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PubMed2003

Shyness: relationship to social phobia and other psychiatric disorders.

The relationship between shyness, social phobia and other psychiatric disorders was examined. The prevalence of social phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of social phobia, but the data suggest that social phobia is not merely severe shyness. Social phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with social phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with social phobia from those without social phobia. The proportion of the shy group with psychiatric diagnoses other than social phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and social phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.

Adult↗
PubMed2002

The spectrum of social phobia in the Zurich cohort study of young adults.

BACKGROUND: The goals of the present study are to describe the prevalence, risk factors, course, and impact of social phobia in a 15-year prospective longitudinal community study; and to examine an expanded conceptualization of social phobia with respect to clinical indicators of severity, as well as gender differences, personality traits, and stability over 15 years. METHODS: The sample is a cohort of 591 young adults aged 18-19 from the general population of Zurich, Switzerland at study entry who have been followed to age 35. RESULTS: Six percent of participants met lifetime criteria for social phobia at the diagnostic level, 12% at the subthreshold level, and 24% had social phobia symptoms alone. Women had higher lifetime rates of diagnostic and subthreshold-level social phobia, whereas there was an equal gender ratio of social phobia symptoms. There was a direct association between strictness of the diagnostic threshold and severity, such that work impairment, social impairment, treatment rate, medication use, and subjective distress decreased from the diagnostic to the symptom level. Similarly, family history of phobias, autonomic lability, and comorbidity decreased across the spectrum. Although there was a substantial degree of longitudinal stability at each level of the spectrum, significant oscillation across levels suggests that the spectrum concept better characterizes the longitudinal course of social phobia. CONCLUSIONS: These findings demonstrate the utility of the social phobia spectrum. Application of the spectrum concept provides coverage of treated but undiagnosed cases of social phobia as well as those who vacillate across the diagnostic threshold over time.

Adolescent↗
PubMed1998

Subtypes of social phobia and comorbidity with depression and other anxiety disorders.

Epidemiological studies have identified two subtypes of social phobia: speaking-only social phobia which is characterized by the fear of public speaking situations and complex social phobia which is characterized by the fear of multiple social situations. Speaking-only social phobia most closely corresponds to the DSM-IV's 'nongeneralized social phobia' while complex social phobia resembles 'generalized social phobia'. In contrast to the speaking-only social phobia, the complex form is usually more disabling, familial and longer-lasting. In addition, the complex form has a lower chance of spontaneous recovery and carries a higher risk of comorbidity and impairment. Overall, both types of social phobia tend to be underdiagnosed and under-treated. Effective treatments which can manage not only complex social phobia, but also its spectrum of comorbid conditions, are required.

Anxiety Disorders↗
PubMed2000

Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades.

Previous analysis of data from the U.S. National Comorbidity Survey (NCS) [24] suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data [21] revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

Adolescent↗
PubMed2004

Left hemisphere dysfunction during verbal dichotic listening tests in patients who have social phobia with or without comorbid depressive disorder.

OBJECTIVE: Behavioral, electrophysiological, and imaging studies have found evidence that anxiety disorders are associated with left hemisphere dysfunction or higher than normal activation of right hemisphere regions. Few studies, however, have examined hemispheric asymmetries of function in social phobia, and the influence of comorbidity with depressive disorders is unknown. The present study used dichotic listening tests to assess lateralized cognitive processing in patients with social phobia, depression, or comorbid social phobia and depression. METHOD: The study used a two-by-two factorial design in which one factor was social phobia (present versus absent) and the second factor was depressive disorder (present versus absent). A total of 125 unmedicated patients with social phobia, depressive disorder, or comorbid social phobia and depressive disorder and 44 healthy comparison subjects were tested on dichotic fused-words, consonant-vowel syllable, and complex tone tests. RESULTS: Patients with social phobia with or without a comorbid depressive disorder had a smaller left hemisphere advantage for processing words and syllables, compared with subjects without social phobia, whereas no difference between groups was found in the right hemisphere advantage for processing complex tones. Depressed women had a larger left hemisphere advantage for processing words, compared with nondepressed women, but this difference was not seen among men. CONCLUSIONS: The results support the hypothesis that social phobia is associated with dysfunction of left hemisphere regions mediating verbal processing. Given the importance of verbal processes in social interactions, this dysfunction may contribute to the stress and difficulty experienced by patients with social phobia in social situations.

