Onset Of Social Anxiety Disorder Research Articles

Volume of subcortical brain regions in social anxiety disorder: mega-analytic results from 37 samples in the ENIGMA-Anxiety Working Group.

There is limited convergence in neuroimaging investigations into volumes of subcortical brain regions in social anxiety disorder (SAD). The inconsistent findings may arise from variations in methodological approaches across studies, including sample selection based on age and clinical characteristics. The ENIGMA-Anxiety Working Group initiated a global mega-analysis to determine whether differences in subcortical volumes can be detected in adults and adolescents with SAD relative to healthy controls. Volumetric data from 37 international samples with 1115 SAD patients and 2775 controls were obtained from ENIGMA-standardized protocols for image segmentation and quality assurance. Linear mixed-effects analyses were adjusted for comparisons across seven subcortical regions in each hemisphere using family-wise error (FWE)-correction. Mixed-effects d effect sizes were calculated. In the full sample, SAD patients showed smaller bilateral putamen volume than controls (left: d = -0.077, pFWE = 0.037; right: d = -0.104, pFWE = 0.001), and a significant interaction between SAD and age was found for the left putamen (r = -0.034, pFWE = 0.045). Smaller bilateral putamen volumes (left: d = -0.141, pFWE < 0.001; right: d = -0.158, pFWE < 0.001) and larger bilateral pallidum volumes (left: d = 0.129, pFWE = 0.006; right: d = 0.099, pFWE = 0.046) were detected in adult SAD patients relative to controls, but no volumetric differences were apparent in adolescent SAD patients relative to controls. Comorbid anxiety disorders and age of SAD onset were additional determinants of SAD-related volumetric differences in subcortical regions. To conclude, subtle volumetric alterations in subcortical regions in SAD were detected. Heterogeneity in age and clinical characteristics may partly explain inconsistencies in previous findings. The association between alterations in subcortical volumes and SAD illness progression deserves further investigation, especially from adolescence into adulthood.

Social Anxiety Disorder, An Insidious and Silent Disease – A Constructed Case Study and Cultural Reviews from Singapore, India and Indonesia

Social anxiety disorder (SAD) is a form of anxiety disorder that is often under-diagnosed. Commonly masked as shyness or introversion, many who are suffering from symptoms of SAD do not receive treatment. The onset of SAD is in childhood and/or early adolescence, and often accompanied by a wide range of comorbidities, including anxiety and depression. As a result, those who suffer from SAD are functionally impaired, likely under-achieve in work and school, and may possibly have unfulfilling relationships. The paper, firstly, reviews various available literature on SAD, its clinical symptoms, prevalence, onset, comorbidities and possible etiologies. Secondly, a case study, constructed based on the authors’ counselling experiences and observations, highlights the common behavioural patterns, cognitive distortions and emotional distress of clients undergoing SAD. Possible perpetuating factors and circumstances further provide a relevant and realistic perspective of the disorder within the Singapore context. Finally, through a review of the unique cultures of three countries, namely Singapore, India and Indonesia, the paper highlights the effects of social competitiveness, social appearance, social hierarchy, shame, technology and social media on the development and perpetuation of SAD amongst children, adolescents and females.

Age of onset of social anxiety disorder and psychiatric and mental health outcomes: Results from a nationally representative study

ObjectivePrior studies support that younger age of onset would be associated with poorer psychiatric and mental health outcomes for many psychiatric disorders. However, such relationship has never been examined for social anxiety disorder (SAD) in a nationally representative sample. MethodsUsing data from the second Wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we have identified four groups of participants with a lifetime DSM-IV diagnosis of SAD based on the self-reported age of onset (childhood onset (<12 years, N = 658), adolescence onset (12–17 years, N = 663), early-adulthood onset (18–39 years, N = 663), and late-adulthood onset (>39 years, N = 415)), and a control group without a lifetime history of SAD (N = 32,205). We performed multinomial logistic regression models to compare lifetime DSM-IV psychiatric disorders and current mental health-related quality of life (assessed with the mental component summary score (MSC) of the SF-12) across these groups. ResultsThe lifetime prevalence rates of panic disorder, agoraphobia and post-traumatic stress disorder were significantly higher in the adulthood onset groups than in groups with an onset during childhood or adolescence (p < 0.01 for most models). MCS score was significantly higher in the childhood (46.0 (SE = 0.5)) or adolescence (46.5 (SE = 0.5)) onset groups than in the groups with an onset during adulthood (early-adulthood onset: 43.5 (SE = 0.6), and late-adulthood onset: 43.0 (SE = 0.8)). LimitationsOur results relied on retrospective self-reported data. ConclusionAmong individuals with SAD, a later age of onset was significantly associated with greater lifetime rates of psychiatric disorders and diminished quality of life.

