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When social anxiety disorder co-exists with risk-prone, approach behavior: Investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication

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Abstract

Little is known about people with social anxiety disorder (SAD) who are not behaviorally inhibited. To advance knowledge on phenomenology, functional impairment, and treatment seeking, we investigated whether engaging in risk-prone behaviors accounts for heterogeneous outcomes in people with SAD. Using the National Comorbidity Survey-Replication (NCS-R) dataset, our analyses focused on people with current (N = 679) or lifetime (N = 1143) SAD diagnoses. Using latent class analysis on NCS-R risk-prone behavior items, results supported two SAD classes: (1) a pattern of behavioral inhibition and risk aversion and (2) an atypical pattern of high anger and aggression, and moderate/high sexual impulsivity and substance use problems. An atypical pattern of risk-prone behaviors was associated with greater functional impairment, less education and income, younger age, and particular psychiatric comorbidities. Results could not be subsumed by the severity, type, or number of social fears, or comorbid anxiety or mood disorders. Conclusions about the nature, course, and treatment of SAD may be compromised by not attending to heterogeneity in behavior patterns.

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... Kashdan and colleagues (2008) suggest that socially anxious adults who engage in aggressive or risky behaviors may be part of a disinhibited subtype of social anxiety . Research has supported this assertion and suggests some important distinctions between traditionally inhibited and disinhibited socially anxious groups (Kashdan, McKnight, Richey, & Hofmann, 2009). Typically, many individuals with social anxiety (59-79%) are classified as behaviorally inhibited, withdrawn, and risk averse. ...
... Within the disinhibited group, socially anxious adults tend to seek out new experiences and engage in higher levels of risky behaviors (e.g., frequent unsafe sexual activity, aggression, substance use). In addition, they have trouble regulating their emotions, greater hostile impulses (Kashdan, McKnight, Richey, & Hofmann, 2009), increased anger, and poorer emotional awareness (Kachin, Newman, & Pincus, 2001;. Further, these individuals are at increased risk for several maladaptive outcomes, including poorer mental and physical health, less education, lower socioeconomic status, earlier onset of social anxiety, higher risk for comorbidities, lower self-reported quality of life, and a lower likelihood of seeking or completing mental health treatment (Kashdan, McKnight, Richey, & Hofmann, 2009). ...
... In addition, they have trouble regulating their emotions, greater hostile impulses (Kashdan, McKnight, Richey, & Hofmann, 2009), increased anger, and poorer emotional awareness (Kachin, Newman, & Pincus, 2001;. Further, these individuals are at increased risk for several maladaptive outcomes, including poorer mental and physical health, less education, lower socioeconomic status, earlier onset of social anxiety, higher risk for comorbidities, lower self-reported quality of life, and a lower likelihood of seeking or completing mental health treatment (Kashdan, McKnight, Richey, & Hofmann, 2009). ...
Article
Social anxiety is linked to more covert forms of aggressive behavior, particularly reactive and relational aggression in early adolescent and young adult samples. Adolescents with social anxiety and those who engage in reactive relational aggression are also more likely to have difficulties regulating emotions (e.g., anger) and show maladaptive cognitive coping styles (e.g., rumination). The goal of the present study was to assess the relationship between social anxiety and reactive relational aggression in adolescents (14-17 years), combining the form and function of aggression, and to examine trait anger and anger rumination as underlying factors that may explain the relationship between social anxiety and reactive relational aggression. The current study hypothesized that adolescents with social anxiety would engage in reactive relational aggression through the use of anger rumination, and this relationship would only be present in adolescents with higher levels of trait anger. High school adolescents in grades 9 to 12 (N=105; Mage = 15.43; 61% female) were recruited through their local school and community to complete a 30-minute, battery of questionnaires examining social anxiety, trait anger, anger rumination, and reactive relational aggression. Adolescents completed questionnaires anonymously via an online survey platform, Qualtrics, and were subsequently compensated for their time. Results supported study hypotheses. Simple regression analyses found that social anxiety was positively related to trait anger, anger rumination and reactive relational aggression. Trait anger and anger rumination were also positively correlated with reactive relational aggression. A conditional process analysis was conducted to test the major study hypothesis. Adolescents with social anxiety were more likely to engage in reactive relational aggression if they ruminated about experiences that created anger, and this relationship was present in adolescents with higher levels of trait anger. Gender differences were also explored. Higher rates of social anxiety and anger rumination were found in females. No other gender differences were found. Overall, socially anxious adolescents showed a greater tendency to engage in reactive relational aggression adding to the current literature. Difficulties regulating negative emotions, like anger, and ineffective cognitive coping strategies, such as anger rumination, were precipitating factors that likely maintained socially anxious and aggressive behaviors.
... High novelty-seeking, which is characterized by dislike of monotony and exploratory endeavors, is highly related to impulsivity (Kashdan & Hofmann, 2008). Studies on subclinical samples of socially anxious-impulsive adults show they have higher levels of risky behaviors such as aggression and drug use compared with adults low on novelty-seeking Kashdan et al., 2009;Lipton, Weeks, Daruwala, & De Los Reyes, 2016). Undergraduates with elevated levels of social anxiety-impulsivity exhibit higher levels of coping-motivated drinking compared to those with low levels of impulsivity (Keough, Badawi, Nitka, O'Connor, & Stewart, 2016). ...
... A growing literature has identified a small and uncharacteristic subgroup of highly socially anxious individuals who are also impulsive among clinical adults (Kashdan & McKnight, 2010;Kashdan et al., 2009;Mörtberg et al., 2014), and subclinical early adolescents (Tillfors, Mörtberg, et al., 2013; as well as adults Nicholls et al., 2014). Using a subclinical longitudinal sample of Swedish early adolescents (N T1 = 2,509, M age = 14.80; 52.6% girls), we expected to identify similar subgroups of social anxiety-impulsivity, including the atypical Anxious-Impulsive subgroup. ...
... According to the results from this study, this would be true for a small subset of adolescents with subclinical social anxiety. Social anxiety paired with impulsivity has indeed previously been linked with engaging in risky externalizing problems such as substance use (Kashdan & Hofmann, 2008), as well as drug use, unsafe sex, and aggression Kashdan et al., 2009) for adults. Anxious-Impulsive girls as well as boys in this study primarily had high levels of internalizing problems (anxiety and depressive symptoms) a year later, however, which could be a sample-or an age-specific effect. ...
Article
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A growing body of research has acknowledged the heterogeneity of subclinical social anxiety, identifying a subgroup of individuals who exhibit high levels of impulsivity. In a sample of Swedish early adolescents ( N = 2,509, M age = 13.64; 52.8% girls), we conducted latent transition analyses (LTA) to identify four classes of subclinical social anxiety-impulsivity across three time points. We identified a Low Social Anxiety-Low Impulsivity class, as well as a High Anxiety-High Impulsivity class for girls and boys, which had high levels of Time-4 internalizing problems. The latter class was less stable but larger for boys. There was also a more typical High Anxiety-Low Impulsivity class for both genders. Nevertheless, Low Anxiety-High Impulsivity girls and boys fared the worst in terms of both internalizing and externalizing problems later on. To our knowledge, this is the first study to adopt an LTA framework to investigate trajectories of early adolescent social anxiety-impulsivity over time.
... Others may become angry as a result of social stressors they encounter (Attwood, 2007;Tantam, 2003). Indeed, social anxiety has been associated with the experience and expression of anger in typically developing adults (Kachin et al., 2001;Kashdan et al., 2009). The perception of rejection from significant others may lead to hostile or aggressive responses (Leary et al., 2006). ...
... Among children with ASD, aggression has been cited as a frequent problem (Farmer and Aman, 2011;McCracken et al., 2002;Storch et al., 2012), and evidence indicates that, similar to neurotypical samples (e.g. Kashdan et al., 2009), social anxiety and facets of aggression co-occur (Farrugia and Hudson, 2006;Green et al., 2000;Meyer et al., 2006). Social anxiety is related to aggressive behavior in children and adolescents with ASD in a curvilinear fashion, such that too much or too little social anxiety predicts more aggression (Pugliese et al., 2013). ...
... A growing body of research indicates that social anxiety is associated with the experience of anger and anger expression in adults without ASD (Kashdan et al., 2009). Rumination is defined as a pattern of responding to distress with perseverative thinking about the causes or consequences related to that distress, at the expense of using problem-solving techniques to improve one's mood (Nolen-Hoeksema and Morrow, 1991). ...
Article
This study (a) examined the role of anger rumination as a mediator of the relation between social anxiety and the experience of anger, hostility, and aggression, in the general population, and (b) evaluated the degree to which the presence of autism spectrum disorder characteristics moderates the indirect influence of anger rumination. We then explored whether social cognition and perseveration characteristic of autism spectrum disorder uniquely accounted for the predicted moderation. In this survey study of young adults (n = 948), anger rumination mediated the relation between social anxiety and hostility, as well as verbal and physical aggression, as predicted. Greater autism spectrum disorder characteristics augmented the effect of social anxiety on hostility and physical aggression by increasing the effect of anger rumination, but not by increasing the effect of social anxiety on anger rumination. Implications for developing treatment approaches that target hostility and aggression among young adults who may not be formally diagnosed but have characteristics of autism spectrum disorder are discussed.
... Moreover, studies have found evidence of qualitatively different SAD subgroups based on Cloninger's temperamental characteristics [22]. By use of cluster or latent class analysis, researchers have identified not only a prototypical SAD subgroup characterized by high harm-avoidance and low novelty seeking, but also an anxious-impulsive subtype scoring high on novelty seeking [36][37][38][39]. While individuals in the former group show behavioral inhibition and risk aversion, individuals in the latter exhibit an atypical pattern of risk-prone approach behaviors while still being highly anxious. ...
... It is not well understood how SAD subgroups compare with these personality types. Presumably, prototypical SAD individuals are overcontrollers but this may not be true for the anxious-impulsive SAD subtype [36][37][38][39]. Anyhow, studies exploring subtypes of SAD by personality inventories are scant and, to our knowledge, no previous study has evaluated potential subtypes of SAD derived from the widely researched Big Five personality dimensions. ...
... All differences remained significant also with healthy controls included in the analyses (Table 4). Differences between clusters at the facet level are listed in S3 Bonferroni post hoc comparisons revealed that all clusters differed significantly from the healthy controls on neuroticism and extraversion, cluster 1 having the most deviant profilesee Fig 2. This cluster was labelled Prototypical, to conform with terminology used in other studies [e.g., [36][37][38][39]. Although cluster 1 and 2 had comparable levels of low extraversion (significant differences were noticed only on assertiveness-E3), cluster 2 had much lower scores of neuroticism. ...
Article
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Social anxiety disorder (SAD) can come in different forms, presenting problems for diagnostic classification. Here, we examined personality traits in a large sample of patients (N = 265) diagnosed with SAD in comparison to healthy controls (N = 164) by use of the Revised NEO Personality Inventory (NEO-PI-R) and Karolinska Scales of Personality (KSP). In addition, we identified subtypes of SAD based on cluster analysis of the NEO-PI-R Big Five personality dimensions. Significant group differences in personality traits between patients and controls were noted on all Big Five dimensions except agreeableness. Group differences were further noted on most lower-order facets of NEO-PI-R, and nearly all KSP variables. A logistic regression analysis showed, however, that only neuroticism and extraversion remained significant independent predictors of patient/control group when controlling for the effects of the other Big Five dimensions. Also, only neuroticism and extraversion yielded large effect sizes when SAD patients were compared to Swedish normative data for the NEO-PI-R. A two-step cluster analysis resulted in three separate clusters labelled Prototypical (33%), Introvert-Conscientious (29%), and Instable-Open (38%) SAD. Individuals in the Prototypical cluster deviated most on the Big Five dimensions and they were at the most severe end in profile analyses of social anxiety, self-rated fear during public speaking, trait anxiety, and anxiety-related KSP variables. While additional studies are needed to determine if personality subtypes in SAD differ in etiological and treatment-related factors, the present results demonstrate considerable personality heterogeneity in socially anxious individuals, further underscoring that SAD is a multidimensional disorder.