Adult↗
PubMed2000

Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study.

BACKGROUND: This article examines the associations between DSM-IV social phobia and parental psychopathology, parenting style, and characteristics of family functioning in a representative community sample of adolescents. METHODS: Findings are based on baseline and first follow-up data of 1047 adolescents aged 14 to 17 years at baseline (response rate, 74.3%), and independent diagnostic interviews with one of their parents. Diagnostic assessments in parents and adolescents were based on the DSM-IV algorithms of the Munich-Composite International Diagnostic Interview. Parenting style (rejection, emotional warmth, and overprotection) was assessed by the Questionnaire of Recalled Parental Rearing Behavior, and family functioning (problem solving, communication, roles, affective responsiveness, affective involvement, and behavioral control) was assessed by the McMaster Family Assessment Device. RESULTS: There was a strong association between parental social phobia and social phobia among offspring (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.6-13.5). Other forms of parental psychopathology also were associated with social phobia in adolescents (depression: OR, 3.6; 95% CI, 1.4-9.1; any anxiety disorder other than social phobia: OR, 3.5; 95% CI, 1.4-8.8; and any alcohol use disorder: OR, 3.0; 95% CI, 1.1-7.8). Parenting style, specifically parental overprotection (OR, 1.4; 95% CI, 1.0-1.9) and rejection (OR, 1.4; 95% CI, 1.1-1.9), was found to be associated with social phobia in respondents. Family functioning was not associated with respondents' social phobia. CONCLUSIONS: Data suggest that parental psychopathology, particularly social phobia and depression, and perceived parenting style (overprotection and rejection) are both associated with the development of social phobia in youth.

Adolescent↗
PubMed1993

The Zurich study. XX. Social phobia and agoraphobia.

The problems in association with agoraphobia and social phobia were examined in an 11-year prospective longitudinal study of a Swiss cohort of young adults. The weighted prevalence rates according to DSM-III were 2.9% for agoraphobia and 3.8% for social phobia. Although the problem of agoraphobia was greater in females, an equal sex ratio was observed for social phobia. There was a significant degree of comorbidity between the two subtypes of phobia, with females exhibiting a significantly greater frequency of co-occurrence of both disorders than males. The course of the two disorders was quite similar. In general, subjects with both disorders reported a more severe course. Assessment of comorbidity of phobias and other disorders revealed that agoraphobia was most significantly associated with extended neurasthenia, sexual problems, and the consumption of cannabis. On the other hand, social phobia was associated with other disorders than agoraphobia, with the strongest associations emerging for simple phobia, extended insomnia, and alcohol abuse. These findings support the validity of the distinction between different subtypes of phobia. The longitudinal analysis revealed that also phobia in general was not stable at the diagnostic level phobic symptoms were quite persistent across time.

Adolescent↗
PubMed1990

AIDS-phobia and political reaction in California: student versus public responses to reactive political initiatives.

A "social reactivist" study was conducted of the responses of 563 students enrolled in a Southern California university compared with those of a random sample of 1002 Californians telephone-polled by the California Poll. The study focused on AIDS-phobia, the fear of getting AIDS or the AIDS virus, HIV, from casual contact. In both samples, AIDS-phobia correlated well with reactive political sentiment. Students who were AIDS-phobic were expected to vote in favor of proquarantine initiatives (Proposition 64 in 1986 and Proposition 69 in June 1988). California Poll respondents who were AIDS-phobic, likewise, were expected to vote in favor of Proposition 102 (November 1988) which required reporting HIV-positive patients to local health officers. In the student samples, however, AIDS-phobia was found by factor analysis to have two subsets: AIDS-phobia-Wet and AIDS-phobia-Dry. These did not appear in the California Poll results. In the 1988 student sample, AIDS-phobia-Wet was significant in explaining proquarantine sentiment, while AIDS-phobia-Dry proved significant in explaining sexual activity. The converse was not true. AIDS-phobia is a major characteristic of the social audience to AIDS as a disease and may prove decisive in the evolution of the disease. Support for the victim (or lack of it) may influence the course of the disease and even public funding to fight the disease. AIDS-phobia may also blind heterosexuals to their own vulnerability, thus making them vulnerable to the disease.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Cognitive-behavioral treatment for specific phobias with a child demonstrating severe problem behavior and developmental delays.