Frontal EEG alpha-delta ratio and social anxiety across early adolescence

Although the mean age of onset of social anxiety disorder (SAD) is during adolescence, we know relatively little about the neurodevelopmental correlates of subsyndromal social anxiety in early adolescence before SAD manifests. Here we examined frontal EEG alpha/delta ratio (a putative proxy of brain maturation) in relation social anxiety symptoms across early adolescence. Resting regional EEG spectral power measures were collected continuously for 4 min (2 min eyes-open, 2 min eyes-closed) in slow (i.e., delta) and fast (i.e., alpha) frequencies at Time 1, and self-reported social anxiety measures were collected concurrently at Time 1 and then prospectively approximately one year later (Time 2) in 103 typically developing 12- to 14-year-olds (46.6% female, Mage = 12.91 years, SDage = 0.81 years). Using a latent class growth curve analysis, stable high and stable low social anxiety classes were derived from the two assessments. Controlling for children's age, sex, and pubertal development, we found that youth in the stable high social anxiety class were more likely to exhibit a relatively lower frontal alpha/delta ratio, reflecting ostensibly less brain maturation relative to youth in the stable low social anxiety class. Results were specific to social anxiety and did not extend to symptoms of generalized anxiety. Findings are discussed in terms of the putative functions of less brain maturation in understanding individual differences in complex human social behavior.

Association of theory of mind and empathy abilities in adolescents with social anxiety disorder

Studies have shown that elevated empathic abilities and impaired theory of mind (ToM) tasks may be associated with social anxiety disorder (SAD). Adolescence is a critical period for the onset of SAD which may cause impairment in various domains of functioning. We aimed to investigate the association of ToM and empathy characteristics in adolescents diagnosed as having SAD. Forty-one drug-naive adolescents (between 12 and 18 years), who were diagnosed as having SAD without comorbidities were enrolled in the patient group. Forty adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The sample was evaluated via the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The severity of the SAD symptoms was evaluated using the Social Anxiety Scale for Adolescents. ToM was evaluated with the Reading the Mind in the Eyes Test and emotion recognition was assessed by Faces Test. The KA-SI Empathic Tendency Scale was used to assess empathic abilities. The average age was 14.36 ± 1.41 years in the SAD group and 14.30 ± 1.04 years in the control group. Twenty-eight adolescents were female in the SAD and control groups. SAD and healthy controls did not differ in terms of sociodemographic data. There were higher scores in the KA-SI cognitive and affective empathic subscales (p < .001 in all scales) in the SAD group compared with the healthy controls. Adolescents with SAD have more difficulties both in Reading the Mind in the Eyes Test and Faces Test. The results of this study may indicate that although adolescents with SAD may be impaired in decoding aspects of ToM they may evaluate themselves as more empathic in self-report tests. The discrepancy between objective tests of ToM decoding and subjective reports of empathy may play an important role in the etiology and treatment of SAD in adolescents.

Impaired early visual categorization of fear in social anxiety.

Social anxiety is associated with biased social perception, especially of ambiguous cues. While aberrations in high-level processes (e.g., cognitive appraisal and interpretation) have been implicated in such biases, contributions of early, low-level stimulus processing remain unclear. Categorical perception represents an efficient process to resolve signal ambiguity, and categorical emotion perception can swiftly classify sensory input, "tagging" biologically important stimuli at early stages of processing to facilitate ecological response. However, early threat categorization could be disrupted by exaggerated (or disinhibited) threat processing in anxiety, resulting in biased perception of ambiguous signals. We tested this hypothesis among individuals with low and high trait social anxiety (LSA/HSA; defined relative to the current sample), who performed a two-alternative forced-choice (fear or neutral) task on facial expressions parametrically varied along a neutral-fear continuum. The groups diverged in the reaction time (RT) profile along the neutral-fear continuum, which was characteristic of categorical perception in the LSA (vs. HSA) group with drastically increased RT from neutral to intermediate (boundary) fear intensities, contrasting monotonic, nonsignificant RT changes in the HSA group. Neurometric analysis along the continuum identified an early neutral-fear categorization operation (arising in the P1, an early visual ERP at 100ms), which was nonetheless impaired in the HSA group (due to disinhibited response at the neutral-fear boundary). Absent group differences in higher-level cognitive operations (identified by later ERPs), current findings highlight a dispositional cognitive vulnerability in early visual categorization of social threat, which could precipitate further cognitive aberrations and, eventually, the onset of social anxiety disorder.

