Quality of life in social phobia

The person's perception of his or her quality of life has been neglected in studies of mental health in general and anxiety disorders in particular. However, the judgement of the impact of a mental disorder based on symptomatic distress while ignoring one's overall quality of life is incomplete. In the present study, we examined social phobic patients' judgments of their satisfaction with various domains of life they deem important using the Quality of Life Inventory (QOLI; Frisch, unpublished). Social phobics judged their overall quality of life lower than Frisch's (unpublished) normative sample. Quality of life was inversely associated with various measures of severity of social phobia (especially social interaction anxiety), functional impairment, and depression. It was not, however, related to performance anxiety or trait anxiety. Quality of life also varied across combinations of subtype of social phobia and the presence/absence of avoidant personality disorder, and as a function of marital status. Patients showed significant improvement in quality of life scores after completion of cognitive-behavioral group therapy for social phobia. Depression and Anxiety 4:126–133, 1996/1997.© 1997 Wiley-Liss, Inc.     

Epidemiology of social phobia in later life.

OBJECTIVE: Although anxiety disorders, including social phobia (SP), are common among older adults, very little is known about the epidemiology of SP in later life. METHOD: Using data drawn from a large, nationally representative sample of older adults from Canada (N=12,792), the authors estimate lifetime and 12-month prevalence of social phobia and examine demographic predictors and patterns of comorbidity of current SP in this population. RESULTS: The results reveal that SP is a prevalent disorder in later life with lifetime and 12-month prevalence estimates of 4.94% and 1.32%, respectively. Current SP (12-month) declines with age and is more common in individuals with other psychiatric disorders. Interestingly, there is no correlation between current SP and gender, marital status, or socioeconomic status. CONCLUSIONS: SP remains a highly prevalent disorder even in late life with the pattern of feared/avoided situations being strikingly similar to that of younger populations.     

The role of life events in social phobia

The aim was to investigate the relationship between life events and social phobia. An inventory assessing life events during childhood, adulthood as well as life events experienced in relation to the onset of the disorder was administrated to 30 subjects with a DSM-IV diagnosis of social phobia. They were recruited by announcement and diagnosed by the Structured Clinical Interview for DSM-IV for axes I and II disorders. Seventy-five controls were selected by matching age and gender from the local population register. Individuals with social phobia reported significantly more life events during childhood and more life events with negative impact during the social phobia debuting year. Conversely, they described fewer events in the adult life than the controls. Close relatives with disabling conditions in the childhood, conflicts with wife/husband/cohabitant and divorces or similar were significantly more common in the debuting year in social phobic group. In adult life, the healthy individuals described significantly more often increased authority at work. A gender-specific analysis revealed significantly more experiences of a death of a relative/close friend during the year before the social phobia debut and significantly more negative life events in the women's adult life. In summary, the present results support that life events have a role in social phobia that may be gender influenced.     

负性生活事件对抑郁症患者血清细胞因子水平的影响

目的　探讨负性生活事件对抑郁症患者血清细胞因子水平的影响。方法　采用酶联免疫吸附法 (EL SIA)对有负性生活事件诱因的抑郁症患者 2 3例、无诱因的抑郁症患者 2 9例和 2 9名正常人的血清白介素 2 (IL 2 )、可溶性白介素 2受体 (sIL 2R)、白介素 10 (IL 10 )和白介素 12 (IL 12 )水平进行检测。结果　 3组间IL 2、sIL 2R及IL 12水平存在显著性差异 ,而IL 10则 3组间无显著性差异 ,有负性生活事件诱因组IL 2及sIL 2R水平明显低于无诱因组和对照组 (P <0 0 1) ;有诱因组其负性生活事件对患者心理活动影响的严重程度与IL 2和sIL 2R水平呈负相关(P <0 0 5 )。结论　负性生活事件对抑郁症患者的细胞免疫激活系统有抑制作用 ,IL 2可能是起主要的中介作用。     

Mode of onset of simple phobia subtypes: further evidence of heterogeneity

Previous research has demonstrated heterogeneity of the simple phobia diagnostic category. As a further test of the notion of heterogeneity of the DSM-III-R simple phobia diagnostic category, mode of onset was examined in a sample of simple phobic outpatients. Patients were separated into one of four subtypes: animal or insect, blood and injury, situational, and choking-vomit phobias. Careful study yielded five distinct mode-of-onset categories. Two researchers independently determined the mode of onset for the patients studied: direct trauma, spontaneous, vicarious learning, gradual, and lifelong. Significant mode of onset differences were observed across groups. Situational phobics reported a preponderance of spontaneous onsets as compared to the other groups studied. These results offer further evidence of the heterogeneity of the simple phobia diagnostic category and also support the contention that situational simple phobias are closely related to agoraphobia.     

