Subtype Of Social Anxiety Disorder Research Articles

Informant discrepancies in adult social anxiety disorder assessments: Links with contextual variations in observed behavior.

Multi-informant assessments of adult psychopathology often result in discrepancies among informants' reports. Among 157 adults meeting criteria for either the generalized (n = 106) or nongeneralized (n = 51) social anxiety disorder (SAD) subtype, we examined whether discrepancies between patients' and clinicians' reports of patients' symptoms related to variations in both SAD subtype and expressions of social skills deficits across multiple social interaction tasks. Latent class analyses revealed two behavioral patterns: (a) context-specific social skills deficits and (b) cross-context social skills deficits. Similarly, patients' symptom reports could be characterized by concordance or discordance with clinicians' reports. Patient-clinician concordance on relatively high levels of patients' symptoms related to an increased likelihood of the patient meeting criteria for the generalized relative to nongeneralized subtype. Further, patient-clinician concordance on relatively high levels of patients' symptoms related to an increased likelihood of consistently exhibiting social skills deficits across social interaction tasks (relative to context-specific social skills deficits). These relations were robust in accounting for patient age, clinical severity, and Axis I and II comorbidity. Further, clinical severity did not completely explain variability in patients' behavior on laboratory tasks or discrepancies between patient and clinician reports. Findings provide the first laboratory-based support for the ability of informant discrepancies to indicate cross-contextual variability in clinical adult assessments, and the first of any developmental period to indicate this for SAD assessments. These findings have important implications for clinical assessment and developmental psychopathology research.

EVALUATION OF THE PROPOSED SOCIAL ANXIETY DISORDER SPECIFIER CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH

The current proposal for the DSM-5 definition of social anxiety disorder (SAD) is to replace the DSM-IV generalized subtype specifier with one that specifies fears in performance situations only. Relevant evaluations to support this change in youth samples are sparse. The present study examined rates and correlates of the DSM-IV and proposed DSM-5 specifiers in a sample of treatment-seeking children and adolescents with SAD (N = 204). When applying DSM-IV subtypes, 64.2% of the sample was classified as having a generalized subtype of SAD, with the remaining 35.2% classifying as having a nongeneralized subtype SAD. Youth with generalized SAD, relative to those with nongeneralized SAD, were older, had more clinically severe SAD, showed greater depressive symptoms, and were more likely to have a comorbid depressive disorder. No children in the current sample endorsed discrete fear in performance situations only in the absence of fear in other social situations. The present findings call into question the meaningfulness of the proposed changes in treatment-seeking youth with SAD.

Social anxiety and functional impairment in patients seeking surgical evaluation for hyperhidrosis

Primary hyperhidrosis is characterized by excessive sweating and often accompanied by social avoidance. Social anxiety disorder (SAD) is characterized by fear and avoidance of social situations, often partly related to fears of showing signs of excessive autonomic nervous system activation, such as sweating. To clarify the relationship of hyperhidrosis and SAD, this study assessed severity of sweating, overall social anxiety and social anxiety due to sweating, and disability in 2 groups: patients seeking surgical treatment for hyperhidrosis (n = 40) and patients seeking treatment for SAD (n = 64).Hyperhidrosis and SAD patients overlapped in severity of overall social anxiety and social anxiety related to sweating. Hyperhidrosis patients reported elevated levels of social anxiety, with mean severity near the threshold for the generalized subtype of SAD, but significantly lower social anxiety than in the SAD patients. Significantly more hyperhidrosis patients than SAD patients attributed most of their social anxiety to sweating (76% vs 20%). Among hyperhidrosis patients, the pattern of correlations of sweating, social anxiety, and disability was consistent with a model of social anxiety as a mediator of sweating-related disability. The overlap of symptoms in patients presenting for treatment of SAD or hyperhidrosis suggests that both social anxiety and sweating should be assessed in these patients and considered as potential targets of treatment.

Functional impairment in social anxiety disorder

The present study examined functional impairment among treatment seekers with social anxiety disorder (SAD). We investigated the effects of diagnostic subtypes of SAD and comorbidity with mood and anxiety disorders on impairment. In addition, we used cluster analysis procedures to empirically identify subgroups of individuals with distinct patterns of impairment. Participants were 216 treatment-seeking individuals with SAD. Clinical interviews were undertaken to determine diagnoses of anxiety disorders and major depressive disorder, and a battery of self-report measures was administered to index symptoms of social anxiety, depression and extent of impairment. Results indicated that individuals with the generalized subtype of SAD had greater impairment in all three life domains compared to individuals with the nongeneralized subtype. Comorbidity with mood disorders was associated with greater impairment than SAD alone, but comorbidity with anxiety disorders was not. Four distinct impairment profiles emerged from the cluster analysis: primary work/studies impairment, primary social life impairment, both work/studies and social impairment, and impairment in all domains. Findings from this study suggest that SAD is associated with substantial impairment across multiple domains, and that individuals with SAD present diverse impairment profiles. These profiles may inform subtyping of the disorder as well as therapeutic interventions.