... Future research should consider parental anxiety symptoms as mechanisms of influence in the association between adolescent social anxiety and parent-adolescent hostility. Additionally, the link between social anxiety and parent-adolescent hostility may characterize only a subgroup of individuals with social anxiety (Kashdan, McKnight, Richey, & Hofmann, 2009). Thus, the association between adolescent social anxiety and parent-adolescent hostility might depend on levels of adolescent or environmental characteristics such as emotional regulation or social support (Kashdan et al., 2009). ...
... Additionally, the link between social anxiety and parent-adolescent hostility may characterize only a subgroup of individuals with social anxiety (Kashdan, McKnight, Richey, & Hofmann, 2009). Thus, the association between adolescent social anxiety and parent-adolescent hostility might depend on levels of adolescent or environmental characteristics such as emotional regulation or social support (Kashdan et al., 2009). To our knowledge, this is the first study to examine the association between adolescent social anxiety symptoms and dyadic parent-adolescent relationships (i.e., hostility). ...
Article
Early adolescence is characterized by increases in parent-adolescent hostility, yet little is known about what predicts these changes. Utilizing a fairly large sample (N = 416, 51 % girls, 91 % European American), this study examined the conjoint and unique influences of adolescent social anxiety symptoms and parental intrusiveness on changes in parent-adolescent hostility across early adolescence. Higher mother and father intrusiveness were associated with increased mother- and father-adolescent hostility. An examination of reciprocal effects revealed that mother- and father-adolescent hostility predicted increased mother and father intrusiveness. Significant associations were not substantiated for adolescent social anxiety symptoms. These findings suggest that intrusive parenting has important implications for subsequent parent-adolescent interactions and that similar patterns may characterize some aspects of mother- and father-adolescent relationships.
... Despite prototypical patterns of avoidance and withdrawal, some individuals with social interaction anxiety are more likely to engage in risky behaviors, including health-risk sexual behavior (HRSB; Kashdan et al. 2011a;Kashdan and Hofmann 2008;Rahm-Knigge et al. 2018). Previous studies have found two subgroups of social interaction anxiety, with one group engaging in risky behaviors and the other avoiding (Kashdan and Hofmann 2008;Kashdan et al. 2009). Distinguishing between the risk-approach and risk-avoidant subgroups is clinically important. ...
... People with social interaction anxiety are likelier to feel distressed regarding emotional experiences, avoid or suppress emotions, avoid emotion expression, and express negative emotions more than positive emotions (Spokas et al. 2009;Turk et al. 2005). Emotional difficulties relate to challenges with regulating impulsivity and engagement in potentially harmful behaviors, including HRSB (Kashdan et al. 2009;Kashdan and Hofmann 2008;Kashdan and McKnight 2010). Regarding sexual satisfaction, difficulties with emotions among men are associated with increased solitary sexual behavior and decreased partnered sexual behavior, perhaps to distract from negative emotions (Dosch et al. 2016). ...
Article
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Social anxiety disorder is prevalent and negatively impacts adolescents and young adults. People with social interaction anxiety, a presentation category of social anxiety disorder pertaining to social relationships, tend to be more withdrawn, avoidant, and sexually dissatisfied. Some individuals with social interaction anxiety are more likely to engage in health-risk sexual behavior (HRSB), likely associated with individual differences. The present study used finite mixture modeling to discern profiles comprised of social interaction anxiety and individual differences previously associated with HRSB, replicating and extending previous findings (Rahm-Knigge et al. 2018). We also examined differences in sexual satisfaction among profiles. We replicated identifying two profiles high in social interaction anxiety that substantively differed in response to positive and negative emotions, emotion-regulation strategies, risk seeking, and non-acceptance of emotions. The profile high in social interaction anxiety and these individual differences was likelier to engage in HRSB than the other high social anxiety profile. Both high social interaction anxiety profiles were similarly low in sexual satisfaction. Despite differences in individual differences and engagement in HRSB, profiles high in social interaction anxiety reported similarly lower sexual satisfaction than the profiles low in social interaction anxiety.
... Social anxiety almost exclusively first manifests in individuals younger than 25, with onset generally in late childhood or early adolescence [30]. Like depression, social anxiety is associated with risk averse behaviour in experimental tasks [17,[31][32][33][34], though a growing body of evidence suggests a subset of socially anxious individuals develop risk prone behaviours to increase acceptance from others [35][36][37][38]. Differences in one's developmental status or competence may present as social and emotional immaturity [39]. ...
... Young people spend a substantial amount of time with their peers and a growing body of evidence suggests susceptibility to their influence, being it overt or just their mere presence [3,15,16,77]. Besides taking more risks to increase acceptance from peers, meet expectations or achieve status [35][36][37][38], it needs to be acknowledged that those who are more anxious in social situations often tend to be more risk avoidant and report to take fewer risks than their less socially anxious counterparts in experimental settings or self-report research. The latter was predicted and observed in the current study; socially anxious symptoms were associated with a decrease in risk-taking behaviour. ...
Article
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Risk-taking behaviour and onset of mental illness peak in adolescence and young adulthood. This study evaluated the interconnectedness of the domains of risk-taking behaviour, mental health (symptoms of depression and social anxiety), psychosocial maturity, risk perception, age, and gender in a sample of 306 adolescents and young adults. Participants between the ages of 16 and 35 completed online self-report measures assessing risk-taking behaviour, depressive symptoms, socially anxious symptoms, psychosocial maturity and risk perception. Socially anxious symptoms, psychosocial maturity, and risk perception were directly associated with risk-taking behaviour. Correlations between depressive symptoms, socially anxious symptoms, and psychosocial maturity were found. Psychosocial maturity proved a better predictor of risk-taking behaviour than age in this cohort. The findings indicate that mental health impacts upon risk-taking behaviour and that consideration should be given to psychosocial maturity in attempts to reduce adolescent and young adult risk-taking behaviour.
... However, there is reason to expect heterogeneity in the self-regulatory strategies used to cope with potential rejection. At least a subset of individuals with social anxiety difficulties use qualitatively different strategies that are best described as risk-prone, approach behavior (Kashdan, Collins, & Elhai, 2006;Kashdan, Elhai, & Breen, 2008;Kashdan & Hofmann, 2008;Kashdan, McKnight, Richey, & Hofmann, 2009). For instance, an individual with social anxiety difficulties might find amusement by mocking someone else to win the favor of a crowd and have fun. ...
... This can manifest as rumination and difficulties handling physiological arousal (Luminet, Rime, Bagby, & Taylor, 2004). Instead of psychological flexibility, individuals with social anxiety difficulties might be more prone to responding to problematic situations with reflexive, self-protective responses such as aggression, avoidance, or excessive alcohol use-all of which aim to downregulate negative emotions and up-regulate short-lived positive experiences (e.g., Kashdan & McKnight, 2010;Kashdan, McKnight, et al., 2009). ...
Article
When there is an opportunity to engage in an activity that can generate positive experiences, people with emotional disturbances might be expected to be less successful than other people. Despite the appeal of this formulation, there is reason to believe that attenuated positive experiences are only relevant to a selective number of disturbances. This chapter discusses recent advances in the phenomenology of social anxiety. This includes data showing that social anxiety is associated with low intensity, short-lived positive experiences, infrequent positive events, and distinct cognitive biases that restrict the quality of life. For decades, psychologists have advocated a single, bipolar continuum with positive emotions and approach behavior at one endpoint, and negative emotions and avoidance behavior as the other endpoint. However, recent research in personality, motivation, and social neuroscience suggests that there are two separate biobehavioral systems that reflect very different purposes. Specifically, on the one hand, there is an avoidance system whose purpose is to prevent people from being exposed to danger. To meet this aim, behavior that might lead to pain, punishment, or other undesirable outcomes is inhibited. On the other hand, independent from the avoidance system, there is an approach system whose purpose is to guide people toward situations that might offer rewards. To meet this aim, attention and energy are mobilized to pursue activities that can generate resources such as food, the cooperation of others, sexual partners, and knowledge that provides an evolutionary advantage for survival and reproduction.
... Our group (Adams et al., 2019;Keough et al., 2016) and others (Kashdan et al., 2009) have examined trait impulsivity as a central moderator of the effects of SA on risk for problem drinking. As noted above, SA is a mixed (and often weak) standalone predictor of alcohol use outcomes in emerging adults. ...
... After engaging in the Trier Social Stress Test, socially anxious participants reported elevated alcohol cravings, but only when they were concurrently high in trait impulsivity. Finally, subtyping work from Kashdan and Hofmann (2008) and Kashdan et al. (2009) demonstrates that there are two general types of socially anxious people. One subtype is characterized by high levels of inhibition, social avoidance, and low levels of engagement in risky behaviours. ...
Article
Aims Alcohol use follows a developmental trajectory—steadily increasing and peaking in the early stages of emerging adulthood (e.g. first year of university) and declining thereafter. While most individuals ‘mature out’ of problem drinking as they move through emerging adulthood, some continue to drink heavily and experience serious problems. Tension reduction theory identifies social anxiety (SA) as a potential risk factor for problem drinking during emerging adulthood. However, mixed data suggest that the associations between SA and drinking behaviours are not straightforward. Cross-sectional studies demonstrate that socially anxious emerging adults are at risk for problem drinking, but only if they are also high in trait impulsivity. This study aimed to expand on previous work by examining trait impulsivity as moderator of the prospective associations between SA and maturing out of problem drinking in emerging adulthood. Methods Undergraduates (N = 302) completed online self-reports at regular intervals (6-months) over an 18-month period, resulting in four waves of data. Results Unconditional latent growth curve models indicated that alcohol problems (but not use) declined linearly over time. Next, conditional growth curve models revealed that SA was associated with impeded maturing out of alcohol problems, but this effect was only present in socially anxious participants with high levels of trait impulsivity. Conclusion Our study advances growing literature on the crucial moderating role that impulsivity plays in the SA pathway to problem drinking. Clinical interventions for problem drinking among socially anxious students should both assess for and target concurrent impulsivity.
... 7-020-01543 -2) contains supplementary material, which is available to authorized users. anxiety disorder exhibits externalizing behaviour, including outwardly directed anger expression [3,4], especially in response to criticism or negative evaluation (angry reaction) and without provocation (angry temperament) [5]. The elevated level of anger is an important clinical indicator of psychopathological symptoms' severity, as it is associated with worse impairment, including problematic substance use [4], greater risk for suicide [6] and higher incidence of depression [7]. ...
... anxiety disorder exhibits externalizing behaviour, including outwardly directed anger expression [3,4], especially in response to criticism or negative evaluation (angry reaction) and without provocation (angry temperament) [5]. The elevated level of anger is an important clinical indicator of psychopathological symptoms' severity, as it is associated with worse impairment, including problematic substance use [4], greater risk for suicide [6] and higher incidence of depression [7]. ...
