FR. At the time of competition, eating restraint increased in FA only, concurrent with a reduction in symptoms of disordered eating. The levels of DFL, drive for muscularity, eating restraint, and exercising for figure toning were higher in FA compared to FR. At one-month post-competition, the differences between groups from competition time remained. Generally, perfectionism correlated with eating restrictions in FA and with disordered eating in FR. Overall, FA coped with the dieting, but self-control deteriorated post-competition with higher levels of disordered eating and an increased body shape concern. High DFL generally associated with more disordered eating behaviour, specifically in FR.

Association between Exposure to Media and Body Weight Concern among Female Students at Private University in Selangor, Malaysia.

These days, media has become a huge part of everyday life. Unrealistic thin body weight and body shape portrayed by media has led to body weight concern especially among females. The aim of this study is to investigate the associations between media exposure and body weight concern among female university students in Management and Science University. A cross-sectional study was conducted among 363 female students aged 17 to 26 years from the Management and Science University. A self-administered questionnaire was used to assess on socio-demographic information, media usage, body shape concern, body appreciation scale, and the sociocultural attitudes toward appearance. The highest number of media usage were among students between 17 to 20 years old, 31.7% overweight students had high body shape concern, 40.8% student had high sociocultural attitudes towards appearance and 44.6% normal weight student perceived high body appreciation scale. In the association between media usage and body weight concern, a significant association was found on body shape concern (p=0.01), body appreciation scale (p=0.001) and sociocultural attitudes toward appearance (p=0.001). In socio-demographic and body weight concern, the result also indicated a significant association between BMI (p=0.001), monthly income (p=0.013) and education (p=0.001) with body shape concern, body appreciation scale and sociocultural attitudes towards appearance. As a conclusion, 52% in the present study showed that exposure to media have association with body weight concern among female university students.

INTERRELATIONSHIP OF STRESS, BODY IMAGE, NEGATIVE MOOD STATE AND SUSCEPTIBILITY TO ABNORMAL EATING BEHAVIOUR AMONG GAME SPECIFIC FEMALE ATHLETES: AN EXPLORATORY APPROACH

Purpose: To achieve and maintain a perfect body shape athlete often follows restrictive dieting which ultimately leads them to eating disorders. The purpose of the study was to identify whether there is an interrelationship of abnormal eating behaviours, perceived stress, negative mood state and self-perception of body image among athletic population and another was to observe the consequences of negative psychological well-being and game specificity on food choices and frequency. A secondary purpose of this study was to identify the “at risk-eating disorder” participants who were involved in different sports category. Methods: One thirty eight healthy young female participants matched for BMI were selected by purposive sampling. Subjects were divided into 4 categories i.e. aesthetic games group, endurance groups, strength group and healthy controls. Structured questionnaires were used for data collection during their non-competitive session. ANOVA followed by Scheffe’s test was applied to compare different parameters among the groups. Regression model examined the associations among disordered eating behaviours, stress, body shape concern, emotional eating, total mood disturbance and food choice. Findings: Result revealed disordered eating behaviour was significantly prominent in control and aesthetic game group than other two groups. Control group obtained the highest score in stress and emotional eating while aesthetic game group secured the highest score in body shape concern. Mood disturbance was more prevalent in strength group. Body mass index, body shape concern, emotional eating and total mood disturbance were identified as strongest predictor of EAT-26 scores. The result revealed that controls and aesthetic game group exhibit more abnormal eating behaviours than others. Value: This result will help to indicate abnormal eating behaviour and its relation with psychological well-being among female athletic population. Interventions programmes should be designed to cope up with competitive pressure to avoid abnormal eating behaviour. Article visualizations:

Social phobia and its association with body shape and internet addiction among private university students in Selangor, Malaysia

Social phobia is a strong fear of being judged by others and of being embarrassed in social situations. This study aimed to examine the prevalence of social phobia and its correlates among university students in a Malaysian university. A crosssectional study design was conducted among 674 university students recruited using convenience sampling. Besides providing socio-demographics information, the participants completed a set of self-administered questionnaires including the Social Phobia Inventory (SPIN), the Rosenberg Self-Esteem Scale (RSES), the Body Shape Questionnaires (BSQ) and the Internet Addiction Test (IAT). Majority of respondents were female (77.0%) and from non-medical faculties (59.2%). The prevalence rates for moderate and severe social phobia among the students were 43.9% 19.1% respectively. The associations between gender, self-esteem, body shape concern and internet addiction with social phobia were significant (p=0.01, <0.001, <0.001, <0.001 respectively). As a conclusion, the prevalence of social phobia among private university students are influenced mainly by self-esteem, body shape concern and internet addiction. Provision of mental health education and counseling to students who are most affected by social phobia merit further consideration.