Recent Insight Into the Subtypes of Social Anxiety Disorder

Risk factor patterns define social anxiety subtypes in adolescents with brain and clinical feature differences

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.

Personality subtypes in adults with social anxiety disorder - novelty seeking makes the difference

BACKGROUND

Up to now several subtypes of social anxiety disorder (SAD) have been proposed.

METHODS

In the present study, we used a cluster analytic approach to identify qualitatively different subgroups of SAD based on temperament characteristics, that is, harm avoidance (HA) and novelty seeking (NS) dimensions of Cloninger's Temperament and Character Inventory.

RESULTS

Based on a large, diverse clinical sample (n = 575), we found evidence for two distinct subgroups of SAD: a larger (59%) prototypic, inhibited cluster characterized by high HA and low NS, and a smaller atypic, and comparatively more impulsive cluster characterized by medium to high HA and increased NS. The subgroups differed regarding a variety of sociodemographic and clinical variables. While the prototypic SAD subtype suffered from more severe SAD and depressive symptoms, suicidal ideation, and reduced social functioning, the atypic NS subtype showcased higher reproductive behaviour, self-directedness and -transcendence, comparatively. Additional hierarchical logistic regression highlights the contribution of age and education.

CONCLUSIONS

Our results valuably extend previous evidence for the existence of at least two distinct subtypes of SAD. A better knowledge of the characteristic differences in prototypic behaviour, personality, coping strategies and comorbidities between the identified (and further) subtypes can contribute to the development of effective prevention interventions and promotes the conceptualization of tailored treatments.

Electrophysiological Measures of Visual Working Memory in Social Anxiety

Socially anxious individuals are very sensitive to threatening information in the environment, so visual working memory (VWM) is of great significance for them. However, the influence of social anxiety on VWM is unclear. In the present study, we aimed to investigate the VWM in individuals with social anxiety using electrophysiological techniques. Event-related potentials (ERPs) of high socially anxious (HSA) individuals and low socially anxious (LSA) individuals were recorded during a change-detection task with two memory conditions (two and four items). Electrophysiological results indicated that compared with the LSA individuals, the HSA individuals had significantly more active contralateral delay activity (CDA) in condition of memorizing four items. However, there was no significant difference between the HSA and LSA groups in response accuracy in the conditions memorizing two and four items. From the electrophysiological results, individuals with high social anxiety could maintain more information in VWM. However, maybe anxiety consumes the available cognitive resources to compensate for the supposed to be impaired effective performance, so that individuals with high social anxiety perform the same as individuals with low social anxiety in terms of behavioral outcomes.

Social anxiety disorder: looking back and moving forward

Fifty years have passed since social anxiety disorder (SAD) was first differentiated from other phobias. In the years since research has largely aligned with the zeitgeist of categorical classificatory frameworks, and has spanned identifying causes, maintenance factors and innovative interventions. Despite significant advances in the field, the capacity to conceptualise SAD as an independent entity is limited given the heterogeneity and dimensionality of diagnostic criteria, high rates of comorbidity, and non-specificity of aetiological mechanisms, maintaining factors and approaches to treatment. The Research Domain Criteria (RDoC) initiative was developed in an effort to overcome the inherent limitations posed by descriptive diagnostic systems - particularly in terms of reliability and validity - and in doing so seeks to facilitate research into underlying pathophysiological and behavioural mechanisms that cut across traditional diagnostic boundaries. The RDoC framework is furnished with a 'matrix', which in essence corresponds to a set of research principles that attempt to reconcile neuroscience and psychopathology. This review outlines a rationale for integrating SAD research with the RDoC approach, and offers examples of how future studies may wish to frame hypotheses and design experiments as the field moves towards classifying dimensions of psychopathology through a mechanistic understanding of underlying neurobiological and behavioural processes.