Article
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Higher levels of anger expression, as well as lower levels of anger control, have been reported for adults with anxiety disorders compared to individuals without anxiety disorders. Different to the research on adults, very few studies examined the relationship between anxiety and anger in childhood. In our study, we investigated 398 Italian twin pairs (74 MZ male, 70 MZ female, 134 same-sex dizygotic-53 male, 81 female-, and 120 unlike-sex dizygotic twin pairs), aged 8–17 (mean 13.06 ± 2.59): (i) the heritability of a childhood anger phenotype; (ii) the association between five anxiety domains and anger; (iii) the role of possible common etiological factors in explaining the observed comorbidity and overlap in the risk between anxiety phenotypes and anger. The study demonstrated that anger, assessed by CBCL items, is heritable in children at a similar rate to prior studies (40%). Our research found low to moderate rate of correlation between anger and anxiety (from 0.10 to 0.19). Finally, the present study found that the majority of etiological influences on anxiety and anger are independent of each other. Data showed that shared environmental influences have some small effects on the phenotypic covariation between the anxiety phenotypes and anger (12%); whereas unique environmental influences have an almost negligible effect (1%). Our analyses did not reveal the effect of genetic effects in explaining the covariation between these phenotypes.
... First, although the prototypical person with SAD is characterized by avoidance and inhibited behavior, emerging research suggests that not all people with SAD engage in avoidance to manage their anxiety (Kachin, Newman, & Pincus, 2001;Kashdan, Elhai, & Breen, 2008;Kashdan & Hofmann, 2008). At least a subset of individuals with SAD, with some estimates as high as approximately 1 in 5, engage in approach-oriented behavior (Kashdan, McKnight, Richey, & Hofmann, 2009). Rather than avoid social situations, people in this subgroup may approach them with aggression or impulsivity. ...
Article
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People with anxiety disorders tend to make decisions on the basis of avoiding threat rather than obtaining rewards. Despite a robust literature examining approach-avoidance motivation, less is known about goal pursuit. The present study examined the content, motives, consequences, and daily correlates of strivings among adults diagnosed with social anxiety disorder and healthy controls. Participants generated six strivings along with the motives and consequences of their pursuit. Compared with controls, people with social anxiety disorder were less strongly driven by autonomous motives and reported greater difficulty pursuing strivings. Coders analyzed strivings for the presence of 10 themes: achievement, affiliation, avoidance, emotion regulation, generativity, interpersonal, intimacy, power, self-presentation, and self-sufficiency. People with social anxiety disorder constructed more emotion regulation strivings than did controls, but they did not differ across other themes. This research illustrates how studying personality at different levels of analysis (traits, strivings) can yield novel information for understanding anxiety disorders.
... There are also social costs that may be particularly relevant to social anxiety (e.g., acting aggressively towards someone). At least a subset of individuals with SAD deviate from the prototypical avoidance orientation and are characterized by risky, disinhibited behavior (Kashdan & McKnight, 2010;Kashdan, McKnight, Richey, & Hofmann, 2009;Nicholls, Staiger, Williams, Richardson, & Kambouropoulos, 2014). More research is needed to determine thresholds at which alcohol use becomes problematic and identify relevant individual differences that increase susceptibility to risky drinking behavior among individuals high in social anxiety. ...
Article
Most research on the link between social anxiety and alcohol consumption has examined problematic outcomes without consideration of potential adaptive functions. Alcohol is an anxiolytic that has the short-term benefit of reducing anxiety; consumption may act as a social lubricant that facilitates higher quality social interactions. Using experience-sampling methodology, we examined how consuming alcohol attenuates the adverse effects of social anxiety in naturally occurring social interactions. Participants (N = 160) completed demographic and trait measures, then completed daily assessments for 14 consecutive days. Results from multilevel model analyses revealed that during face-to-face social interactions, state social anxiety was inversely related to 10 indicators of healthy social interactions (e.g., enjoyment, laughter, feelings of acceptance). Alcohol consumption moderated seven of these associations, such that when participants consumed alcohol in social situations, state social anxiety was no longer associated with social interaction quality. The quantity of alcoholic drinks consumed moderated two of these associations. Furthermore, we found evidence for directionality, such that social anxiety in a given social interaction predicted alcohol consumption in a subsequent social interaction, but not the reverse (i.e., alcohol consumption did not prospectively predict state social anxiety). In social situations that involved alcohol, experiences of social anxiety no longer thwarted one's ability to derive social benefits. These results should be interpreted in the context of a participant sample with relatively low levels of trait social anxiety and frequency of alcohol use. Nonetheless, obtaining social rewards may be a reinforcement mechanism that maintains the link between social anxiety and alcohol consumption.
... In the co-occurring perspective, social anxiety may co-occur with antisocial behavior or delinquency without any buffering or protective benefits, not only in clinical samples (e.g., Galbraith et al., 2014;Goodwin & Hamilton, 2003;Kashdan, McKnight, Richey & Hofmann, 2009;Marmorstein, 2007;Sareen, Stein, Cox, Hassard, 2004) but also in community samples (Tillfors, El-Khouri, Stein & Trost, 2009). Instead, co-occurrence has been related to more impairment and distress than either social anxiety or antisocial behavior alone (Galbraith et al., 2014;Goodwin & Hamilton, 2003). ...
Article
Background and objectives: Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and delinquency in adolescence and the interplay between adolescent social anxiety and delinquency on perceived relationship quality in emerging adulthood. Design and methods: In a 10-year long prospective study (T1 n = 923; T2 n = 727; Mage T1 = 12; 49% female), we examined competing hypotheses using regression analyses: the protective perspective, which suggests social anxiety protects against delinquency; and the co-occurring perspective, which suggests social anxiety and delinquency co-occur leading to increased negative interpersonal outcomes. Results: In adolescence, the relation between social anxiety and delinquency was consistent with the protective perspective. In emerging adulthood, consistent with the co-occurring perspective, ever-delinquents (but not delinquency abstainers) with higher social anxiety reported less perceived best friend, mother, and father support compared to delinquents with lower social anxiety. There was no interaction between anxiety and delinquency in predicting perceived conflict. Conclusion: This study highlights the importance of examining the relation between social anxiety and delinquency with regards to different interpersonal outcomes.
... The results of this study contribute to the literature on the relation of social anxiety to aggression and impulsivity (Kashdan et al., 2009;Nicholls et al., 2014), suggesting that some individuals with elevated social anxiety may struggle to manage urges to engage in impulsive behaviors in the context of intense anxiety or other forms of distress, increasing the likelihood of aggression in the form of anger, hostility, and verbal and physical aggression. Although no other studies have examined the relevance of this particular emotion regulation dimension to SOCIAL ANXIETY AND AGGRESSION 13 aggression among individuals with social anxiety, impulsivity more broadly has been linked to a variety of negative outcomes within this population, including risk-taking, interpersonal problems, risky sexual behaviors, psychological inflexibility, and co-occurring substance use problems (Kashdan & McKnight, 2010;Nicholls et al., 2014). ...
Article
Objectives: To enhance our understanding of the factors that may account for increased aggression in socially anxious individuals, this study examined associations among emotion-driven impulse control difficulties, social anxiety, and dimensions of aggression (i.e., hostility, anger, physical aggression, verbal aggression). Method: Individuals (N = 107; 73.8% male; Mage = 40.8 years) receiving residential substance abuse treatment participated in this cross-sectional study. Results: Social anxiety symptoms were significantly positively correlated with emotion-driven impulse control difficulties, anger, and hostility, but not verbal or physical aggression. Separate models for each aggression facet were examined to test the direct and indirect paths. Bootstrapped mediation analyses indicated a significant indirect path from social anxiety symptoms to each facet of aggression through emotion-driven impulse control difficulties (ps < .05). Conclusions: Results highlight the potential utility of targeting emotion-driven impulse control difficulties to decrease aggression among socially anxious individuals.
... The pathology of antisocial personality disorder is suggestive of behaviors such as deceit, irresponsibility, unreliability, and inability to feel love or guilt, all of which are damaging to children's emotional, cognitive, and social development (Torry and Billick, 2011). A family history of antisocial personality disorder is one of the strongest predictors of antisocial behavior and antisocial personality disorder is increasingly recognized to co-occur with SAD (Galbraith et al., 2014;Kashdan et al., 2009). In addition to the individual contributions of familial risk factors to the development of mental health problems such as SAD, there may be an accumulation of risks since parents with mental health conditions who pass on the susceptibility genes are also more likely to be parents with poor parenting styles that may promote the development of SAD (Knappe et al., 2010). ...
Article
Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6±8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.
... Hostile impulses have been included among known risk-prone activities for social anxiety disorder in response to impulsive decision-making [16]. Impulsivity has been linked to 2 different classes of social anxiety disorder, one of which is associated with higher levels of anger, aggression, sexual impulsivity and substance abuse [17] [18]. ...
Article
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Abstract Evidence is growing that aggressive behavior and impulsivity have subgroups. The subscales of the Urgency, Premeditation, Perseverance and Sensation seeking (UPPS) impulsivity scale and the Bryant and Smith shortened and refined version of the Aggression Questionnaire were used to describe and compare impulsive and aggressive behavior in extremely violent and aggressive male inmates and non-violent healthy male controls. The Mann-Whitney test showed that there was a significant difference (p < 0. 006) in the total UPPS impulsivity scale scores between the aggressive inmates and the controls. The subscales revealed that this difference was based mainly on the urgency score (p < 0. 003). On the aggression subscales, the inmates scored significantly higher for physical aggression than the controls (p < 0.001), but no significant difference was seen between inmates and controls for verbal aggression, anger and hostility, although the exact pvalue was very close to statistical significance at 0.054. Regression analysis revealed a strong relationship between urgency and the aggression subscales hostility (p = 0.0004) and anger (p = 0.003) and that urgency was also linked to symptoms of anxiety (p = 0.008). Finally, a statistically significant link was found between both hostility (p = 0.0003) and anger (p = 0.002) and symptoms of anxiety. The highly selected subgroup of extremely violent criminals in this study were more physically aggressive than non-violent controls, with urgency as the driving feature in their impulsive behavior, and hostility, anger and symptoms of anxiety as underlying traits.
... A review has pointed out that there are several explanation mechanisms for the link between impulsiveness and anxiety [42]. As indicated in this review, some previous research has found significant associations between impulsiveness and anxiety disorders [43,44]. Hence, there is a high comorbidity between anxiety and impulse control disorders [45]. ...
Article
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It has been demonstrated that athletes in competitive sports suffer from high levels of competitive anxiety, especially in the case of females. In this sense, it is necessary to identify possible risk and protective factors of those athletes in this collective who suffer from this type of anxiety. However, few studies analyze the relationship between Physical Activity (PA) and anxiety, identifying the possible mediation effect of trait variables such as impulsivity and mindfulness in female athletes. Hence, the aims of this study were: to determine differences between PA levels with anxiety, mindfulness, and impulsiveness; to identify the predictive value of sociodemographic factors and physical activity, impulsivity, and mindfulness on anxiety factors; and to analyze the possible mediating effects of mindfulness on the relationship between impulsivity and anxiety. A total of 242 female athletes underwent an assessment of physical activity, anxiety, mindfulness traits, and impulsivity using validated questionnaires. Data were analyzed according to (1) individual or collective sport, and (2) PA levels according to energy expended (METs min/day). Participants were grouped by light, moderate, and vigorous PA levels. There were 30.5% elite athletes and 73.2% collective sports athletes. Mean age was 22.1 years and mean light, moderate, and vigorous PA were 86.1 ± 136.2, 114.4 ± 159.8, and 370.1 ± 336.3 METs min/day, respectively. Those athletes performing vigorous PA exhibited lower levels of impulsiveness and higher mindfulness traits. As expected, the mindfulness trait was a mediating factor in the relationship between impulsiveness and each factor of competitive anxiety (cognitive, somatic, and self-efficacy). Female athletes could suffer competitive anxiety, especially those who present higher levels of impulsivity. However, higher levels of mindfulness traits seem to be a protective factor in the effects of impulsivity on anxiety in this population and have demonstrated to be significant mediators in this association. Further studies are needed with other female athletes to replicate these results and to determine the specific protective mechanisms of mindfulness traits in preventing competitive anxiety.