Current status of knowledge on public-speaking anxiety

This review examines the current knowledge on public-speaking anxiety, that is, the fear of speaking in front of others. This article summarizes the findings from previous review articles and describes new research findings on basic science aspects, prevalence rates, classification, and treatment that have been published between August 2008 and August 2011. Recent findings highlight the major aspects of psychological and physiological reactivity to public speaking in individuals who are afraid to speak in front of others, confirm high prevalence rates of the disorder, contribute to identifying the disorder as a possibly distinct subtype of social anxiety disorder (SAD), and give support to the efficacy of treatment programs using virtual reality exposure and Internet-based self-help. Public-speaking anxiety is a highly prevalent disorder, leading to excessive psychological and physiological reactivity. It is present in a majority of individuals with SAD and there is substantial evidence that it may be a distinct subtype of SAD. It is amenable to treatment including, in particular, new technologies such as exposure to virtual environments and the use of cognitive-behavioral self-help programs delivered on the Internet.

Admixture analysis of the diagnostic subtypes of social anxiety disorder: Implications for the DSM-V

Background and objectivesMuch controversy exists regarding diagnostic subtypes of social anxiety disorder (SAD). The present study used admixture analysis to examine whether individuals with generalized and nongeneralized SAD belong to the same or different populations of origin. This can inform diagnostic subtyping of SAD in the forthcoming DSM-V. MethodsTreatment-seeking individuals with generalized SAD (n = 154) and nongeneralized SAD (n = 48) completed a battery of questionnaires. Based on participants’ responses to the Liebowitz Social Anxiety Scale (LSAS), we estimated log likelihood and chi-square goodness-of-fit for models with 1, 2, 3, or 4 populations of origin, and compared models using forward stepwise estimation and maximum likelihood ratio tests. ResultsAdmixture analyses suggested that the two diagnostic subtypes of SAD belong to the same underlying population of origin. In addition, observable differences in depression, general anxiety, and comorbidity were no longer significant when controlling for social anxiety severity. LimitationsOur sample was recruited in the U.S. and was a treatment-seeking sample. Future studies should examine whether our results generalize to different cultures, and community samples. ConclusionsSupport for qualitative differences between SAD subtypes was not found. Rather, our findings support the notion that the diagnostic subtypes of SAD differ quantitatively, and that SAD exists on a continuum of severity. This finding informs diagnostic subtyping of SAD in the forthcoming DSM-V.

Linguistic correlates of social anxiety disorder

The goal of this study was to examine the linguistic correlates of social anxiety disorder (SAD). Twenty-four individuals with SAD (8 of them with a generalised subtype) and 21 non-anxious controls were asked to give speeches in front of an audience. The transcribed speeches were examined for the frequency of negations, I-statements, we-statements, negative emotion words, and positive emotion words. During their speech, individuals with either SAD subtype used positive emotion words more often than controls. No significant differences were observed in the other linguistic categories. These results are discussed in the context of evolutionary and cognitive perspectives of SAD.

IS THERE A PLACE FOR FEAR OF BLUSHING IN SOCIAL ANXIETY SPECTRUM?

Fear of blushing (FB) in front of other people is a frequent and potentially incapacitating problem, but is not yet described as a specific diagnosis in psychiatric classifications. This can be explained by a lack of comparative studies with other forms of social anxiety disorder (SAD). Our aim was thus to explore the specificity of FB in patients with SAD. SAD patients with FB but without other social threat (n = 142), the majority of whom were referred by a department of surgery after an initial request of sympathetic block for facial blushing, were compared to SAD patients with FB and other associated social fears (n = 97), and to SAD patients without FB (n = 190). They were assessed and compared with a structured diagnostic interview for DSM-IV and various scales measuring social anxiety, other anxiety and depressive symptoms, impairment and personality traits. The group with pure FB showed specific profiles when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, and higher self-esteem. However, their levels of social anxiety and impairment were high. No important differences appeared between the two other groups. The specificity of FB should be considered in the social anxiety spectrum, and could be viewed either as a SAD subtype or as SAD form secondary to facial blushing. Further epidemiological and therapeutic studies on this disorder are necessary.