A longitudinal exploration of the impact of social anxiety and individual attachment on depression severity

BackgroundResearch suggests that insecure attachment and early onset of social anxiety disorder (SAD) create vulnerability for future depression. The current study explores the mediating role of social anxiety symptoms in the relationship between attachment and depression at baseline and one year later. The study also looks at the longitudinal impact of changes in attachment and social anxiety, on depression severity. MethodsParticipants (n = 162) completed structured clinical interviews and measures of depression, social anxiety, and adult attachment. A subsample of the participants (n = 77) returned for a follow-up one year later and repeated the measures. Mediation analysis and multivariate linear regression were performed to examine the relationships between depression, social anxiety, and attachment. ResultsSocial anxiety was a full mediator of the relationship between attachment avoidance and depression severity at baseline but only a partial mediator at one-year follow-up. Social anxiety was a partial mediator of the relationship between attachment anxiety and depression severity at both baseline and follow-up. Lower baseline depression levels, improvement in social anxiety and improvement in attachment avoidance over the next year, predicted lower levels of depression at follow-up. LimitationsThe study did not gather information regarding the treatments received between baseline and follow-up. ConclusionsSocial anxiety plays a significant role in mediating the vulnerability towards severe depression in insecurely attached individuals. Treating social anxiety, particularly in individuals with avoidant attachment, might decrease the severity of future depression. In addition, interventions targeting attachment avoidance in youth might aid primary prevention strategies.

Peer Victimization and Onset of Social Anxiety Disorder in Children and Adolescents.

Background: In the literature, several studies have proposed that children and adolescents with social anxiety had experienced previously victimization from peers and siblings. The aim of this review was to contribute to the updating of recent findings about the relationship between peer victimization and onset of social anxiety in children and adolescents. Methods: A selective review of literature published between 2011 and 2018 on Social Anxiety Disorder in children and adolescents that experienced peer victimization during childhood and adolescence. Results: Seventeen studies are included. All studies showed that peer victimization is positively correlated to the presence of social anxiety. Moreover, the perpetration of peer victimization may contribute to the maintenance and the exacerbation of social anxiety symptoms. Conclusions: In children and adolescents with Social Anxiety Disorder, it is necessary to evaluate firstly the presence of peer victimization experiences. Subsequently, therapeutics programs targeted to elaborate these experiences and to reduce the anticipatory anxiety and the avoidance that characterized these children and adolescents can be proposed.

The Presence of Childhood Attention Deficit/Hyperactivity Disorder May Be Associated With Interpersonal Sensitivity in Patients With Social Anxiety Disorder

The goal of this study was to evaluate a possible association between childhood attention deficit/hyperactivity disorder (ADHD) and interpersonal sensitivity in patients with social anxiety disorder (SAD). The study involved 125 adult outpatients with a primary diagnosis of SAD. To evaluate childhood ADHD, the ADHD module of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was used. Clinical and sociodemographic data were collected and clinical rating scales were completed. Mean total scores on the Interpersonal Sensitivity Measure were significantly higher in the group with SAD and ADHD than in the group with SAD without ADHD. Interpersonal Sensitivity Measure total scores were positively correlated with the severity of SAD symptoms and negatively correlated with mean age of onset of SAD. The presence of childhood ADHD may be associated with greater interpersonal sensitivity in patients with SAD.

P.1.j.009 - The emotional processing network at the onset of social anxiety disorder: a combined diffusion tensor imaging and functional connectivity study

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.

