Associations of familial risk factors with social fears and social phobia: evidence for the continuum hypothesis in social anxiety disorder?

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIA-X/M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-to-offspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.     

Which future for social psychiatry?

Social psychiatry started over a century ago under the auspices of mental and racial hygiene, but after World War II it embraced concepts of community-based care and de-institutionalization. The major psychiatric reforms in the second half of the last century were mainly based on such concepts, including the reforms of Swiss and especially Zurich psychiatry. The present needs for psychiatric care, and the specific political and economic conditions for a continuation along this line are explored and found to be favourable. Also, the profile of future psychiatrists, as formulated by professional associations and expert groups, corresponds to concepts of social psychiatry. The World Health Organization stimulates service improvements in the same direction. The consequences concern the education and training, and the professional role of future psychiatrists. Finally, the future of social psychiatry will be shaped by public expectations and acceptance of community-based services.     

What determines well-being in obesity? Associations with BMI, social skills, and social support

OBJECTIVE: Theory and research suggest that the stigma associated with obesity has an impact on the development of social skills and social relationships which may be related to subjective well-being. The main objective was to clarify the associations between BMI (kg/m2), social skills, social support and subjective well-being in a sample of obese subjects. METHODS: Cross-sectional study of 226 obese adults (75 females and 151 males) from the general population between the ages of 19 and 74 [mean (SD), 46.9 (13.7) years]. Mean (SD) BMI of the subjects was 36 (5.3). Outcome measures: subjective well-being was measured by the Satisfaction With Life Scale (SWLS) and by the Positive And Negative Affect Scales (PANAS). Social support was assessed with scales of the Social Support Questionnaire F-SozU and social skills with a short form of the German Insecurity Questionnaire U-24. RESULTS: Hierarchical regression analysis showed that social support and social skill measures are relevant predictors of subjective well-being (with both independent and shared influences), while BMI is not. The obese people in our study neither differed from other comparison groups in their subjective well-being, nor did they report greater impairments in social skills or social support. CONCLUSION: BMI does not seem to be the major determinant of low subjective well-being in obesity. As in healthy controls, subjective well-being is principally associated with social skills and social support.     

Why take social anxiety disorder seriously?

Social anxiety disorder (social phobia) is a disabling psychiatric condition, characterized by a fear of negative evaluation by others. Epidemiological studies have shown a high prevalence of the condition in the general population; the disorder is more common in women than in men. Social anxiety disorder has a typical onset during adolescence and a chronic course; remission rarely occurs without therapeutic intervention. Comorbid psychiatric conditions such as depression and alcoholism commonly occur in patients with preexisting social anxiety disorder, and increase the burden of the condition. Two subtypes of social anxiety disorder have been identified: "nongeneralized" and "generalized"; the latter form causes greater disability and is more often associated with comorbidity. The socioeconomic impact of social anxiety disorder on both sufferers and the community is considerable. For a person with social anxiety disorder, quality of life is greatly reduced; work, social, and personal relationships are all affected. Social anxiety disorder demands increased recognition, so that sufferers receive the treatment they need, in order to improve their quality of life through better social functioning.     

How does social functioning in the early stages of psychosis relate to depression and social anxiety?

Aims: The study aims to compare social functioning in young people considered to be at risk of psychosis with those meeting criteria for first episode psychosis (FEP) and controls, and to determine the association between social functioning and positive and negative symptoms, depressive symptoms, and social anxiety. Methods: This study examined social functioning in 20 individuals at risk of psychosis, 20 FEP patients and 20 healthy controls. Social functioning was measured using the Social Functioning Scale and World Health Organization Disability Assessment Scale. Psychiatric variables were also measured using the Comprehensive Assessment of At‐Risk Mental States, the Brief Psychiatric Rating Scale, the Brief Social Phobia Scale, and the Depression Anxiety and Stress Scale. Results: At‐risk individuals had comparable social deficits to the FEP group, and both patient groups had significantly poorer social functioning than controls. Importantly, social functioning was most strongly associated with depressive and social anxiety symptoms and to a lesser extent with positive symptoms. However, negative symptoms did not appear to relate to social functioning. Conclusion: Social functioning impairments precede the onset of full‐threshold psychosis and may therefore be a significant marker for the illness. Additionally, associated psychiatric symptoms such as depression and social anxiety may provide an avenue for early interventions of social functioning deficits in psychosis.     