... Recently, it has been argued by several authors that impulsivity plays a central role in distress-related drinking. 26,[53][54][55][56] Inherent in this perspective is the notion that concurrently elevated impulsivity is needed to clarify why some anxiety-prone individuals -who are by nature indecisive, inhibited, and focused on threat (eg, the negative outcomes of drinking) -approach alcohol for coping-related purposes. Our study moves this literature forward by suggesting that the stressful and uncertain transition out of university is a particularly relevant context for impulsivity and anxiety to interact to promote continued alcohol use risk. ...
Article
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Reinforcement Sensitivity Theory predicts that those with a strong behavioral inhibition system (BIS) likely experience considerable anxiety and uncertainty during the transition out of university. Accordingly, they may continue to drink heavily to cope during this time (a period associated with normative reductions in heavy drinking), but only if they also have a strong behavioral approach system (BAS) to enhance the anxiolytic effects of drinking. The purpose of this study was to test this hypothesis. Participants completed online measures prior to and at 3-month intervals over the course of the year following graduation. As hypothesized, results showed that an elevated BIS predicted impeded maturing out, but only when the impulsivity facet of BAS was also elevated. In contrast, a strong BIS predicted rapid maturing out if BAS impulsivity was weak. Study findings advance our understanding of BIS-related alcohol misuse trajectories in young adulthood and provide direction for clinical interventions.
... However, these same behaviors appear to detract from quality of life in the longer term, perhaps by not helping develop enduring sources of pleasure like social relationships (Kashdan, McKnight, Richey, & Hofmann, 2009;Kashdan & McKnight, 2010). It is worth noting that research has yet to clarify whether these impulsive approach behaviors are a distinctive atypical pattern of social anxiety or if they occur in people who are severely depleted in self-regulatory resources due to biological predispositions or severity of emotion regulation or attention control impairments discussed earlier in this chapter. ...
Chapter
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The primary purpose of this chapter is to review neglected, under-appreciated elements of positivity that are relevant to the phenomenology and treatment of social anxiety disorder (SAD), and distinguish SAD from other emotional disorders. We present theory and research on infrequent positive events, attenuated positive experiences, impaired attention to positive stimuli, atypical reactions to overtly positive social situations, and a meaningful subset of individuals who show signs of impulsive, short-lived positive events. Methodological advances are introduced along with new avenues for enhancing positive experiences, positive events, and a sense of meaning and purpose in life in individuals with social anxiety difficulties. Taken together, this chapter broadens theory, research, and treatment efforts to encapsulate the positive spectrum of human functioning.
... Despite prior evidence that the proposed risky-impulsive SA subtype has an increased propensity for engaging in substance use (e.g., see Kashdan and Hofmann 2008), and the high comorbidity rate between substance use disorders and ADHD (Kessler et al. 2005b), we know of only one study to date that has examined the potential role of ADHD diagnosis in this SA subtype (Kashdan et al. 2009). The sample in this previous study included a wide and varied age range, and thus it is unclear whether the relations between the risky-impulsive SA subtype and ADHD symptoms would generalize to emerging adults, a key developmental period at risk for substance use and risk-taking behavior. ...
Article
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Prior work indicates the presence of a subtype of Social Anxiety (SA) characterized by disinhibition or high externalizing behaviors such as substance use and Attention Deficit Hyperactivity Disorder (ADHD) symptoms. A sample of 375 undergraduates completed an online study including measures of SA, substance use, ADHD symptoms and impulsivity. Latent class analyses revealed three classes of individuals who evidenced: (a) low SA and low impulsivity, (b) high SA and low impulsivity, and (c) high SA and high impulsivity. Individuals high in both SA and impulsivity evidenced greater likelihoods of exhibiting externalizing behavior, relative to the two other classes. Post-hoc analyses revealed the largest and most significant differences between classes were seen with regard to ADHD. This finding extends previous work by replicating distinct profiles of SA and impulsivity, and highlighting that how these profiles relate to externalizing behaviors may depend on the externalizing domain.
... The latter is exactly what we have shown in one study where we investigated what consequences social anxiety has for adolescents' external adjustment (Tillfors et al., 2013b). We identified different subgroups of socially anxious adolescents-those who were behaviorally inhibited, which is how we typically think about socially anxious individuals, and those who were impulsive, which is an atypical combination recently identified among adults (Kashdan et al., 2009). Our study was the first to identify a socially anxious-impulsive subgroup of adolescents, and to show that boys in this subgroup had high levels of both intoxication frequency and delinquency (Tillfors et al., 2013b). ...
Article
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Early adolescence poses many challenges for young people, and it is during this phase that social anxiety disorder (SAD) tends to develop. Research indicates that adolescents have a relatively immature neurobiological brake-system (based in the prefrontal cortex) in relation to a more matured alarm- or gas-system (based in the subcortical regions) compared to adults. For this reason, adolescents are more sensitive for developing vicious circles of dysfunctional emotion regulation strategies like avoidance of frightening situations, worry, and rumination as well as sleep disturbances compared to adults—all of which are factors that may contribute to the development of SAD. In this chapter, we explore the genetic, neurobiological, cognitive, behavioral, and social explanations as to why some adolescents are more vulnerable for developing SAD than others. We propose a theoretical model, based on a neurobiological model proposed by Sommerville and colleagues (Brain Cogn 72(1):124–133, 2010), where early development of the subcortical regions in combination with late development of the prefrontal cortical regions is expected to predict an increase in emotionally driven behavior as well as difficulties to control them during adolescence. According to our model, we hypothesize that adolescents with poor peer and parent relationships will have a larger developmental gap between these regions compared to adolescents with supportive peer and parent relationships. Finally, we discuss how including mothers, fathers, and peers in the study of social anxiety, and taking into account both emotion regulation and sleep patterns, may be an important next step in the understanding of who may be at risk for developing social anxiety and why.
... IMP is also associated with decreased tolerance for negative emotions and increased risky behavior when emotionally distressed (Zuckerman and Kuhlman, 2000). There is some evidence pointing to a sub-group of socially anxious individuals who are behaviorally disinhibited or impulsive (Kashdan et al., 2009). This sub-group has been linked with increased risky behaviors and substance use disorder co-morbidity (Nicholls et al., 2014). ...
Article
According to theory, those high in social anxiety (SA) are at risk for drinking alcohol for coping and conformity motives, which in turn lead to alcohol use and related problems. Empirical tests of this risk pathway in non-clinical samples have produced mixed results. Although those high on SA may drink to cope with anxiety and to reduce the likelihood of social rejection, they may also avoid drinking for fear of embarrassing themselves when intoxicated. Central to alcohol use by those high in SA is a temporary disregard of alcohol's potentially negative consequences. Accordingly, we hypothesized that SA would positively predict alcohol use and problems, but only at high levels of impulsivity (IMP). We expected these interactive effects to be mediated by coping and conformity motives. Undergraduates (N = 461) completed self-reports. Partially supporting hypotheses, IMP moderated the association between SA and alcohol-related problems (but not use), such that SA predicted problems only at high IMP. This interactive effect was mediated by coping (but not conformity) motives, such that SA positively predicted coping motives (especially at high IMP), which in turn predicted problems. Results suggest that IMP and coping motives clarify SA-related drinking. Clinical interventions may consider targeting IMP.
... Anxiety researchers and clinicians should be aware that a subtype of anxious individuals with heightened anger expression is common in the general population. [9,16,32] For those with anxiety disorders, anger and aggression may be a means to avoid feared stimuli; an anxious individual may express extreme or out-of-proportion anger in order to disengage with the stimulus. [33] Further, anxiety-disordered individuals may have difficulty in expressing negative emotional states, which may lead to heightened physiological arousal [12] that can result in intense displays of anger and aggression. ...
Article
Background: Evidence suggests that impulsive aggression and explosive anger are common among individuals with anxiety disorders; yet, the influence of intermittent explosive disorder (IED) on the onset, course, consequences, and patterns of comorbidity among those with anxiety disorders is unknown. Methods: Data were drawn from the National Comorbidity Survey Replication (N = 9,282) and Adolescent Supplement (N = 9,632), nationally representative surveys conducted between 2001 and 2004. Diagnoses were based on structured lay-administered interviews. Lifetime diagnoses were assessed with structured instruments. Outcomes included comorbidity, functional and role impairment, and treatment utilization. Results: Adolescents with a lifetime anxiety disorder had a higher prevalence of a lifetime anger attacks (68.5%) and IED (22.9%) than adolescents without a lifetime anxiety disorder (48.6 and 7.8%, respectively), especially social phobia and panic disorders. Similar elevation was found for adults. Age of onset and course of anxiety disorders did not differ by IED. Severe functional impairment associated with anxiety was higher among adolescents (39.3%) and adults (45.7%) with IED than those without IED (29.2 and 28.2%, respectively). Comorbidity for all other disorders was elevated. However, individuals with anxiety disorders and IED were no more likely to use treatment services than those with anxiety disorders without IED. Conclusions: Individuals with IED concomitant to anxiety disorder, especially social phobia and panic, are at marked risk for worse functional impairment and a higher burden of comorbidity, but onset and course of anxiety disorder do not differ, and those with anxiety and IED are no more likely to utilize treatment services. Assessment, identification, and specialized treatment of anger in the context of anxiety disorders are critical to reducing burden.
... (2011) the state and trait of impulsivity are higher in patients with anxiety disorders than in healthy control. High levels of impulsivity in patients with anxiety disorders comparing to healthy controls were also observed by other authors (del Carlo 1998, Kashdan 2008, Kashdan 2009). Also patients with panic disorder, social anxiety disorder, obsessive-compulsive disorders reported higher scores than healthy controls in total impulsiveness and cognitive dimension comparing to healthy controls (Summerfeldt 2004). ...
Article
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BACKGROUND: Anxiety symptoms and disorders are common. High comorbidity between anxiety and other psychiatric disorders has been observed in community. Still, the relationship between impulsivity and anxiety disorders is controversial and not well explored.
... Research has accumulated over the past years indicating that anxiety disorders bring with them a unique risk of suicide (Bolton et al., 2008;Sareen et al., 2005;Weissman et al., 1989). Growing evidence indicates that the coexistence of cyclothymia and/or cyclothymic temperament identifies a subgroup of patients suffering from anxiety disorders with an atypical pattern of anger and aggression, high novelty-seeking, risk-prone, impulsive and suicidal behaviors (Kashdan and Hofmann, 2008;Kashdan et al., 2009;Perugi et al., 2011). ...
Article
Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities. Copyright © 2015 Elsevier B.V. All rights reserved.
... Two studies found that anxiety disorder patients with prominent mood instability, but not those without mood instability, scored higher than healthy controls on a measure of lack of premeditation impulsivity (Del Carlo et al., 2013;Perugi et al., 2011). There also appears to be a subset of patients with social anxiety disorder characterized by increased levels of impulsivity, risky behaviors, and mood instability, in contrast to the remainder who tend to be risk-averse, are more behaviorally inhibited, and have less mood instability (Kashdan, McKnight, Richey, & Hofmann, 2009). A recent study also found that individuals with any one of five disorders (generalized anxiety disorder, social phobia, panic disorder, agoraphobia, and obsessive-compulsive disorder) were more likely to report trait impulsivity compared to a large general population sample, although these relationships became nonsignificant after controlling for mood instability (Peters, Bowen, & Balbuena, 2018). ...
