Social phobia subtyping with the MMPI-2

A clinical guide to assessing level of ego development using psychological testing

This article presents a clinical guide for relating psychological test findings from the Minnesota Multiphasic Personality Inventory-2 and Rorschach Technique to various levels of ego development. The original three validity and 10 clinical scales from the MMPI and a selected group of traditional determinants from the Rorschach are employed. Expected testing results from these instruments are derived from both the authors' clinical experience and the research literature. These results are presented along a continuum of nine levels of ego development and their associated disorders. The nine levels of ego development are "normal" neurotic, neurotic trait, and neurotic symptom organization; high-, mid-, and low-level borderline organization; and affective, cognitive-affective, and cognitive psychotic organization. The relationships between typical testing responses and indices of personality functioning at each level of ego development would hopefully facilitate accurate diagnosis, which in turn would result in more effective treatment planning.

Recent Insight Into the Subtypes of Social Anxiety Disorder

Systems for subtyping individuals with social anxiety disorder have been the focus of much research attention as a means to improve assessment and treatment of the disorder. This article highlights recent revisions to social anxiety disorder (SAD) subtypes from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to DSM-V, reviewing empirical evidence that served as the impetus for the revisions. Recent research examining the validity of the DSM-V system and alternative subtyping systems is reviewed. Overall, there appears to be greater empirical support for a dimensional subtyping system. Concerns therefore remain with the DSM-V system, which retained a categorical system but replaced the previous subtypes with a subtype of individuals fearing only performance situations. Recommendations for future research are discussed, as well as alternate options for capturing the variability in SAD presentations, including the possibility of eliminating subtyping altogether.

Differentiating the subtypes of social anxiety disorder

Since the inclusion of subtypes of social anxiety disorder (SAD) in the DSM-III-R, the most studied have been generalized versus specific subtypes. Previous research indicated that the generalized subtype was associated with greater severity, comorbidity and functional impairment compared to the specific subtype, but more recent evidence supports a dimensional conceptualization of SAD. Earlier studies also possessed limitations, such as heterogeneity in definitions of generalized SAD. Based on the more recent findings and the limitations of the earlier studies, the DSM-5 eliminated the generalized specifier. However, it also retained a categorical system by including a performance-based fear specifier, thus leaving an open debate on whether or not a dimensional or categorical system best describes SAD. Future research could examine other, more recent concepts as potential subtypes (e.g., attentional biases), or perhaps the larger question of the overall utility in subtyping SAD.

The nature and expression of social phobia: Toward a new classification

Social phobia (social anxiety disorder) was officially recognized as a distinct clinical entity only with the publication of the DSM-III in 1980. Research on the psychopathology of this disorder has revealed a great degree of heterogeneity in its symptomatology. In order to acknowledge this heterogeneity, later versions of the nosological system introduced the generalized subtype of social phobia to describe individuals who fear most or all social situations. The empirical literature on the differences between the diagnostic subtypes has yielded inconsistent findings. Based on the recent emotion literature and concepts from evolutionary psychology, we discuss fearfulness, anxiousness, shyness, self-consciousness, submissiveness, and anger as dimensions of social phobia. The empirical evidence for this classification system and its relationship to the diagnostic subtypes will be discussed.

Psychometric properties and three proposed subscales of a self-report version of the Liebowitz Social Anxiety Scale translated into Hebrew

We investigated the overall test-retest reliability and other psychometric properties of a self-report version of the Liebowitz Social Anxiety Scale (LSAS) translated into Hebrew. We also evaluated the utility of three new subscales that were identified by nonparametric analysis (multidimensional scaling; MDS). Two hundred and seven patients who sought treatment for social anxiety or panic disorder were evaluated. All patients completed the self-administered version of the LSAS. A subsample completed the LSAS a second time prior to the beginning of treatment. The results indicate that the self-report format of the LSAS translated into Hebrew demonstrates high test-retest reliability, internal consistency, and discriminant validity. Additionally, some evidence for convergent and divergent validity was noted, and treatment sensitivity was high. MDS analysis followed by the investigation of common underlying facets for items related in two-dimensional space identified three subgroups: 1) the Group Performance/Interaction ("Group") subscale that consists of group performance and group interaction items; 2) the Dyadic Interaction ("Dyadic") subscale that consists of Dyadic interaction items; and 3) the Public Activities ("Public") subscale that consists of individual activities carried out in public. The three new subscales identified by MDS appear to provide clinically relevant information that relates to both demographic and treatment outcome variables and warrant further study.