Social phobia, fear of negative evaluation and harm avoidance.

This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.     

Memory bias in generalized social phobia: remembering negative emotional expressions

In two experiments, the authors examined memory for facial emotional expressions in patients with generalized social phobia (GSP) and in nonanxious control (NAC) participants. Three main questions were addressed. First, do patients with GSP differ from NAC participants in their overall memory for facial expressions? Second, do patients with GSP exhibit a memory bias for negative versus nonnegative expressions? Third, if such a bias exists, is it specific to angry expressions? The results of both experiments indicated that patients with GSP have better memory for all facial expressions than do NAC participants. Results of experiment 2 suggest that patients with GSP exhibit enhanced recognition for negative compared with nonnegative expressions; in contrast, NAC participants did not exhibit such enhancement. Results concerning specificity were equivocal. The importance of examining cognitive biases in patients with GSP via the use of facial expression is discussed.     

The impact of negative treatment experiences on persistent refusal of antipsychotics

AimsWe investigate reasons for persistent medication refusal in schizophrenia spectrum disorders and test whether factors that speak for a rational decision, such as negative experiences with medication or low symptom distress predict medication refusal, even after taking differences in insight into account.MethodWe included 45 participants with schizophrenia spectrum disorders, of which 20 had refused antipsychotic medication for at least three months and assessed reasons for taking or not taking medication, labeling condition as mental disorder (“insight"), experiences with the previous treatments, symptoms and symptom distress, positive and negative consequences and experiences of psychosis, causal beliefs, therapeutic relationships with previous clinicians and attitudes towards medication.ResultsGroups did not differ in symptom severity but medication refusers reported significantly less insight, less satisfaction with their most-recent psychiatrist and with previous medication, and more negative beliefs about harmful effects of medication. They also felt less informed about medication. After controlling for insight, the perceived helpfulness of the previous treating psychiatrist (OR = 0.30, z = 5.58, p = 0.018) and of previous medication (OR = 0.27, z = 6.87, p = 0.009) and feeling insufficiently informed about medication (OR = 0.53, z = 3. 85, p = 0.050) significantly predicted medication discontinuation.ConclusionsBuilding rapport with patients with a different view of the nature of their condition and encouraging informed decisions on medication are likely to improve medication adherence. However, the findings also suggest that refusing medication after a phase of initial adherence is also the consequence of negative experiences with medication and could result from weighing the pros against the cons.     

Gender differences in the effects of family adversity on the risk of onset of DSM-III-R social phobia

Utilizing a random probability sample of Canadian residents aged 15-64 (n = 8116), this study assessed gender differences in the onset of social phobia and the moderating influence of gender on indicators of childhood family adversity hypothesized to increase the risk of developing the disorder. Results revealed statistically significant "gender by family adversity" interactions that varied by disorder sub-type. Among males, absence of a parent or other adult close confidant during childhood was associated with an elevated risk of developing social phobia (all diagnosed cases and the non-generalized sub-type). Risk factors unique to females included parental conflict while growing up (all diagnosed cases), childhood physical abuse by a father figure (generalized sub-type), and maternal mania (non-generalized sub-type). Results highlight the importance of distinguishing between social phobia sub-types in gender-based research as well as the use of family adversity measures that capture the parenting behaviors and mental health status of both parents.     

Disability and quality of life in social phobia: epidemiologic findings

OBJECTIVE: Social phobia in clinical studies is vividly associated with extensive disability and reduced quality of life. It is difficult to obtain a clear portrayal of the impairment associated with social phobia in community samples. Furthermore, it has been unclear in prior studies to what extent indices were attributable to social phobia as opposed to comorbid major depression. The authors examined relevant data from the Ontario Health Survey Mental Health Supplement. METHOD: The Ontario Health Survey Mental Health Supplement, a survey of more than 8,000 residents of Ontario, Canada, aged 15-64, used the University of Michigan Composite International Diagnostic Interview to assign DSM-III-R diagnoses. Several indicators of disability and quality of life were included. The authors compared these indices for persons with and without social phobia and adjusted where indicated for the effects of major depression and relevant sociodemographic factors. RESULTS: Persons with social phobia were impaired on a broad spectrum of measures, ranging from dropping out of school to experiencing disability in one's main activity. They were also significantly more likely than persons without social phobia to rate themselves as "low functioning" on the Quality of Well-Being Scale and to report dissatisfaction with many aspects of life. Depressive comorbidity seemed to contribute only modestly to these outcomes. CONCLUSIONS: Social phobia can be a serious, disabling anxiety disorder associated with marked reduction in quality of life. Impairment in social phobia is substantial, even in the absence of comorbid major depression.     