Article
This article presents the results of 2 studies that investigated mood instability in the Eysenck neuroticism scales and its relationship to trait impulsivity and risk taking. In Study 1 we examined the relationship between a mood instability factor in the Eysenck Personality Inventory and impulsivity (i.e., rapid unplanned behavior) in a general population sample of 6,066 adults. The mood instability factor was positively correlated with impulsivity. The remaining factors, largely reflecting trait anxiety, were also positively correlated with impulsivity, although these correlations disappeared when mood instability was included in the same regression model. In Study 2 we factor analyzed the short form of the revised Eysenck Personality Questionnaire to isolate mood instability and trait anxiety factors and explore their associations with risk taking in a general population sample of 394,170 adults 40 to 69 years old. The mood instability factor was positively associated with risk taking, whereas the association for the trait anxiety factor was negative. Taken together, the results suggest that mood instability and trait anxiety are separable components of Eysenckian neuroticism and that mood instability is the main component that is positively associated with trait impulsivity and risk taking. Further research is needed to clarify the factor structure of Eysenckian neuroticism.
... Using latent class analysis, Versella et al. (2016) identified four distinct anger profiles among individuals with SAD, and, of those, the profile characterized by high trait anger, anger suppression (i.e., the experience of angry feelings without expressing them; Spielberger, 1999;Swee et al., 2018), and anger expression (i.e., the outward expression of angry feelings toward people or objects in the environment; Spielberger, 1999;Conger et al., 2003) experienced the highest levels of social anxiety, distress, and impairment. As well, Kashdan et al. (2009) differentiated between typical (i.e., behavioral inhibition and risk aversion) and atypical (i.e., heightened levels of anger, aggressiveness, sexual impulsivity, and substance use issues) SAD profiles. Compared with the typical SAD profile, the atypical SAD profile was associated with greater functional impairment, lower levels of education and income, younger age, and greater levels of psychiatric comorbidity. ...
Article
Background : Cognitive-behavioral therapy and mindfulness-based stress reduction (MBSR) are two prominent evidence-based treatments for social anxiety disorder (SAD). It is not clear, however, whether outcomes of these two treatments are moderated by similar factors. For example, whereas anger suppression and anger expression each predict outcomes in cognitive- behavioral group therapy (CBGT), it is unknown whether they differentially influence outcomes in CBGT versus MBSR. Methods : One hundred eight participants with SAD were randomized to CBGT, MBSR or Waitlist (WL). WL participants were later randomized to CBGT or MBSR, and their data were combined with data from those originally randomized to CBGT or MBSR. Anger suppression and anger expression were assessed at pre-treatment, and social anxiety was assessed at pre-treatment, post-treatment, and every 3 months throughout a 12-month follow-up period. Results : From pre- to post-treatment, higher anger suppression was associated with significantly greater reduction in social anxiety in CBGT compared with MBSR. From post-treatment through follow-up, higher anger expression was associated lesser reduction in social anxiety in MBSR but not in CBGT. Limitations : Data are limited by sole reliance on self-report and it is unclear whether these findings generalize beyond group-based interventions. Conclusions : Individuals with SAD who are higher in anger suppression and/or expression might be better suited to CBGT than MBSR.
... The authors also found that the clinician-rated severity of comorbid SUDs was greater in the high novelty seeking group. These results have been validated in a larger sample by Kashdan and colleagues, who investigated impulsive behaviours among individuals with a current (n = 679) or lifetime (n = 1143) diagnosis of SAD [67]. Seventy-nine percent of their sample showed a prototypical pattern of risk aversion and behavioural inhibition, while 21% showed an atypical pattern of risk-prone and impulsive behaviours including elevated anger, aggression, sexual impulsivity, and substance use problems. ...
Article
Anxiety disorders and substance use disorders (SUDs) frequently co-occur, and individuals with this comorbidity demonstrate exacerbated impairment and poorer treatment outcomes compared to individuals with only one of the disorders. This paper reviews the potential mechanisms underlying this comorbidity, with a particular focus on the influence of impulsivity. There is an atypical subset of individuals with anxiety disorders that display elevated impulsivity, and it is suggested that these individuals account for the clinically relevant group of anxiety disorder patients that have a concurrent SUD. Patients with anxiety disorders that show increased impulsivity, particularly within the negative urgency (NU) sub-domain, appear to have a predisposition to engage in risky behaviours to cope with their anxiety symptoms, which includes substance use. Given the promise of impulsivity and NU as endophenotypes of this anxiety-SUD comorbidity, it is recommended that future research investigate gene variants that modulate impulsivity and NU to establish biomarkers predicting an increased risk of a concurrent SUD among anxiety disorder patients. This subtype and endophenotypic investigation may ultimately establish treatment targets that can lead to greater personalization of treatments for the subgroup of anxiety disorder patients that have comorbid SUDs.
... Moreover, we found the IRL can predict the risk-prone subject's decisions better than the risk-averse subject's decisions (Table 2), suggesting the reward functions in risk-prone subjects are highly representative. This might result in high impulsivity and less variety in their decisions under risk, which has been shown in the literature (Adriani et al., 2009;Kashdan et al., 2009). ...
Conference Paper
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We model human decision-making behavior in a risk-taking task using inverse reinforcement learning (IRL) for the purposes of understanding the reward function of real human risk decision making. We are the first work that uses IRL to remove reward function behind human risk-taking decision making and interpret human decisions in risk-prone and risk-averse people. We hypothesize that the state history (e.g. rewards and decisions in previous trials) are related to the human reward function, which leads to risk-averse and risk-prone decisions. In the model, these factors are input to IRL as features, and their reward weights are estimated. The behavioral results confirm the irrational and sub-optimal risk-related decisions. The model results quantify the weight of features and show that risk-prone person tends to decide based on the current bump number, while the risk-averse person relies on burst information from previous trial and the average end status. Our results demonstrate that IRL is an effective tool to model human decision-making behavior and helps interpret human psychological process in risk decisionmaking, and with potential as an assessment tool for risk-taking as well.
... Moreover, we found the IRL can predict the risk-prone subject's decisions better than the risk-averse subject's decisions (Table 3), suggesting the reward functions in risk-prone subjects are highly representative. This might result in high impulsivity and less variety in their decisions under risk, which has been shown in the literature (Adriani et al., 2009;Kashdan et al., 2009). ...
Preprint
Full-text available
We model human decision-making behaviors in a risk-taking task using inverse reinforcement learning (IRL) for the purposes of understanding real human decision making under risk. To the best of our knowledge, this is the first work applying IRL to reveal the implicit reward function in human risk-taking decision making and to interpret risk-prone and risk-averse decision-making policies. We hypothesize that the state history (e.g. rewards and decisions in previous trials) are related to the human reward function, which leads to risk-averse and risk-prone decisions. We design features that reflect these factors in the reward function of IRL and learn the corresponding weight that is interpretable as the importance of features. The results confirm the sub-optimal risk-related decisions of human-driven by the personalized reward function. In particular, the risk-prone person tends to decide based on the current pump number, while the risk-averse person relies on burst information from the previous trial and the average end status. Our results demonstrate that IRL is an effective tool to model human decision-making behavior, as well as to help interpret the human psychological process in risk decision-making.
... Examining times of having meaningful social interactions and times of not having meaningful social interactions is especially important in disorders where strain on the social network is common [12,15,23,27], and patterns of social withdrawal and difficulties in social interactions are characteristic [19,28,29], such as Major Depressive Disorder (MDD) or SP. Studying an affective and an anxiety disorder further allows for clinical specificity (i.e., whether findings are applicable specifically to one of these diagnoses or to all the groups, which could suggest relevance for affective and anxiety disorders). ...
Article
Full-text available
Humans need meaningful social interactions, but little is known about the consequences of not having them. We examined meaningful social interactions and the lack thereof in patients diagnosed with major depressive disorder (MDD) or social phobia (SP) and compared them to a control group (CG). Using event-sampling methodology, we sampled participants’ everyday social behavior 6 times per day for 1 week in participants’ natural environment. We investigated the quality and the proportion of meaningful social interactions (when they had meaningful social interactions) and degree of wishing for and avoidance of meaningful social interactions (when they did not have meaningful social interactions). Groups differed on the quality and avoidance of meaningful social interactions: Participants with MDD and SP reported perceiving their meaningful social interactions as lower quality (in terms of subjective meaningfulness) than the CG, with SP patients reporting even lower quality than the MDD patients. Further, both MDD and SP patients reported avoiding meaningful social interactions significantly more often than the CG. Although the proportion of meaningful social interactions was similar in all groups, the subjective quality of meaningful social interactions was perceived to be lower in MDD and SP patients. Future research might further identify what variables influenced the reinforcement of the MDD and SP patients so that they engaged in the same number of meaningful social interactions even though the quality of their meaningful social interactions was lower. Increasing awareness of what happens when patients do or do not have meaningful social interactions will help elucidate a potentially exacerbating or maintaining factor of the disorders.
... Although the positive function of extrinsic motivation is relatively low compared with intrinsic motivation, extrinsic motivation will play an important role in the reflection of protégés' life purpose when it is integrated with intrinsic motivation (Bono & Judge, 2003). Kashdan and McKnight (2009) feedback environment will get more information that is useful and support which can enhance the positive impact of goal self-concordance on life purpose. life purpose can be clarified and enhanced through perceived selfconcordance level improving. ...
Article
Full-text available
Aim To deepen our research on how to develop a more positive life purpose, this study investigates the role of protégés’ self‐concordance and mentor feedback environment in shaping protégés’ life purpose. Method This study was a cross‐sectional study using a sample of nurses. 700 valid questionnaires were collected. Jamovi and Process Macro were used for analysis. Results The positive association between self‐concordance and protégés’ life purpose is stronger when mentor feedback environment is high than when mentor feedback environment is low. Conclusion Protégés’ life purpose can be enhanced by self‐concordance, especially for protégés who work in supportive mentor feedback environment. Implications for nursing management It is important to build a supportive mentor feedback environment. Further, protégés should promote the transformation of extrinsic motivation to intrinsic motivation.
... Ignore any of these elements and you will be misled about how they operate together. For instance, there is a subgroup of people with social anxiety disorder (as high as one out of five diagnosed with the condition; Kashdan, McKnight, Richey, & Hofmann, 2009) who instead of trying to escape anxious situations and experiences, tend to be novelty seeking, impulsive, and risk-prone (Kashdan & McKnight, 2010). These people might take over a conversation to demonstrate social dominance or engage in risky sexual behavior to control, instead of being controlled by, their anxiety. ...
Chapter
Full-text available
For decades, researchers and practitioners have theorized psychological disorder and health as opposite ends of a single continuum. We offer a more nuanced, data driven examination into the various ways that people with psychological disorders experience well-being. We review research on the positive emotions, meaning and purpose in life, and social relationships of people diagnosed with major depressive disorder, bipolar disorder, social anxiety disorder, schizophrenia, and trauma-related disorders. We also discuss when and how friends, family members, and caregivers of these people are adversely impacted in terms of their well-being. Throughout, we highlight important, often overlooked findings that not all people with mental illness are devoid of well-being. This review is meant to be illustrative as opposed to comprehensive, synthesizing existing knowledge and inspiring explorations of unclear or undiscovered territory.
... In contrast, SA and depression may be negatively associated with a tendency to endorse the motivations ''Casual Sex'' and ''Thrill of Excitement.'' Research demonstrates negative correlations between extraversion and both SA and depression, 8,9 which are positively correlated with behavioral inhibition and risk aversion 10 and negatively correlated with sexual risk taking. 11 Progression from Online to Offline Interactions If individuals with elevated SA or depression use DAs to form intimate relationships, another critical question concerns the extent to which DA ''matches'' lead to actual social interactions. ...