Dysfunctional Attitudes and Anxiety Sensitivity in the Manifestation and First Onset of Social Anxiety Disorder versus Specific Phobia and Healthy: A Prospective Longitudinal Study

This study evaluated the role of two cognitive vulnerability factors, anxiety sensitivity and dysfunctional attitudes, in the prediction of the manifestation and onset of social anxiety disorder relative to specific phobia and relative to healthy controls. Women, aged between 18 and 24 years, were studied at baseline and 18 months later using the Anxiety Disorders Interview Schedule-Lifetime-ADIS-IV-L and the Anxiety Sensitivity Index-ASI and the Dysfunctional Attitude Scale-DAS. First, 52 women with current social anxiety disorder were compared to 97 women with current specific phobia and 1124 healthy controls (cross-sectional analysis). Second, 24 women with a first incidence of social anxiety disorder were compared to 55 women with a first incidence of specific phobia and 684 healthy controls (longitudinal analysis). Multiple logistic regression analyses, adjusted for baseline anxiety and depressive severity, revealed that a) dysfunctional attitudes were elevated in women with current social anxiety disorder versus healthy controls as well as women with current specific phobia in the cross-sectional analysis and b) dysfunctional attitudes were elevated in women who subsequently developed social anxiety disorder versus healthy controls in the longitudinal analysis. However, dysfunctional attitudes were not predictive for women who developed social anxiety disorder during the study relative to women who developed specific phobia. The results suggest that dysfunctional attitudes are a marker of severity for social anxiety disorder relative to other phobias and a risk factor for phobias more generally. Anxiety sensitivity seems not to contribute to the manifestation and onset of social anxiety disorders.

Clinical Effects of ADHD Subtypes in Patients With Social Anxiety Disorder

Objective: Our aim in this study is to evaluate the impacts of inattentive and combined types of childhood ADHD (ADHD-I, ADHD-C) in patients with social anxiety disorder (SAD). Methods: A total of 142 adult outpatients with a primary diagnosis of SAD were included. All patients were assessed by using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL), ADHD module and a clinical and sociodemographic data form and scales were filled out. Results: Childhood ADHD comorbidity rates was found to be 88 (62%) in patients with SAD, and 63 of these patients had the diagnosis of ADHD-I. ADHD-I group had higher scores of social anxiety and avoidance and had earlier onset of SAD than the ADHD-C group. Conclusion: The inattentive subtype of ADHD may have a more specific relationship with SAD than ADHD-C.

Social anxiety and peer helping in adolescent addiction treatment.

The developmental need to fit in may lead to higher alcohol and other drug use among socially anxious youths which exacerbates the drink/trouble cycle. In treatment, youths with social anxiety disorder (SAD) may avoid participating in therapeutic activities with risk of negative peer appraisal. Peer-helping is a low-intensity, social activity in the 12-step program associated with greater abstinence among treatment-seeking adults. This study examined the influence of SAD on clinical severity at intake, peer-helping during treatment, and outcomes in a large sample of adolescents court-referred to residential treatment. Adolescents (N=195; 52% female, 30% Black) aged 14 to 18 were prospectively assessed at treatment admission, treatment discharge, and 6months after treatment discharge. Data were collected using rater-administered assessments, youth reports, clinician reports, medical charts, and electronic court records. The influence of SAD on peer-helping and outcomes was examined using hierarchical linear regression and event history methods. Forty-two percent of youths reported a persistent fear of being humiliated or scrutinized in social situations, and 15% met current diagnostic criteria for SAD. SAD onset preceded initial use for two-thirds of youths with SAD and substance dependency. SAD youths presented for treatment with greater clinical severity in terms of earlier age of first use (p<0.01), greater lifetime use of heroin and polysubstance use (p<0.05), incarceration history (p<0.01), and lifetime trauma (p<0.001). Twelve-step participation patterns during treatment did not differ between youths with and without SAD except for peer-helping, which was associated with reduced risk of relapse (p<0.01) and incarceration (p<0.05) in the 6months posttreatment. This study found evidence of an association between SAD and earlier age of first use, greater lifetime use of heroin, incarceration history, and lifetime trauma. SAD was associated with higher service participation during treatment, which was associated with reduced risk of relapse and incarceration in the 6months posttreatment. Findings indicate the benefits of service participation for juveniles with SAD which provides a nonjudgmental, task-focused venue for developing sober networks in the transition back into the community.