Cognitive-behavioral treatments (CBTs) are widely used for anxiety disorders in typically developing children; however, there has been no previous attempt to administer CBT for specific phobia (in this case study, one-session treatment) to developmentally or intellectually disabled children. This case study integrates both cognitive-behavioral and behavior analytic assessment techniques in the CBT of water and height phobia in a 7-year-old male with developmental delays and severe behavior problems. One-session treatment [Ost, L. G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27, 1-7; Ost, L. G. (1997). Rapid treatment of specific phobias. In G. C. L. Davey (Ed.), Phobias: A handbook of theory, research, and treatment (pp. 227-247). New York: Wiley] was provided for water phobia and then 2 months later for height phobia. The massed exposure therapy sessions combined graduated in vivo exposure, participant modeling, cognitive challenges, reinforcement, and other techniques. Both indirect and direct observation measures were utilized to evaluate treatment efficacy. Results suggested CBT reduced or eliminated behavioral avoidance, specific phobia symptoms, and subjective fear. Negative vocalizations were reduced during height exposure following treatment. Vocalizations following treatment for water phobia were less clear and may have been indicative of typical 7-year-old protests during bath time. Findings indicate CBT can be effective for treating clinical fears in an individual with developmental disabilities and severe behavior. Future research in this population should examine CBT as an alternative to other techniques (e.g., forced exposure) for treating fears.

Child↗
PubMed1998

Assessment of contemporary social phobia verbal report instruments.

The Social Phobia Scale (SPS), the Social Interaction Anxiety Scale (SIAS) and the Social Phobia and Anxiety Inventory (SPAI) were compared to each other and evaluated in patients with social phobia. We examined the relationship of these three contemporary social phobia verbal report instruments with each other, as well as with behavioral and self-report cognitive criteria. As expected, the three social phobia scales were significantly intercorrelated, although they differed in their relationship to the behavioral and cognitive measures. Specifically, the SPS had a significant negative relationship with time spent in a speech behavioral assessment test. The higher the anxiety scores were on the SPS, the less time patients spent giving an impromptu speech in front of a small audience. The SIAS was consistently related to negative and positive self-reported thoughts in speech and conversation behavioral assessment tests. All instruments differentiated patients with speech phobia from those having both generalized social phobia and avoidant personality disorder; on the SPAI and the SIAS, however, distinguished the former group from individuals with generalized social phobia but not without avoidant personality disorder. All three social phobia instruments were sensitive to treatment changes. Results are discussed in terms of the relative utility of each of these measures' total sores and any and their subscales.

Adult↗
PubMedDate not supplied

Multimodal comparisons of social phobia subtypes and avoidant personality disorder.

The purpose of the present study was to further clarify the behavioral, physiological, and verbal response of patients with circumscribed social (speech) phobia, generalized social phobia without avoidant personality disorder, and generalized social phobia with avoidant personality disorder. Patients completed a battery of verbal report instruments and participated in two behavioral assessment tests. Measures of avoidance/escape behavior, cardiac response, level of behavioral skill, state anxiety, and positive and negative self-statements during performance were collected. Significant differences across response domains were found between the circumscribed social phobia and the generalized groups. Most of the distinctions were between individuals with circumscribed social phobia and those with both generalized social phobia and avoidant personality disorder, with the former group having less overall psychopathology. In addition, there was substantial overlap of problems between generalized social phobia individuals with and without avoidant personality disorder. Implications for the conceptualization of social phobia are discussed in terms of the differences among social phobia subtypes.

Adult↗
PubMed1993

Major depression and phobias: the genetic and environmental sources of comorbidity.