Article
This study explores associations between symptoms of social anxiety (SA) and depression with participants' extent of dating app use, self-reported motivations for dating app use, and likelihood of initiating interaction with dating app matches. Three hundred seventy-four participants completed an online battery of surveys that examined psychopathology and dating app use. SA and depression symptoms were positively associated with participants' extent of dating app use, and symptoms of psychopathology and gender interacted to predict various dating app use motivations. Symptoms of SA and depression predicted lower likelihood of initiating contact with a dating app match among men but not women. This study provides an initial step toward understanding the relationship between SA, depression, and use of dating apps.
... These challenges are particularly important for understanding anxious youths who will exhibit heightened risk taking (e.g., substance use, unprotected sex, impulsive decisions), which is often theorized to serve as a strategy for regulating affective distress (108)(109)(110)(111)(112)(113)(114). Whether the tendency toward heightened risk taking is specific to some anxiety disorders versus others and whether it is modulated by age and/or contextual factors also remains unclear. ...
Article
Avoidant behavior is a defining feature of pediatric anxiety disorders. Although prior research has examined it from the perspective of early information processing events, there has been relatively less consideration of the processes by which anxious youth make avoidant decisions and how these choices are reinforced over time. Studies of risk taking are valuable in this regard as they consider how individuals identify the pros and cons of their choices, how they weight potential gains and losses and estimate their respective probabilities, and how they tolerate the uncertainty intrinsic to any decision. In this review, we place risk taking within existing models of information processing in pediatric anxiety disorders and highlight the particular value of this construct for informing models of developmental psychopathology and individual differences in outcome over time. We review existing behavioral and neurobiological studies of risk taking in anxious youth and conclude by identifying directions for future research.
... Here, social anxiety appears to be associated with lower evidence accumulation suggesting more rapid impulsive decision making irrespective of the decision-making scenario. Classically, patients with SAD display behaviours linked to being shy, submissive, behaviourally inhibited, and risk-aversive 46,47 . Our findings suggest social anxiety may be related to inadequate evaluation of evidence. ...
Preprint
Full-text available
Doubt can modulate our decision-making process. Although conceptually different, conflict (choice similarity: difficult or easy) and uncertainty (individual reward-likelihoods: uncertain or certain) are commonly related and often conflated. By posing as an evidence-accumulation problem, we assessed doubt, dissociating contextual conflict, and uncertainty and showed obsessive-compulsive disorder patients have specific impairments while processing difficult-uncertain contexts. It remains unclear whether this deficit is disorder-specific or a reflection of broader mental-health dimension. Multi-dimensional trans-diagnostic approaches help to tease out the mechanistic nature (specific or usual) of clinical observations and their validity in sub-clinical populations. Here, we first aimed to validate our conflict-uncertainty analysis approach in a larger non-clinical cohort (n>1300). Second, we assessed the relationship between decisional-parameters of difficult-uncertain contexts and a trans-diagnostic factor capturing individual differences in ‘compulsive-behavior and intrusive-thoughts’. We replicate our previous findings in a large, general population sample and highlight that the amount of evidence accumulated in difficult–uncertain scenarios increases functionally with compulsive-behavior and intrusive-thought emphasizing greater cautiousness. We further show that those with high social-withdrawal tendencies gather less evidence irrespective of context reflecting a ‘jumping to conclusions’ tendency in judgment. We attempt to bridge the gap between behavior and psychological markers by integrating trans-diagnostic and computational methods.
Article
To cope with their fear of negative evaluation, socially anxious people use protective self-presentation strategies. We hypothesized that the presence of a close friend (vs. being alone) would lead socially anxious people to engage in more acquisitive self-presentation tactics. Results supported the hypotheses. With a friend present versus not, socially anxious participants presented themselves more positively to and selected more self-disclosing topics to discuss with a stranger they believed they would meet face-to-face. Friendship strength moderated some of the effects. Results suggest that friends' support may allow socially anxious people to satisfy safety needs while engaging in less protective self-presentation.
Chapter
In this chapter on social anxiety disorder (SAD), we overview its criteria, epidemiology, and current findings regarding its etiology, maintenance, and treatment. We use case examples throughout to highlight the heterogeneity of SAD. We emphasize the need to better understand cultural factors in SAD both in its development and treatment. Although some factors have clear support as being related to SAD (e.g., neuroticism/negative affect and extraversion/positive affect), we highlight the questionable empirical foundation for many proposed risk and maintenance factors for the disorder. Treatment that includes social practice (via behavioral or cognitive framework) is recommended.
Article
Background: Impulsivity plays a prominent role in numerous psychopathological states and poses an important clinical dilemma. However, different aspects of impulsivity are related to mood disorders, addictions, personality disorders, eating disorders, the relationship between anxiety and impulsivity is controversial and not well explored. The impact of anxiety on cognitive functioning is less explored than in other disorders (e.g. depression). The findings on cognitive functioning and impulsivity in anxiety disorders are inconsistent and are most likely due to methodological differences between the studies. Material and methods: Eleven patients diagnosed with panic disorder (DSM-IV-TR) and nine healthy volunteers were enrolled to the study. Both groups did not differ significantly in terms of age, gender and educational level. The experimental group comprised of psychotropic drug naïve patients. The severity of PD was measured with Panic and Agoraphobia Scale. Impulsiveness was evaluated with the Barratt Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions CANTAB (Cambridge Neuropsychological Test Automated Battery) was used and Paired Associate Learning (PAL) test was chosen for episodic memory evaluation. Results: Mean BIS-11 scores observed in the group of psychotropic drug naïve patients with panic disorder were 71.36 (SD 7.31). Mean BIS-scores recorded in the control group were 60.77 (SD 9.57). The correlation between impulsivity and PAL results in the experimental group was found at the level r=0.708723; p<0.05. The respective value for the controls was r=0.200839; p<0.05. Conclusions: Impulsivity in the experimental group was higher than adjusted average for the control group. Our findings indicate also the correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naïve patients.
Article
Background: Impulsivity is the neurophysiologically based inability to confirm behaviour to its context or consequences. Overimpulsiveness characterizes many mental disorders and poses an important clinical dilemma. Although the relationship between mood disorders and impulsivity has been well studied the relationship between anxiety and impulsivity is controversial and not well explored. Some studies hypothesise that patients with the diagnosis of panic disorders are characterised by higher levels of impulsivity as a trait as compared to healthy individuals. The aim of this study was to assess cognitive correlates in panic disorder as related to impulsivity measures. Material and methods: Within the preliminary studies four patients diagnosed with panic disorder (DSM-IV-TR) were studied. The severity measure was the Panic and Agoraphobia Scale. The experimental group comprised of psychotropic drug naive patients. Impulsiveness was evaluated with the Barrat Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions we used CANTAB (Cambridge Neuropsychological Test Automated Battery). Results: BIS-11 scores observed in the group of psychotropic drug naive patients with panic disorder were higher than the adjusted average for the population and correlated with the number of mistakes in CANTAB (Spatial Working Memory Test); rs=0.949; p=0.0513. Conclusions: The preliminary findings indicate a correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naive patients.
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Anger is often overlooked in the assessment and treatment of pathological anxiety, despite there being evidence that anger is elevated across all anxiety disorders. Anxiety sensitivity (AS), a major risk factor of anxiety disorders, has been shown to modulate anger in response to threat induced hyperarousal. The current study therefore examined if reductions in anxiety sensitivity (AS) mediate reductions in anger symptoms. Outcomes from a randomized control trial evaluating the efficacy of a brief AS mitigation intervention were analyzed. Patients with anxiety and comorbid conditions were randomly assigned to AS reduction (n = 58) or a repeated contact control condition (n = 60) and followed up with for three months. Analyses evaluated whether treatment related change in AS mediated later reductions in anger, hostility, verbal aggression, and physical aggression. Results revealed that reductions in AS temporally mediated the effects of treatment on later reductions in anger, hostility, verbal aggression, and physical aggression. Specificity analyses provided further support for the direction and specific variables examined in these models. Results suggest that AS may be a promising treatment target for anger symptoms among those with elevated anxiety symptoms.
Article
Research on anxiety in children and adolescents with autism spectrum disorder (ASD) has burgeoned in the past 15 years. Most of the research has focused on school‐age children, ages 6 to 18 years. Yet, recent studies suggest that anxiety can emerge in young children, under 6 years, with ASD. This scoping review synthesized the literature on anxiety in young children with ASD. Three domains of anxiety research were reviewed: (a) prevalence/severity, phenomenology, and course; (b) correlates; and (c) treatment. Four online databases were searched from the start of the database until March 2020. Keywords pertaining to anxiety, autism, and young children were entered. The search identified 44 articles for inclusion. These studies varied with respect to sample source, informants, and measures to assess anxiety. The overall prevalence of anxiety ranged from 1.6 to 62%. Sixteen of 17 studies found that young children with ASD had higher levels of anxiety compared to various control groups. A variety of DSM anxiety symptoms and disorders were present in young children with the most common symptoms being specific, social, and generalized fears. Correlates of anxiety included sensory over‐responsivity, sleep disturbance, aggression/defiance, and attention deficit/hyperactivity disorder. Three cognitive behavioral treatment studies for anxiety and one developmental intervention targeting ASD symptoms showed promise in reducing anxiety. Findings indicate an early emergence of anxiety in some children with ASD. Further research on the measurement, pathophysiology, and treatment of anxiety in early childhood is critical to improving outcomes in children with ASD. Lay summary This scoping review synthesizes the literature on anxiety in young children with autism spectrum disorder (ASD). Results indicate that children with ASD have higher levels of anxiety than children without ASD. Potential factors that could be contributing to anxiety include sensory, sleep, and behavioral problems. Preliminary studies show that anxiety can improve with cognitive behavioral treatment. These findings suggest that research on anxiety in young children with ASD should be prioritized to improve mental health outcomes.
Article
Individuals with social anxiety disorder (SAD) exhibit elevated levels of anger and anger suppression, which are both associated with increased depression, diminished quality of life, and poorer treatment outcomes. However, little is known about how anger experiences differ among individuals with SAD and whether any heterogeneity might relate to negative outcomes. This investigation sought to empirically define anger profiles among 136 treatment-seeking individuals with SAD and to assess their association with distress and impairment. A latent class analysis was conducted utilizing the trait subscales of the State-Trait Anger Expression Inventory-2 as indicators of class membership. Analysis revealed four distinct anger profiles, with greatest distress and impairment generally demonstrated by individuals with elevated trait anger, a greater tendency to suppress the expression of anger, and diminished ability to adaptively control their anger expression. These results have implications for tailoring more effective interventions for socially anxious individuals.
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Abstract Introduction: Aggressiveness is an essential component of every living thing and the experience of anger is common to all historical periods, all ages and all mental structures. Different forms and narrative ways of anger can be found in each society and can, therefore, become indicators of some aspects of society itself. Method: Starting from the emphasis that our society attributes to forms of anger and violence and their narration as incomprehensible, the scientific contributions on the subject and some characteristics of our culture are highlighted. Our society, on one hand, increases the triggers suitable to trigger anger, on the other silences and disapproves all forms of anger and even aggressiveness. Conclusions: There is a discrepancy between scientific contributions and the representation of anger in the media. The cultural operation for which we focus only on extreme episodes and repress the presence of other universal forms of anger seems to respond not only to the need to make the news but seems to indicate difficulties and defense mechanisms against aggressiveness and anger (potentially healthy and universal). It is also a way of not seeing our social responsibility and is also a missed opportunity to think about effective prevention
Chapter
Anxiety disorders (ADs) are one of the most common psychiatric disorders, and various epidemiological studies showed that they are more prevalent than mood, substance use, and impulse control disorders in many countries. ADs determine a great psychosocial impairment, represented by a reduced educational attainment, marital problems, and lower occupational status.