Comparison of Anxiety-Related Traits Between Generalized and Nongeneralized Subtypes of Social Anxiety Disorder

This study aimed to investigate the possible difference in anxiety-related traits between the generalized and nongeneralized subtypes of social anxiety disorder (SAD). Two hundred seventy-three SAD Korean outpatients completed the Anxiety Sensitivity Index (ASI), the Trait Form of the State-Trait Anxiety Inventory (STAI-T), Retrospective Self-Report of Inhibition (RSRI), and the Liebowitz Social Anxiety Scale (LSAS) as part of their assessments. The unadjusted total scores of the ASI, STAI-T, RSRI, and LSAS differed between the two subtypes, according to an independent t-test. However, this result was not significant (ASI: F = 2.363, p = 0.127; STAI-T: F = 0.004, p = 0.949; RSRI: F = 1.518, p = 0.220) after adjusting for LSAS total score. The comparison of anxiety-related traits did not show any difference between the subtypes after adjusting for illness severity. These results may suggest that the two SAD subtypes are on a continuum of the same illness, differentiated only by symptom severity.

Correlations between the offensive subtype of social anxiety disorder and personality disorders

Recent studies have revealed the possibility that the offensive subtype of social anxiety disorder (SAD) may no longer be a culture-bound syndrome; however, detailed clinical pictures have never been reported. This study investigated the differences between the offensive and non-offensive subtypes of SAD in terms of the background and axis I and II comorbidity. A total of 139 patients with SAD based on DSM-IV criteria were studied by conducting a semi-structured interview including the Structured Clinical Interview for DSM-IV axis I and II disorders, and the Liebowitz Social Anxiety Scale. Fifty-two (37%) patients were classified with the offensive subtype. There were no significant differences in most demographic variables and axis I lifetime comorbidity between offensive and non-offensive subtype patients. On logistic regression analysis, offensive subtype patients showed a more frequent history of parental physical abuse, higher Liebowitz Social Anxiety Scale scores, and more frequently exhibited obsessive--compulsive personality disorders than non-offensive subtype patients. Yamashita (1977) reported that the majority of offensive subtype patients were doted on by their parents, although current offensive subtype patients are more likely to have had a troubled childhood, show severer forms of SAD, and more frequently exhibit an inflexible personality. This study suggested that the offensive subtype might not be essentially different from the non-offensive subtype (quantitative rather than qualitative).

Social anxiety disorder subtypes and their mental health correlates in a nationally representative Canadian sample.

Social anxiety disorder subtypes and their mental health correlates in a nationally representative Canadian sample.

A Randomized Controlled Trial of Atomoxetine in Generalized Social Anxiety Disorder

The current mainstays of social anxiety disorder pharmacotherapy are serotonergic agents, with less known about the efficacy of more noradrenergic drugs. Atomoxetine (ATM), a highly selective norepinephrine reuptake inhibitor, is currently approved for the treatment of attention-deficit/hyperactivity disorder (ADHD). We describe the first controlled trial of ATM with respect to efficacy and tolerability in adults with the generalized subtype of social anxiety disorder (GSAD) without comorbid ADHD. Twenty-seven outpatients with clinically prevailing diagnoses of GSAD by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were randomized in a 1:1 ratio to 10 weeks of double-blind flexible-dose treatment with either ATM 40-100 mg per day (n = 14) or placebo (n = 13). Primary efficacy outcome was score at end point on the Liebowitz Social Anxiety Scale in the intention-to-treat sample. There were no significant group differences in patients completing the study (ATM, 79%; placebo, 77%). Whereas ATM was well tolerated, there were no significant differences in clinical efficacy between ATM and placebo for GSAD. There were few responders overall (ATM, 21%; placebo, 33%), but proportions were similar in each group (chi [1, 26] = 0.47; P = 0.67). Analysis of variance with repeated measures on the Liebowitz Social Anxiety Scale was performed to detect any differential change in social anxiety symptoms between groups. A significant time effect was found (F = 8.71; P = 0.007), but the time-by-treatment interaction was nonsignificant (F = 0.013; P = 0.91). Although the small sample size limits confidence in the reported results, the comparable, and low, response rates for ATM and placebo suggest that in the absence of comorbid ADHD, ATM is unlikely to be an effective agent for the treatment of GSAD.