Size of the social network versus quality of social support: which is more protective against PTSD?

Purpose

Supportive social networks are important to the post-traumatic response process. However, the effects of social network structure may be distinct from the perceived function of those networks. The present study examined the relative importance of role diversity and perceived strength of social support in mitigating post-traumatic stress disorder (PTSD).

Methods

Data were drawn from respondents who report lifetime potentially traumatic events in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 31,650). The Social Network Index (SNI) was used to measure the diversity of social connections. The Interpersonal Support Evaluation List (ISEL-12) was used to measure the perceived availability of social support within the network. Odds of current PTSD were compared among individuals representing four dichotomous types of social support: high diversity/high perceived strength, high diversity/low perceived strength, low diversity/high perceived strength, and low diversity/low perceived strength to examine which type of support is more protective against PTSD.

Results

Unadjusted odds of PTSD were 1.59 (95 % CI 1.39–1.82) for those with low versus high perceived support strength, and 1.10 (0.94–1.28) among those with non-diverse versus diverse social networks. Compared to the reference group (high diversity/high perceived strength), the adjusted odds of current PTSD were higher for two groups: low diversity/low perceived strength (OR = 1.62; 1.33–1.99), and low diversity/high perceived strength (OR = 1.57; 1.3–1.91). The high diversity/low perceived strength group had no greater odds of PTSD (OR = 1.02; 0.81–1.28).

Conclusion

The diversity of a social network is potentially more protective against PTSD than the perception of strong social support. This suggests that programs, which engage individuals in social groups and activities may effectively attenuate the risk of PTSD. A better understanding of how these networks operate with respect to PTSD prevention and mitigation holds promise for improving psychiatric health.     

Group social skills training or cognitive group therapy as the clinical treatment of choice for generalized social phobia?

This study focused on determining whether group social skills training (SST) or cognitive-behavioral group therapy (CBT) works best to treat social anxiety in psychiatric patients. Participants were psychiatric outpatients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of generalized social phobia (GSP). A matching procedure was used to obtain two equivalent samples in both conditions (N = 48). It was shown that both SST and CBT were effective in reducing social and general anxiety, decreasing the severity of psychopathology and increasing social skills and self-control. As for differential effects, patients participating in SST experienced a significantly greater reduction of social anxiety and a greater increase in social skills than those in CBT. Moreover, it was shown that social anxiety and social skills scores of the SST group at follow-up reached the level of a normal reference group, whereas those of the CBT participants improved only to that of nonsocially anxious patients with anxiety disorders. Finally, it was revealed that commitment to and satisfaction with treatment of participants in both conditions did not differ. Keeping in mind that this was a quasiexperimental study, the authors concluded that in a clinical setting, group SST may be the best way to treat psychiatric patients with GSP, where comorbidity is the rule rather than the exception.     

Is post-event processing specific for social anxiety?

In their model of social phobia, Clark and Wells [1995. A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York, London: The Guilford Press] introduced a process called "post-event processing" (PEP), which is characterized by prolonged rumination about past social situations. The present study examined to what extent PEP is specific for (a) social anxiety or (b) social situations. In a cross-sectional study, 217 participants reported about a social and a phobic event followed by negative thinking. PEP as well as its potential predictors such as social anxiety, general anxiety, and depression were measured by questionnaires. Results showed that social events were followed more often and by more intense PEP. Further confirming specificity, the fear of negative evaluation as an aspect of social anxiety was significantly associated with PEP for social but not for phobic situations, and vice versa; general anxiety predicted PEP only after phobic but not after social situations. Furthermore, PEP was elevated particularly for interaction (as opposed to performance) situations, indicating that the ambiguity of the situation may be an important predictor for prolonged processing.     