Relationship between atypical depression and social anxiety disorder

In this study, we aimed to investigate the effects of atypical and non-atypical depression comorbidity on the clinical characteristics and course of social anxiety disorder (SAD). A total of 247 patients with SAD were enrolled: 145 patients with a current depressive episode (unipolar or bipolar) with atypical features, 43 patients with a current depressive episode with non-atypical features and 25 patients without a lifetime history of depressive episodes were compared regarding sociodemographic and clinical features, comorbidity rates, and severity of SAD, depression and functional impairment. Thirty four patients with a past but not current history of major depressive episodes were excluded from the comparisons. 77.1% of current depressive episodes were associated with atypical features. Age at onset of SAD and age at initial major depressive episode were lower in the group with atypical depression than in the group with non-atypical depression. History of suicide attempts and bipolar disorder comorbidity was more common in the atypical depression group as well. Atypical depression group has higher SAD and depression severity and lower functionality than group with non-atypical depression. Our results indicate that the presence of atypical depression is associated with more severe symptoms and more impairment in functioning in patients with SAD.

Developmental pathways of social avoidance across adolescence: The role of social anxiety and negative cognition

It is argued that the adolescent onset of social anxiety disorder (SAD) may be partly attributable to an increase in avoidance of social situations across this period. The current cohort-sequential study investigated developmental pathways of social avoidance in adolescence and examined the explanatory role of social anxiety and negative cognitive processes. A community sample of youth (9–21 years, N=331) participated in a four-wave study. Trajectory analyses revealed two pathways: an increased avoidance pathway and a low avoidance pathway. The pathways were hardly distinguishable at age 9 and they steadily diverged across adolescence. Logistic regression analyses showed that social anxiety and post-event rumination were significantly related to the increased avoidance pathway; anticipatory processing and self-focused attention were not. The findings suggest that adolescence is a key developmental period for the progression of social avoidance among youth who show relatively high levels of social anxiety and post-event rumination.

Predominantly Inattentive Type of ADHD Is Associated With Social Anxiety Disorder

Objective: The aim of this study was to determine the frequency of childhood ADHD comorbidity in patients with social anxiety disorder (SAD), and the influence of this comorbidity on various demographic and clinical variables in SAD. Method: A total of 130 patients with SAD were assessed with K-SADS-PL’s (Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version) behavioral disorders module to determine the childhood diagnosis of ADHD. Patients with or without a comorbid childhood ADHD were compared in terms of clinical characteristics and rating scores. Results: The mean age at onset of SAD was lower, and lifetime major depressive disorder and bipolar disorder (BD) comorbidity were higher in the SAD–ADHD group than in the SAD–without ADHD group. Conclusion: We have found high ADHD comorbidity in patients with SAD. Presence of comorbid ADHD was associated with increased severity, functional impairment, and BD comorbidity.

Pediatric Social Anxiety Disorder: Predictors of Response to Pharmacological Treatment

Pediatric social anxiety disorder (SAD) is associated with an increased risk of comorbid mental disorders, with implications for prognosis and treatment strategy. The aim of this study is to explore predictors of treatment response, and the role of comorbidity in affecting refractoriness. One hundred and forty consecutive youths (81 males, 57.9%), ages 7-18 years (mean age 13.7 ± 2.5 years, mean age at onset of SAD 10.6 ± 2.7 years) met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for SAD as primary diagnosis, according to a structured clinical interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version [K-SADS-PL]). All received a pharmacological treatment with serotonin reuptake inhibitors (SSRIs) targeted to SAD, associated with additional medications for comorbidities (mood stabilizers in 27.1%, antipsychotics in 12.8%) and 57.9% received an additional psychotherapy. Eighty-nine patients (63.6%) responded to treatments after 3 months, namely 72.8% with psychotherapy plus medication and 50.8% with medication only. Nonresponders had more severe symptoms at baseline in terms of both clinical severity and functional impairment, and had more comorbid disruptive behavior disorders. The backward logistic regression indicated that clinical severity and functional impairment at baseline, comorbid disruptive behavior disorders, and bipolar disorders were predictors of nonresponse. Our data suggest that SSRIs can be effective in pediatric SAD, but that the more severe forms of the disorder and those with heavier comorbidity are associated with poorer prognosis.