Article
Background: Individuals with social interaction anxiety, a facet of social anxiety disorder, are heterogeneous with respect to approaching or avoiding risky behaviors, including substance use. Additionally, the relation between social anxiety and cannabis use frequency has been inconsistent in the literature. Objective: The present study aimed to clarify the relation between social interaction anxiety and cannabis use by examining the effects of personality traits known to differentially predict substance use, including sensation seeking, emotion dysregulation, urgency, behavioral approach, and behavioral inhibition. Methods: We explored heterogeneity in social interaction anxiety using finite mixture modeling to discern profiles differing in mean scores on measures of social interaction anxiety and personality. We then examined how profiles differed in their likelihood of cannabis use. Results: The profile with low social interaction anxiety and high scores on personality measures was the most likely to use cannabis at all time periods. Two profiles with high social interaction anxiety scores were discerned. Between these two profiles, the profile with the highest levels of social interaction anxiety and most measured personality traits was more likely to use cannabis across all measured time periods. The profile with the high social interaction anxiety and low scores on personality measures was the least likely to use cannabis. Conclusions: Results of the present study identified personality traits most associated with increased risk of cannabis use for people high and low in social interaction anxiety, including facets of emotion regulation, urgency, and sensation seeking.
Article
Background Impulsivity is a key feature of numerous psychiatric disorders. However, the relationship between impulsivity and anxiety disorders is arguable and not well explored. Several methodological considerations related to data interpretation arise when patients previously exposed to psychotropic medication are included in the study population. To address those issues we designed a study in a well defined cohort of treatment-naïve panic disorder patients. Material and methods This case-control study was designed to evaluate impulsivity and its dimensions in the group of 21 psychotropic drug-naïve outpatients with panic disorder and 20 healthy controls. The severity of Panic Disorder was assessed with Panic and Agoraphobia Scale (PAS). Impulsiveness was evaluated with the Barratt Impulsiveness Scale, 11th version (BIS-11). Results According to our study patients with panic disorders had higher level of both total impulsivity and all impulsivity dimensions comparing to healthy controls. Limitations The number of participating subjects was relatively small. The study results apply to drug-naïve panic disorder patients without agoraphobia. Conclusion Opposing to the traditional conceptualizations suggesting that impulsivity displays a negative relationship with anxiety this study provides evidence for higher level of impulsivity in drug-naïve patients with panic disorder comparing to healthy controls.
Article
Emotion dysregulation has been identified as a transdiagnostic mechanism underlying social phobia and depression; however, there is much to learn about how emotion dysregulation leads to these specific outcomes. Thus, this study examined the relationship pattern between anger dysregulation and depression and how it is mediated by social phobia. Anger dysregulation was examined specifically considering anger as a significant emotional feature of both social phobia and depression. The mediation hypothesis within this study was empirically established. The data was drawn from the Collaborative Psychiatric Epidemiology Surveys (2001–2003), in which 2,827 participants met DSM-IV criteria for lifetime major depressive disorder (14.3%), and 1,905 participants met criteria for DSM-IV lifetime social anxiety disorder (9.6%). Among participants, 4,250 (21.5%) reported that they perceived their anger as out of control and either broke items or hit (or tried to hit) others. The mediation hypothesis was tested with logistic regression models. Anger dysregulation was significantly related to social phobia and depression. A significant indirect effect of social phobia was detected through bootstrap analysis, supporting the partial mediation hypothesis. This study represents the first attempt to examine the mediating role of social phobia in the relationship between anger dysregulation and depression. The findings of this study suggest that anger dysregulation may be a transdiagnostic factor across social phobia and depression.
Article
Social anxiety (SA) is thought to relate to alcohol misuse. However, current evidence is inconsistent - especially in young adulthood. Recent non-experimental data show that trait impulsivity moderates the effect of SA on alcohol misuse. Specifically, this work suggests that concurrently elevated impulsivity may draw attention to the immediate, anxiolytic effects of drinking - thus promoting alcohol misuse among those high in SA. Otherwise, without elevated impulsivity, a socially anxious person may not drink due to focusing on alcohol's possible negative outcomes (e.g., embarrassing behaviours). The next step in this research is to examine if impulsivity impacts in-the-moment subjective craving among socially anxious individuals. This was the goal of the present experiment. After baseline measures, undergraduate participants (N = 110) completed the Trier Social Stress Test followed by an alcohol (versus neutral) cue exposure. Subjective craving ratings were collected at both baseline and post-cue exposure. Moderation analyses revealed that socially anxious individuals endorsed strong cravings following an alcohol (but not a neutral) cue exposure, but only if they also had elevated impulsivity. In-lab craving was positively correlated with retrospective reports of alcohol misuse. Our findings demonstrate that impulsivity contributes to SA-related risk for alcohol misuse.
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In a study of self-presentational motives in everyday social encounters, 164 first-year and upper-class undergraduate students described their social interactions for 1 week using a variant of the Rochester Interaction Record. These descriptions focused on the strength of self-presentational motives and concerns for others’ evaluations. Participants also completed measures of individual differences hypothesized to be relevant to self-presentation, which formed four distinct factors. A series of multilevel random coefficient modeling analyses found that individual differences in factors labeled Impression Motivation, Impression Construction Positivity, and Impression Construction Appropriateness were positively related to participants’ nervousness in interaction and individual differences in Impression Motivation were positively related to the strength of self-presentational motives in interaction. A fourth factor, Negative Self-Evaluation, was positively related to the strength of participants’ self-presentational motives for first-year students but negatively related to self-presentational motives for upper-class students, and Negative Self-Evaluation was related to self-presentation differently for men and women.
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Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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poLCA is a software package for the estimation of latent class and latent class regression models for polytomous outcome variables, implemented in the R statistical computing environment. Both models can be called using a single simple command line. The basic latent class model is a finite mixture model in which the component distributions are assumed to be multi-way cross-classification tables with all variables mutually independent. The latent class regression model further enables the researcher to estimate the effects of covariates on predicting latent class membership. poLCA uses expectation-maximization and Newton-Raphson algorithms to find maximum likelihood estimates of the model parameters.
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This study tested hypotheses about patterns of familial association between attention deficit disorder (ADD) and anxiety disorders among 356 first-degree relatives of 73 clinically referred children with ADD and 26 normal comparison children. Through structured diagnostic interviews with trained raters, relatives were assessed for adult and childhood psychopathology. After stratifying the sample of ADD probands into those with anxiety disorders and those without, the authors examined patterns of aggregation of ADD and anxiety disorders in the relatives of these probands as well as in the relatives of the normal comparison subjects. Familial risk analyses revealed that 1) familial risk for anxiety disorders was higher among all ADD probands than among the normal subjects; 2) familial risk for ADD was similar in the relatives of the ADD probands and of the probands with ADD and anxiety disorder; 3) the relatives of the ADD probands with and without anxiety disorders were at greater risk for ADD than the relatives of the normal subjects; 4) the risk for anxiety disorders was two times higher in the relatives of the probands who had ADD with anxiety disorder than in those of the ADD probands without anxiety disorders; and 5) there was a tendency for ADD probands' relatives who themselves had ADD to have a higher risk for anxiety disorders than ADD probands' relatives who did not have ADD (cosegregation). The results were most consistent with the hypotheses indicating that ADD and anxiety disorders segregate independently in families.
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Previous research showed that conscientiousness (social dependability) in childhood predicted longevity in an archival prospective cohort study of bright children first studied by Terman in the 1920s (H. S. Friedman et al., 1993). Possible behavioral mechanisms for this robust association are now examined by gathering cause of death information and by considering the possible mediating influences of drinking alcohol, smoking, and overeating. Survival analyses (N = 1,215) suggest that the protective effect of conscientiousness is not primarily due to accident avoidance and cannot be mostly explained by abstinence from unhealthy substance intake. Conscientiousness may have more wide-ranging effects on health-relevant activities.
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This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
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Many functions have been suggested for low mood or depression, including communicating a need for help, signaling yielding in a hierarchy conflict, fostering disengagement from commitments to unreachable goals, and regulating patterns of investment. A more comprehensive evolutionary explanation may emerge from attempts to identify how the characteristics of low mood increase an organism's ability to cope with the adaptive challenges characteristic of unpropitious situations in which effort to pursue a major goal will likely result in danger, loss, bodily damage, or wasted effort. In such situations, pessimism and lack of motivation may give a fitness advantage by inhibiting certain actions, especially futile or dangerous challenges to dominant figures, actions in the absence of a crucial resource or a viable plan, efforts that would damage the body, and actions that would disrupt a currently unsatisfactory major life enterprise when it might recover or the alternative is likely to be even worse. These hypotheses are consistent with considerable evidence and suggest specific tests.
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The present study used cluster analysis procedures to identify empirically subgroups of patients with social phobia in a large clinical sample. The Liebowitz Social Anxiety Scale (LSAS) was administered to 382 patients from several studies of the treatment of social phobia. LSAS fear ratings were summed into four subscale scores (social interaction, public speaking, observation by others, eating and drinking in public) based on a previous factor analytical study of the LSAS. In order to produce a stable and robust solution, these factor scores were submitted to a two-stage clustering procedure consisting of an agglomerative-hierarchical clustering method followed by an iterative non-hierarchical clustering method. Three patient subgroups were identified based on their pattern of feared social situations on the LSAS. These groups were labelled: (1) pervasive social anxiety; (2) moderate social interaction anxiety; and (3) dominant public speaking anxiety. Clusters differed significantly on age and age of social phobia onset, as well as on measures of social anxiety, general anxiety and depressive symptomatology. Clusters also differed in the percentage of assigned patients who met criteria for the generalized subtype of social phobia and avoidant personality disorder. The results provide empirical support for the existence of three subgroups in a clinical sample of individuals with social phobia and contribute to the growing evidence for the heterogeneity of social phobia. Further study of the conceptual, clinical and aetiological significance of these subgroups is needed.
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The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV :Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.
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Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
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Preface 1. Temperament and personality: trait structure and persistence 2. Psychobiological methods 3. Extraversion/sociability 4. Neuroticism 5. Psychoticism (psychopathy), impulsivity, sensation and/or novelty seeking, conscientiousness 6. Aggression-hostility/agreeableness 7. Consilience References.
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This study seeks to broaden the base upon which findings regarding the cognitive antecedents to anger are based by empirically addressing the question, «What is intrinsic to anger provocative circumstances that elicits the emotion of anger?» Other studies and a survey which were forerunners in the study of antecedents to anger, for the most part, used students as subjects. Large samples (not predominately students) of subjects were used as the source of the naturally occurring anger provocative circumstances utilized and as respondents to a questionnaire made up of the circumstances. The questionnaire developed was made up of 360 naturally occurring anger provocative circumstances. The questionnaire was responded to by 177 males and 200 females, a total of 377 subjects
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When women express hostility, the target is typically a significant other. Our efforts to account for this observation center on the role of rejection sensitivity - the disposition to anxiously expect, readily perceive, and overreact to rejection - in women's hostility. We have previously shown that dispositional anxious expectations about rejection by a significant other prompt women to readily perceive rejection and to react with hostility in situations that activate rejection expectations. These findings led us to propose that the hostility of women in such situations is a specific reaction to perceived rejection. Results from three studies support this proposition. Using a priming-pronunciation task paradigm, Study 1 revealed that rejection thoughts facilitated hostile thoughts to a greater extent in women high in rejection expectations (HRS) than in those low in rejection expectations (LRS). Chronic accessibility of hostile thoughts was unrelated to rejection expectations. Study 2 found that, following rejection by a potential dating partner, HRS women evaluated their prospective partners less positively than LRS women. Partner evaluations were unrelated to rejection expectations in a nonrejection control condition. Using a daily diary methodology, Study 3 showed that HRS women were more likely than LRS women to report a conflict with their romantic partners only when they had felt rejected on the previous day.