Assessing the validity of social anxiety disorder subtypes using a nationally representative sample

The purpose of this study was to examine and validate social anxiety disorder subtypes using the nationally representative National Comorbidity Survey Replication ( N = 9282). Generalized and non-generalized subtypes were defined as fearing at least 8 (i.e., most) and fewer than 7 of 14 possible social situations, respectively, following the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Results indicated that in those with social anxiety disorder, the odds of having comorbid major depression, a comorbid anxiety disorder, and suicidal ideation were significantly greater in the generalized subtype. However, differences were no longer significant when adjusting for the number of feared social situations. Results further indicated that the number of feared social situations was significantly associated with comorbid major depression, a comorbid anxiety disorder, and suicidal ideation. These findings call into question the validity of DSM-IV-defined subtypes and provide additional support for the notion that clinicians and researchers should consider viewing this disorder on a single continuum with greater number of feared situations associated with greater clinical severity.

Childhood maltreatment linked to greater symptom severity and poorer quality of life and function in social anxiety disorder

There is a paucity of data examining the prevalence and impact of childhood maltreatment in patients presenting with a primary diagnosis of social anxiety disorder (SAD). We thus examined the presence of a broad spectrum of childhood maltreatment, including physical, sexual, and emotional abuse and neglect, in treatment-seeking individuals with the generalized subtype of SAD (GSAD). We hypothesized that a history of childhood maltreatment would be associated with greater SAD symptom severity and poorer associated function. One hundred and three participants with a primary diagnosis of GSAD (mean age 37+/-14; 70% male) completed the well-validated, self-rated Childhood Trauma Questionnaire (CTQ), as well as measures of SAD symptom severity and quality of life. Fully 70% (n=72) of the GSAD sample met severity criteria for at least one type of childhood abuse or neglect as measured by the CTQ subscales using previously established thresholds. CTQ total score adjusted for age and gender was associated with greater SAD severity, and poorer quality of life, function, and resilience. Further, the number of types of maltreatment present had an additive effect, with specific associations for emotional abuse and neglect with SAD severity. Despite the use of validated assessments, our findings are limited by the retrospective and subjective nature of self-report measures used to assess childhood maltreatment. Nonetheless, these data suggest a high rate of childhood maltreatment in individuals seeking treatment for GSAD, and the association of maltreatment with greater disorder severity suggests that screening is clinically prudent.

Panic disorder and social anxiety disorder subtypes in a caffeine challenge test

Studies have demonstrated the vulnerability of anxiety disorder patients to challenge tests. Our aim was to observe if panic disorder (PD) patients and generalized social anxiety disorder (GSAD) and performance social anxiety disorder (PSAD) patients respond in a similar way to the induction of anxiety symptoms and panic attacks by an oral caffeine challenge test. We compared 28 PD patients, 25 GSAD patients, 19 PSAD, and 26 control subjects after a 480-mg caffeine test. The patients had not received psychotropic drugs for at least a 4-week period. In a randomized double-blind experiment performed in two occasions 7 days apart, 480 mg of caffeine and a caffeine-free solution were administered and anxiety scales were administered before and after each test. A panic attack was induced in 17 (60.7%) PD patients, 4 (16.0%) GSAD patients, and 10 (52.6%) PSAD patients, during the caffeine test. None of the control subjects had a panic attack after the caffeine intake. Neither patients nor any control subject had a panic attack after drinking the caffeine-free solution. Our data suggest that there is an association between PD and PSAD hyperreactivity to an oral caffeine challenge test. The PD and PSAD patients had a higher number of induced panic attacks, some specific anxiety symptoms, and a more severe anxiety response than GSAD patients and normal volunteers.

Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale

This study examined whether the self-report version of the Liebowitz Social Anxiety Scale (LSAS-SR) could accurately identify individuals with social anxiety disorder and individuals with the generalized subtype of social anxiety disorder. Furthermore, the study sought to determine the optimal cutoffs for the LSAS-SR for identifying patients with social anxiety disorder and its generalized subtype. Two hundred and ninety-one patients with clinician-assessed social anxiety disorder (240 with generalized social anxiety disorder) and 53 control participants who were free from current Axis-1 disorders completed the LSAS-SR. Receiver Operating Characteristic analyses revealed that the LSAS-SR performed well in identifying participants with social anxiety disorder and generalized social anxiety disorder. Consistent with Mennin et al.'s [2002: J Anxiety Disord 16:661-673] research on the clinician-administered version of the LSAS, cutoffs of 30 and 60 on the LSAS-SR provided the best balance of sensitivity and specificity for classifying participants with social anxiety and generalized social anxiety disorder, respectively. The LSAS-SR may be an accurate and cost-effective way to identify and subtype patients with social anxiety disorder, which could help increase the percentage of people who receive appropriate treatment for this debilitating disorder.