Effects of participant modeling and desensitization on childhood warm water phobia

Parental participant modeling and contact desensitization were used to reduce phobia of warm water bathing in a 6-year-old male burn victim traumatized by his natural parents. Cradled in an adoptive parent's arms, the child contacted, entered, and remained in increasingly warmer and deeper water for 3-min intervals during daily 15-min bathing routines. Treatment effected heat and depth tolerance to the point that the subject maintained desired behavior without parental assistance. Heat and depth tolerance persisted through a 6-month follow-up period.     

Loneliness and the psychosis continuum: a meta-analysis on positive psychotic experiences and a meta-analysis on negative psychotic experiences

Abstract

There is an increase in interest in the relationships between loneliness and psychosis. The notion of psychosis continuum implies that psychotic experiences extend from clinical populations with psychotic disorders to non-clinical populations. This meta-analytic review aimed to examine the respective associations of loneliness with positive and negative psychotic experiences along the psychosis continuum. A systematic database search was conducted and a total of 30 studies were included in the first meta-analysis and 15 studies were included in the second meta-analysis. There was a medium association between loneliness and positive psychotic experiences (r?=?0.302, p?<?0.001). In particular, the association between loneliness and paranoia was robust (r?=?0.448, p?<?0.001). The second meta-analysis revealed a medium association between loneliness and negative psychotic experiences (r?=?0.347, p?<?0.001). The associations between loneliness and both positive and negative psychotic experiences were found to be smaller among clinical than non-clinical samples. The above findings provided evidence for the associations between loneliness and the two core dimensions of psychotic experiences along the phenomenological continuum. Future research should examine the dynamics of these relationships in both clinical and non-clinical samples, preferably using a single-symptom approach.     

Understanding personality traits from early life experiences

The contribution of early experiences towards the onset of personality disorder has often been stressed. However, the contribution to trait personality has received less attention. To examine the impact of early experiences on the development of personality, two subscale scores of the Eysenck Personality Questionnaire (EPQ): neuroticism (N) and extroversion (E), were used to assess a total of 220 residents of a rural city of Japan (aged > or =18 years). After controlling for age and social desirability response bias, the N score of men could be predicted by the experience of relocation; the E score of men by high parental care and low parental overprotection; and the E score of women by the experience of death of a sibling. Personality traits in a non-patient population may be explained by early experiences.     

Pregnancy affects appraisal of negative life events

Objective

It has been demonstrated that physiological responses to stress are diminished late in pregnancy. This study investigates whether emotional responding is diminished as well by measuring affective responses to specific life events during pregnancy.

Methods

A total of 292 pregnant women reported the occurrence of and affective responses to a range of major life events during gestation. Two analyses were conducted (across events and within events) on these responses to determine whether life events occurring in the first trimester were rated as more stressful than those that occurred in the third trimester.

Results

Both within-event and across-events analyses of responses to life events demonstrated that events occurring early in pregnancy were perceived as more stressful than events occurring later in pregnancy.

Conclusion

Responses to stress and affective state are progressively altered in pregnant women, suggesting that timing of stress exposure during gestation may be critical in determining its impact.     

Slow negative cortical potential preceding the onset of postural adjustment

We investigated whether a cortical potential exists, that is similar to the Bereitschaftspotential, preceding postural adjustment followed by voluntary ballistic rising on tiptoe in 10 healthy subjects. On the basis of the electromyogram (EMG) activities of the soleus muscle, the onsets of the premotion silent period (PMSP) and EMG discharge were determined. The negative potentials associated with a voluntary rise-on-tiptoe movement with respect to EMG onset were similar to the readiness potential associated with voluntary foot movement. The slopes of the slow negative potential associated with the PMSP onset were significantly more negative than those of the potential associated with rise-on-tiptoe movement, particularly over the frontal electrode positions. The results suggest that a cortical potential precedes postural adjustment that is followed by voluntary rising on tiptoe.     

Perceived experiences of racism as stressful life events

The impact of racism on African American personality, behavior, and health has been debated in the psychological literature. There has been little research however, on racism as a stressful life event. The goal of this study was to learn whether perceived racism produces symptoms of subjective distress noted in relationship to other stressful life events. In addition, this study sought to find whether racial identification mediated the psychological impact of perceived experiences of racism. Two hundred African American adults were surveyed. Participants completed a 30 item racial identification measure, a questionnaire that requested information on the experience of racism, and the Impact of Events scale. The results showed that one third of the participants reported a perceived experience of racism within six months of the interview. Mean scores for intrusion symptoms were higher as the seriousness of the reported event increased. While participants reported avoidance symptoms, there were no differences based on the seriousness of the racial incident. Racial identification did not mediate the impact of the experience of racism.Vetta L. Sanders Thompson, Ph.D., is affiliated with the University of Missouri-St. Louis, Department of Psychology.