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Background: Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment.Method: A prospective assessment of untreated anxiety symptoms and disorders among primary care patients.Results: Approximately 10% of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and/or disorders of anxiety that were unrecognized and untreated. These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than "not anxious" comparison patients; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases, such as diabetes and congestive heart failure. The most severe reductions in functioning were reported by untreated patients whose anxiety was mixed with depression symptoms or disorders.Conclusion: Primary care physicians may benefit from screening tools and consultations by mental health specialists to assist in recognition and diagnosis of anxiety symptoms and disorders alone and mixed with depression.
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This article outlines some basic ideas of an evolutionary approach to psychopathology. It focuses on human competition to be seen as attractive in order to elicit the investment of resources from others (e.g., approval, support, and care). It is argued that social anxiety may be a form of competitive anxiety, triggered in contexts where individuals see themselves as relatively low in the status hierarchy of desirable attributes and/or at risk of losing status (and control over social resources such as approval, help, and support) by being seen as having undesirable attributes. To improve (or defend) their position and garner the investments of others (e.g., win approval, support, friendships or status, or defend their status) requires a competitive venture; however, in attempting to compete, social phobics automatically recruit various evolved modules and mentalities for behaving in competitive arenas when one is low in the hierarchy (e.g., social comparison, placating dominant others and various submissive defenses such as concealment, high self-monitoring, and eye-gaze avoidance). These previously adaptive subordinate defenses interfere with status acquisition based on demonstrating attractive attributes to others.
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Objective: This study compared dopamine D(2) receptor binding potential in patients with social phobia and healthy comparison subjects. Method: Dopamine D(2) receptor binding potential was assessed in 10 unmedicated subjects with generalized social phobia and no significant lifetime psychiatric comorbidity and 10 healthy comparison subjects matched for age and sex. Binding potential was measured in the striatum by using single photon emission computerized tomography and constant infusion of the D(2) receptor radiotracer [(123)I]iodobenzamide ([(123)I]IBZM). Results: Mean D(2) receptor binding potential was significantly lower in the subjects with social phobia than in the comparison subjects. Within the social phobia group, there was a nonsignificant correlation of binding potential with the Liebowitz Social Anxiety Scale score. Conclusions: Generalized social phobia may be associated with low binding of [(123)I]IBZM to D(2) receptors in the striatum.
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This review starts with a discussion of what is meant by developmental change. It is concluded that development is an inherently “fuzzy” concept but that it constitutes a useful framework for research into psychopathology. Some of the major changes over the last four decades in the approach taken for the study of development are noted. Ten key developmental issues are discussed: (1) prenatal influences; (2) sensitive period effects; (3) mechanisms mediating long-term effects of experiences; (4) age of onset differences; (5) sex differences; (6) normality and disorder; (7) connections among different psychological domains; (8) psychopathological progressions; (9) resilience; and (10) gene – environment interplay. It is concluded that developmental research is a rich field of high potential but it needs to be process-oriented rather than norm-oriented, it needs to focus on interconnections between brain and mind, and it needs to have a major interest in individual differences.
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This paper compares diagnoses of the DSM-IV algorithms of the computer-assisted version of the Munich-Composite International Diagnostic Interview (M-CIDI) with clinical diagnoses made by treating physicians using the standard LEAD procedure. A random sample of 68 patients being treated in three psychiatric and one neurological ward of the Max Planck Institute of Psychiatry were first examined with the CIDI, using the M-CIDI/DSM-IV algorithms. Diagnostic findings were then compared with lifetime and cross-sectional diagnoses assigned by the treating physician, who was blind to the CIDI findings, taking into account all available symptom and diagnostic information from current and previous charts as well as his own assessments. Clinicians were encouraged to use the DSM-IV manual to assign multiple lifetime diagnoses and not to focus exclusively on primary diagnoses. To explore agreements and disagreements further, all discrepant cases were subsequently discussed with the treating physicians. There was generally good concordance between clinicians and interview DSM-IV diagnoses, with the exception of psychotic disorders (kappa: 0.21), dysthymia (0.54) and somatoform disorders (0.50), with kappa values for the remaining categories ranging from 0.63 (any panic disorder) to 0.96 (any depressive episode). It is concluded that the M-CIDI, in clinical cases, provides valid diagnoses for almost all non-psychotic disorders and is sensitive for all disorders but might have reduced specificity and predictive value in some anxiety and somatoform disorders. Copyright © 1998 Whurr Publishers Ltd.
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The ability of the self to alter its own responses, including thoughts, emotions, impulsive behaviors, and performances, is powerfully adaptive, and failures of selfcontrol contribute to most personal and social problems. A program of laboratory studies suggests that self-control depends on a limited resource, akin to energy or strength. Acts of self-control and, more generally, of choice and volition deplete this resource, thereby impairing the self's ability to function. These effects appear after seemingly minor exertions because the self tries to conserve its remaining resources after any depletion. Rest and positive affect help restore the self's resources.
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While most books on missing data focus on applying sophisticated statistical techniques to deal with the problem after it has occurred, this volume provides a methodology for the control and prevention of missing data. In clear, nontechnical language, the authors help the reader understand the different types of missing data and their implications for the reliability, validity, and generalizability of a study’s conclusions. They provide practical recommendations for designing studies that decrease the likelihood of missing data, and for addressing this important issue when reporting study results. When statistical remedies are needed--such as deletion procedures, augmentation methods, and single imputation and multiple imputation procedures--the book also explains how to make sound decisions about their use. Patrick E. McKnight's website offers a periodically updated annotated bibliography on missing data and links to other Web resources that address missing data.
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We examined the hypothesis that under specific conditions, socially anxious individuals may be risk-prone as opposed to risk-averse in domains such as heavy drinking, illicit drug use, unsafe sexual practices, and aggression. A college-aged sample, predominantly women, completed a series of questionnaires on social anxiety and risk-taking behavioral intentions. Results of hierarchical regression analyses indicated that positive outcome expectancies moderated relationships between social anxiety and sexual risk-taking and aggression. Socially anxious individuals expecting desirable outcomes reported the greatest risk-taking behavioral intentions. Socially anxious individuals expecting less desirable outcomes reported the least risk-taking intentions. Social anxiety interaction effects were not accounted for by other anxiety and depressive symptoms. Data suggested that social anxiety was also positively related to illicit drug use. Although preliminary, these significant findings suggest that a subset of socially anxious individuals may engage in risky activities that likely serve the purpose of regulating emotions.
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The present study examined social anxiety, anger, and depression among 234 persons with social anxiety disorder and 36 nonanxious controls. In addition to greater social anxiety, persons with social anxiety disorder exhibited more severe depression, greater anger, and poorer anger expression skills than did nonanxious control participants. Analyses investigating attrition and response to cognitive-behavioral group treatment (CBGT) among a subset of 68 persons treated for social anxiety disorder indicated that patients who experienced anger frequently, perceived unfair treatment, and were quick-tempered were less likely to complete a 12-session course of CBGT. Among treatment completers, significant reductions in the frequent experience of anger to perceived negative evaluation and in anger suppression were noted. However, those who suppressed anger responded less favorably to CBGT. Future directions and clinical implications are discussed.
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The goal of the present study was to determine whether the investigation of interpersonal problems in social phobia would lead to qualitatively different subgroups, subgroups that would provide additional nonoverlapping information to the Mental Disorders-IV (DSM-IV) classification. 30 generalized socially phobic (college students, aged 18-29 yrs old), 30 nongeneralized socially phobic, and 30 nondisordered control participants were selected based on dual structured interviews. All participants completed the Inventory of Interpersonal Problems Circumplex Scales (IIP-C). Results showed that when social phobia subtypes were classified using the DSM-IV definition, the IIP-C reflected subgroup differences in global severity of interpersonal problems, with the generalized social phobia group evidencing the greatest difficulty. However, the subgroups could not be discriminated on core or central interpersonal problems. In contrast, when an interpersonal analysis of subtype classification was employed, 2 groups were formed, each with discriminating core unifying features suggesting qualitatively different problematic reactions to interpersonal situations. The potential clinical relevance of an assessment of interpersonal dysfunction to the treatment of social phobia is discussed.
Book
This chapter describes a refinement and extension of the self-presentational theory of social anxiety, which explains social anxiety in terms of people's concerns with the impressions that other people are forming of them. Theoretical developments involving the need for belonging and acceptance demonstrate precisely why people worry so much about what other people think of them, identify the conditions under which such concerns do and do not cause people to feel socially anxious, and link social anxiety to the processes by which people assess the degree to which they are relationally valued by others. The revised self-presentational theory also explains the behaviors that accompany social anxiety and offers implications for clinical treatment of socially anxious clients.
Book
People who are sensitive to social rejection tend to anxiously expect, readily perceive, and overreact to it. This article shows that this cognitive-affective processing disposition undermines intimate relationships. Study 1 describes a measure that operationalizes the anxious-expectations component of rejection sensitivity. Study 2 provides experimental evidence that people who anxiously expect rejection readily perceive intentional rejection in the ambiguous behavior of others. Study 3 shows that people who enter romantic relationships with anxious expectations of rejection readily perceive intentional rejection in the insensitive behavior of their new partners. Study 4 demonstrates that rejection-sensitive people and their romantic partners are dissatisfied with their relationships. Rejection-sensitive men's jealousy and rejection-sensitive women's hostility and diminished supportiveness help explain their partners' dissatisfaction. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
An overview is presented of the design and field procedures of the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a US face-to-face household survey of the prevalence and correlates of DSM-IV mental disorders. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the US National Comorbidity Survey Replication (85.9% response rate) and 9244 adolescent students selected from a nationally representative sample of 320 schools (74.7% response rate). After expositing the logic of dual-frame designs, comparisons are presented of sample and population distributions on Census socio-demographic variables and, in the school sample, school characteristics. These document only minor differences between the samples and the population. The results of statistical analysis of the bias-efficiency trade-off in weight trimming are then presented. These show that modest trimming meaningfully reduces mean squared error. Analysis of comparative sample efficiency shows that the household sample is more efficient than the school sample, leading to the household sample getting a higher weight relative to its size in the consolidated sample relative to the school sample. Taken together, these results show that the NCS-A is an efficient sample of the target population with good representativeness on a range of socio-demographic and geographic variables.
Article
The frequency of additional self-reported diagnoses in a large, heterogeneous sample of attention deficit disorder (ADD) children (N = 182) was determined using the Diagnostic Interview for Children and Adolescents (DICA). Over half the children had additional DICA diagnoses, with oppositional disorder and anxiety/mood disorders the most frequent. ADD boys with internalizing-type diagnoses had lower verbal IQs and arithmetic scores and performed more poorly on attention tasks than those without; parents also rated them more adversely. Those with externalizing-type diagnoses were rated as more aggressive by teachers and had sociopathic, thrill-seeking profiles on paper-pencil self-ratings. Over 40% of the children were dyslexic or slow learners but they had no higher rate of DICA diagnoses than those who read adequately.