Gender effect on clinical features and drug treatment response in social anxiety disorder (social phobia)

Objective. To investigate differences concerning clinical and treatment response features in male and female patients with social anxiety disorder (SOAD). Method. Male (n=41) and female patients (n=21) with SOAD were compared with regard to age and mode of onset; SOAD subtype; symptom severity; presence of comorbid psychiatric conditions; and response after drug treatment. The χ2-test was used for comparisons between categorical variables and Student's t-test for continuous variables. The adopted level of statistic significance was 5%. Results. Male patients had a higher mean age (t= −2.9; df =42; P=0.006), more severe initial symptoms (t =−2.6; df =37.4; P =0.01) and, more often, more than one comorbid psychiatric condition (χ2=10.98; df =1; P =0.001). Alcohol abuse was more frequent in men (χ2=7.62; df =1; P =0.006). With regard to treatment response, male patients displayed greater reductions in the severity of their baseline symptoms. Patients with SOAD were randomly selected from both samples in order to generate subgroups of 18 male and 18 female age-matched patients. Despite controlling for age, we still found that men exhibited a trend toward greater severity of symptoms at baseline than women with SOAD (t =−1.8; df =33.1; P =0.07). Conclusion. The findings suggest differences concerning initial severity and comorbidity rates between men and women suffering from SOAD.

Sensory-processing sensitivity in social anxiety disorder: Relationship to harm avoidance and diagnostic subtypes

Sensory-processing sensitivity is assumed to be a heritable vulnerability factor for shyness. The present study is the first to examine sensory-processing sensitivity among individuals with social anxiety disorder. The results showed that the construct is separate from social anxiety, but it is highly correlated with harm avoidance and agoraphobic avoidance. Individuals with a generalized subtype of social anxiety disorder reported higher levels of sensory-processing sensitivity than individuals with a non-generalized subtype. These preliminary findings suggest that sensory-processing sensitivity is uniquely associated with the generalized subtype of social anxiety disorder. Recommendations for future research are discussed.

Early-onset social anxiety disorder in adults: clinical and therapeutic features

To investigate possible differences in clinical and treatment response in patients suffering from early-onset (< 18 years) and late-onset (> or =18 years) social anxiety disorder. Patients diagnosed with social anxiety disorder of early-onset (n = 47; 75.8%) were compared to those diagnosed with late-onset social anxiety disorder (n = 15; 24.2%) in terms of age, mode of onset, subtype, psychiatric comorbidities (according to the Structured Clinical Interview for DSM-IV), symptom severity and response (assessed according to the Clinical Global Impression scale) after at least ten weeks of drug treatment. The statistical analyses included chi2 tests with Yates correction or Fisher's exact test, as well as Student's t-test or Mann-Whitney test. The level of statistic significance adopted was 5%. Patients presenting early-onset phobic symptoms more frequently: were inactive (chi2 = 4.28; df = 1; p = 0.04); suffered from the generalized subtype of social phobia (chi2 = 6.53; df = 1; p = 0.01); and presented psychiatric comorbidity (chi2 = 6.71; df = 1; p = 0.01). No differences were observed between the groups in severity of symptoms and therapeutic response. The findings suggest the existence of a possible social anxiety disorder subtype characterized by early onset of symptoms, higher rates of absenteeism, a wider range of social phobia symptoms and psychiatric complications.

Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample

Background: Comorbidity between adult social anxiety disorder and major depression is extensive. Considerably less information about this relationship is available among youth. Methods: A randomly selected (from enrollees in a pediatric primary care clinic) sample of 190 families with children between the ages of 8 and 17 responded by mail to questionnaires assessing social anxiety, depression, and social functioning. Parents also completed a semi-structured telephone diagnostic interview about their child. Results: The generalized type of social anxiety disorder was highly comorbid with major depression, generalized anxiety disorder, specific phobias, and ADHD, while little comorbidity was present for the nongeneralized subtype of social anxiety disorder. Logistic regression analyses indicated that generalized social anxiety disorder was the only anxiety disorder associated with an increased likelihood of major depression (OR=5.1). In all cases, social anxiety disorder had a significantly earlier age of onset than major depression. Limitations: This study relies on cross-sectional data and diagnoses are based on parent reporting of child behavior. Conclusions: Generalized social anxiety disorder is strongly associated with depressive illness in youth. Screening and treatment approaches that consider both social anxiety and depressive symptoms are necessary. Early intervention to treat social anxiety disorder may prevent later depressive disorders.