In a population based sample of 2163 personally interviewed female twins, substantial comorbidity was observed between DSM-III-R defined major depression (MD) and 4 subtypes of phobia: agoraphobia, social phobia, animal phobia and situational phobia. However, the level of comorbidity of MD with agoraphobia was much greater than that found with the other phobic subtypes. We concluded bivariate twin analyses to decompose the genetic and environmental sources of comorbidity between MD and the phobias. Our results suggest that a modest proportion of the genetic vulnerability to MD also influences the risk for all phobic subtypes, with the possible exception of situational phobias. Furthermore, the magnitude of comorbidity resulting from this shared genetic vulnerability is similar across the phobic subtypes. By contrast, the non-familial environmental experiences which predispose to depression substantially increase the vulnerability to agoraphobia, have a modest impact on the risk for social and situational phobias and no effect on the risk for animal phobias. The increased comorbidity between MD and agoraphobia results, nearly entirely, from individual-specific environmental risk factors for MD which also increase the risk for agoraphobia but not for other phobias.

Adult↗
PubMed1996

The cross-national epidemiology of social phobia: a preliminary report.

We present a preliminary report on cross-national rates, age at onset, comorbidity, suicide attempts and symptom profiles of social phobia. These data are based on epidemiologic community surveys using similar methods from the United States, Canada, Puerto Rico and Korea. The lifetime rate of social phobia (cases per 100 persons) varies by country, from 2.6 in the United States to 0.5 in Korea. Rates are higher in females than in males in all countries. The age of onset for any phobia is mid-teens to early twenties, and social phobia usually has its first onset before other psychiatric disorders. Only a third or fewer cases of social phobia are uncomplicated by another psychiatric disorder. The presence of social phobia increases the risk of suicide attempts in persons with any other psychiatric disorder. Symptom profiles vary by country. Our data indicate consistent patterns but different cultural expressions of social phobia in the countries studied. The early age of onset of social phobia followed subsequently by another psychiatric disorder raises the possibility that early treatment of social phobia could prevent the onset of other psychiatric disorders.

Adolescent↗
PubMed2006

The prevalence of phobia and its associated factors in a multiracial aging urban population.

OBJECTIVE: There have been few multiracial epidemiologic community-based studies of phobia in older adults. The aim of this study was to determine the prevalence of phobia and associated factors among older persons living in a northeastern urban area. METHODS: Using 1990 census data for Brooklyn, NY, the authors attempted to interview all persons age 55+ in randomly selected block groups. The final sample consisted of 214 whites and 860 blacks. The authors used an adaptation of George's Social Antecedent Model for examining the association of 18 individual variables and one interactive variable with the presence of a phobia. The dependent variable was derived from the Guy's/Age Concern community survey. The sample was weighted by race and gender. To control for design effects, the authors used SUDAAN for the data analysis. RESULTS: A total of 8.9% of the sample met criteria for a current phobia and 10.2% met phobia criteria at some time during their life. Using logistic regression analysis, the authors found six variables-higher personal income, more depressive symptoms, poorer physical health, use of prayer as a coping strategy, use of spiritualists or their products, and not having been raised by both parents-to be significantly associated with a current phobia. CONCLUSION: The prevalence rate of phobia was comparable to rates for older adults in the urban areas of the Epidemiologic Catchment Area study suggesting that prevalence has remained stable over the past two decades. Consistent with earlier studies, there were significant associations among phobia, depressive symptoms, and physical illness. Many of the demographic and social variables, including race, that had been reported previously to be associated with phobias in younger samples were not significant in this study.

Adaptation, Psychological↗
PubMed2003

Specific phobia is a frequent non-motor feature in stiff man syndrome.