Social phobia with sudden onset--post-panic social phobia?

Overlap between social phobia (SP) and panic disorder (PD) has been observed in epidemiological, family, and challenge studies. One possible explanation is that some cases of SP develop as a consequence of a panic attack in a social situation. By definition, these cases of SP have sudden onset. It is hypothesized that patients with SP with sudden onset are more similar to patients with comorbid SP and PD than to patients with SP without sudden onset regarding age of onset, extraversion, and prevalence of anxiety symptoms. One hundred and eighty-two patients with a lifetime diagnosis of PD and/or SP were recruited as part of an etiological study. Patients with SP with sudden onset did, as hypothesized, differ from patients with SP without sudden onset with regard to age of onset and extraversion, but not with regard to symptoms. They did not differ markedly from patients with comorbid SP and PD. The concept of post-panic SP is discussed.     

Selective mutism: more than social anxiety?

This study investigated the relationship between selective mutism (SM), social phobia (SP), oppositionality, and parenting styles. Twenty-one children with SP, 21 children with SM and SP, and 21 normal children ages 7-15, and the mother of each child, participated in an assessment of psychopathological factors potentially related to SM. Children with SM did not endorse higher levels of social anxiety than did children with SP, although clinicians gave higher severity ratings to those who had both disorders. In addition, although a dimensional measure of oppositionality (Eyberg Child Behavior Inventory) did not reveal group differences, there were significantly more diagnoses of oppositional defiant disorder among children with SM (29%) in comparison to children with SP alone (5%). With respect to parenting styles, there were no significant differences among parents of children with SM and the other groups, except that children with SP reported significantly less warmth/acceptance from parents than normal children. These data replicate previous findings that children with SM do not report greater social anxiety than other children with a SP diagnosis. Furthermore, they suggest that oppositional behaviors may be part of the clinical presentation of a subset of children with SM.     

How much do young offenders need social work?

The current orthodoxy in social work with young offenders centres on the twin themes of justice and systems management. The first beseeches social work to use mechanisms, such as the 1982 Criminal Justice Act, as a means of improving the juvenile court process. The second seeks to provide a clear alternative to custody by redefining Intermediate Treatment as a strategy aimed primarily at "heavy end" offenders. The recent news that the numbers of those receiving Youth Custody has risen sharply since the implementation of the above Act, only serves to amplify the importance of the debate about what kind of social work young offenders should receive. The current implication for both the courts and social work practice is that justice is not being done and diversion not being achieved. However, should social work respond by concentrating the vast majority of its endeavours in one particular area, then it would clearly have major implications both for practice and for the allocation of resources. It would therefore have an effect on the kind of social work young offenders might receive and hence how much such a service may be required.     

Narcissists’ social pain seen only in the brain

Narcissism is a complex phenomenon, involving a level of defensive self-enhancement. Narcissists have avoidant attachment styles, maintain distance in relationships and claim not to need others. However, they are especially sensitive to others’ evaluations, needing positive reflected appraisals to maintain their inflated self-views, and showing extreme responses (e.g. aggression) when rejected. The current study tested the hypothesis that narcissists also show hypersensitivity in brain systems associated with distress during exclusion. We measured individual differences in narcissism (Narcissistic Personality Inventory) and monitored neural responses to social exclusion (Cyberball). Narcissism was significantly associated with activity in an a priori anatomically defined social pain network (anterior insula, dorsal anterior cingulate cortex and subgenual anterior cingulate cortex) during social exclusion. Results suggest hypersensitivity to exclusion in narcissists may be a function of hypersensitivity in brain systems associated with distress, and suggests a potential pathway that connects narcissism to negative consequences for longer-term physical and mental health—findings not apparent with self-report alone.     