Maternal Over-Control Moderates the Association Between Early Childhood Behavioral Inhibition and Adolescent Social Anxiety Symptoms

Behavioral inhibition (BI) and maternal over-control are early risk factors for later childhood internalizing problems, particularly social anxiety disorder (SAD). Consistently high BI across childhood appears to confer risk for the onset of SAD by adolescence. However, no prior studies have prospectively examined observed maternal over-control as a risk factor for adolescent social anxiety (SA) among children initially selected for BI. The present prospective longitudinal study examines the direct and indirect relations between these early risk factors and adolescent SA symptoms and SAD, using a multi-method approach. The sample consisted of 176 participants initially recruited as infants and assessed for temperamental reactivity to novel stimuli at age 4 months. BI was measured via observations and parent-report across multiple assessments between the ages of 14 months and 7 years. Maternal over-control was assessed observationally during parent-child interaction tasks at 7 years. Adolescents (ages 14-17 years) and parents provided independent reports of adolescent SA symptoms. Results indicated that higher maternal over-control at 7 years predicted higher SA symptoms and lifetime rates of SAD during adolescence. Additionally, there was a significant interaction between consistently high BI and maternal over-control, such that patterns of consistently high BI predicted higher adolescent SA symptoms in the presence of high maternal over-control. High BI across childhood was not significantly associated with adolescent SA symptoms when children experienced low maternal over-control. These findings have the potential to inform prevention and early intervention programs by identifying particularly at-risk youth and specific targets of treatment.

Discrepancies between implicit and explicit self-esteem among adolescents with social anxiety disorder

Abstract Background and objectives Previous studies have found high implicit self-esteem (ISE) to prevail concurrently with low explicit self-esteem (ESE) in socially anxious adults. This suggests that self-esteem discrepancies are associated with social anxiety disorder (SAD). Given that the onset of SAD often occurs in adolescence, we investigated self-esteem discrepancies between ISE and ESE in adolescents suffering from SAD. Methods Two implicit measures (Affect Misattribution Procedure, Implicit Association Test) were used both before and after a social threat activation in 20 adolescents with SAD (14–20 years), and compared to 20 healthy adolescents who were matched for age and gender. The Rosenberg Self-Esteem Scale, the Social Cognitions Questionnaire and Beck Depression Inventory were administered as explicit measures. We expected discrepant self-esteem (high ISE, low ESE) in adolescents with SAD, in comparison to congruent self-esteem (positive ISE, positive ESE) in healthy controls, after social threat activation. Results Both the patient and control groups exhibited high positive ISE on both implicit measures, before as well as after social threat induction. Explicitly, patients suffering from SAD revealed lower levels of ESE, compared to the healthy adolescents. Conclusions This study is the first to examine ISE and ESE in a clinical sample of adolescent patients with SAD. Our results suggest that SAD is associated with a discrepancy between high ISE and low ESE, after a social-threat manipulation. The findings are discussed in relation to other studies using implicit measures in SAD and may provide a more comprehensive understanding of the role of self-esteem in adolescent SAD.

Discrepancies between implicit and explicit self-esteem among adolescents with social anxiety disorder

Background and objectivesPrevious studies have found high implicit self-esteem (ISE) to prevail concurrently with low explicit self-esteem (ESE) in socially anxious adults. This suggests that self-esteem discrepancies are associated with social anxiety disorder (SAD). Given that the onset of SAD often occurs in adolescence, we investigated self-esteem discrepancies between ISE and ESE in adolescents suffering from SAD. MethodsTwo implicit measures (Affect Misattribution Procedure, Implicit Association Test) were used both before and after a social threat activation in 20 adolescents with SAD (14–20 years), and compared to 20 healthy adolescents who were matched for age and gender. The Rosenberg Self-Esteem Scale, the Social Cognitions Questionnaire and Beck Depression Inventory were administered as explicit measures. We expected discrepant self-esteem (high ISE, low ESE) in adolescents with SAD, in comparison to congruent self-esteem (positive ISE, positive ESE) in healthy controls, after social threat activation. ResultsBoth the patient and control groups exhibited high positive ISE on both implicit measures, before as well as after social threat induction. Explicitly, patients suffering from SAD revealed lower levels of ESE, compared to the healthy adolescents. ConclusionsThis study is the first to examine ISE and ESE in a clinical sample of adolescent patients with SAD. Our results suggest that SAD is associated with a discrepancy between high ISE and low ESE, after a social-threat manipulation. The findings are discussed in relation to other studies using implicit measures in SAD and may provide a more comprehensive understanding of the role of self-esteem in adolescent SAD.