OBJECTIVE: To investigate systematically the rate and type of phobia in stiff man syndrome and its variants, and to compare patients with stiff man syndrome with and without phobia for sociodemographic and neurological characteristics. METHODS: 43 consecutive patients with stiff man syndrome referred to a university department of neurology were assessed using the anxiety disorders interview schedule, revised (ADIS-R), a structured diagnostic interview for anxiety disorders, in addition to a full clinical neurological and psychiatric assessment. RESULTS: 19 patients (44.2%) developed task specific phobia--that is, fear and avoidance of situations difficult to master owing to the motor symptoms of stiff man syndrome (such as crossing streets). Three further patients (7%) had subthreshold phobia--that is, phobic anxiety without avoidance. There were no significant differences between patients with and without phobia in terms of age, illness duration, type of stiff man syndrome, antibody status, or frequency of falls. Patients with phobia were more likely to present with exaggerated startle responses and to have an initial misdiagnosis of psychogenic movement disorder. CONCLUSIONS: Specific phobia is a frequent non-motor symptom of stiff man syndrome. Early recognition is an important aid to correct diagnosis. The aetiology of phobia in stiff man syndrome is unknown. There is no evidence of a direct pathogenic role of autoantibodies directed against glutamic acid decarboxylase in the development of phobia.

Adolescent↗
PubMed2001

Risk of heavy drinking and alcohol use disorders in social phobia: a prospective analysis.

OBJECTIVE: The risks of heavy drinking and alcohol abuse/dependence were prospectively assessed among individuals with DSM-III social phobia and individuals with subclinical social phobia (irrational fear of social situations without significant impairment or avoidance). METHOD: The baseline interview for the Baltimore site of the Epidemiologic Catchment Area program was completed in 1981. Between 1993 and 1996 the original cohort was traced. Among the 1,161 individuals who did not have episodes of heavy drinking or current or prior alcohol abuse/dependence at baseline, logistic regression was used to assess the association of social phobia and subclinical social phobia with incident alcohol abuse/dependence and incident episodic heavy drinking. RESULTS: Among the 33 individuals with a DSM-III diagnosis of social phobia at baseline, only one developed heavy drinking by follow-up, and none developed alcohol abuse or dependence. Among the 84 individuals with a history of subclinical social phobia, the cumulative incidence rates of heavy drinking and alcohol abuse/dependence were 119 per 1,000 and 95 per 1,000, respectively. After adjustment for sex, age, race, education level, marital status, age at first alcohol intoxication, and history of other psychiatric or illicit drug use disorder, the estimated relative risk for heavy drinking among respondents with subclinical social phobia was 2.41, and the estimated relative risk for alcohol abuse/dependence was 2.30, relative to respondents without social phobia or subclinical social fears. CONCLUSIONS: The data may improve our understanding of the relationship of social phobia and risk for alcohol conditions, which may have important implications for preventive measures.

Adolescent↗
PubMed2004

Social phobia among university students and its relation to self-esteem and body image.

OBJECTIVE: To demonstrate the prevalence of social phobia and its relation to body image and self-esteem. METHOD: Study participants were 1003 students recruited from Cumhuriyet University as a randomized sample. Subjects were administered the Diagnostic Interview Schedule-III-Revised (DIS-III-R) Social Phobia Scale, the Rosenberg Self-Esteem Scale, and the Multidimensional Body-Self Relations Questionnaire (MBSRQ). We analyzed the data, using Fisher's exact chi-square test. RESULTS: Lifetime prevalence of social phobia among university students was 9.6% and past-year prevalence was 7.9%. Self-esteem was lower (P < 0.05) among those with social phobia than among those without social phobia. Students with social phobia had lower scores on the MBSRQ than did those without social phobia (P < 0.0001). CONCLUSIONS: The results show that persons with social phobia have lower self-esteem and more distorted body image than do those without social phobia.

Adult↗
PubMed1990

Alcohol consumption and pain phobia: toward a unifying theory of alcoholism.

An attempt is made to contribute toward a unifying theory of alcoholism with the concept of "pain phobia" as its central factor. A brief theoretical exposition of pain phobia is offered and results of an empirical study are presented which lend considerable support to the position that pain phobia may be a central factor underlying alcoholism. The research utilizes the Pain Phobia Scale (PPS) as the measure of pain phobia and finds that pain phobia is present to a significantly greater degree in problem drinkers than a norm group and that pain phobia also discriminates non-problem drinkers in the degree of their consumption of alcohol. Suggestions are made for how the concept of pain phobia and the PPS can be useful in the treatment and prevention of alcoholism. The possible relationship between pain phobia and all addictions is also considered.

Adaptation, Psychological↗