Neurobiological underpinnings of dogs’ human-like social competence: How interactions between stress response systems and oxytocin mediate dogs’ social skills

Domestic dogs (Canis familiaris) have been suggested as a natural model for human social cognition, possessing social skills that are in many ways functionally analogous to those of young humans. Researchers have debated the origins of dogs’ human-like social competence and the underlying cognitive mechanisms, but only recently have researchers begun to explore their neurobiological underpinnings. In this review, findings from behavioral studies are integrated with what is known about the biological basis of dogs’ human-directed social competence, with an emphasis on how stress-mediating systems, particularly the hypothalamic-pituitary-adrenal (HPA) axis, interact with oxytocin and underlying neural systems to facilitate dogs’ interspecific social-cognitive abilities. The working model presented in this paper offers a biological explanation for many of the inconsistent findings from past work on social cognition in dogs and generates questions for future research in the field of canine social competence.     

Predictors of outcome in residential cognitive and interpersonal treatment for social phobia: Do cognitive and social dysfunction moderate treatment outcome?

Background

: The predictors of residential cognitive (RCT) and residential interpersonal Treatment (RIPT) for social phobia were explored. (1) Sotsky et al. (1991) found differential effects of CT and IPT for depression, suggesting that the level of cognitive or social dysfunction predicted differential outcome. We examined whether an analogous effect could be demonstrated in 10 weeks of residential treatment of 80 social phobia subjects. (2) We also included expectations, age of onset, severity of illness, concurrent anxiety, mood, avoidant personality disorder, and body dysmorphic disorder as predictors in this exploratory study.

Method

: Main outcome was the social phobia subscale of Social Phobia and Anxiety Inventory (SPAI SP). DSM-IV axis I and II interviews were completed.

Results

: (1) Sotsky et al. (1991) findings were not reproduced. However, RIPT subjects with poor general functioning were less improved following treatment. Subjects with concurrent agoraphobia responded better with RCT than subjects without agoraphobia. (2) Age of onset and expectations were the most powerful predictors of post treatment outcome.

Conclusion

: Some patient characteristics appear to impact outcome with RIPT and RCT differentially. The findings are discussed.     

Outcome of social rehabilitation: Whom does it help?

Summary This study examines the outcome of a social rehabilitation program for clients who were defined as socially disabled as a result of severe emotional disorder. Results indicate that a relatively successful subgroup was comprised of clients who had a psychotic diagnosis and a history of acute psychiatric hospitalization. An unsuccessful sub-group was comprised of clients who had neurotic and characterological diagnoses. They had no hospitalizations. This population we define as silent disabled. They present a life style of chronic social disability with attendant chronic marginal emotional compensation. This latter population typically does not receive mental health services. The needs for social rehabilitation are quite different for the two sub-groups. Observations of the differences between populations are presented along with suggestions for different social rehabilitation programs.     

Assessing behavior in extinct animals: was Smilodon social?

It has been suggested that saber-tooth species such as Smilodon fatalis were social because partially healed skeletal injuries were found at Rancho La Brea, California. This conclusion assumes injured animals would die without help. This paper will rebut assertions of sociality. First, cats use metabolic reserves to heal quickly without feeding. Second, dehydration is a more profound limitation than starvation as prey carcasses only provide a quarter of necessary water. Injured animals must be mobile enough to find water or die of dehydration. Their presence in a tar pit also strongly suggests locomotion. Finally, the relatively small brain found in Smilodon is not consistent with sociality. Another argument for sociality has been the large ratio of Smilodon to other species in the La Brea tar pits. However, the remains of a non-social species, the Golden eagle (Aquila chrysaetus), are about as common as Smilodon. Contrariwise, the highly social grey wolf (Canis lupus) and coyote (Canis latrans) are extremely rare. Available evidence does not support sociality in Smilodon.     

Are there social class differences in patients' treatment conceptions?

Traditionally, lower-class individuals who have sought psychiatric help have been hampered in their efforts by classrelated inequities in the delivery of psychiatric services. A common explanation for this phenomenon has been that the treatment conceptions of lower-class individuals are "inappropriate." This report presents theoretical and research evidence challenging this notion. A review of the literature from 1954 through 1974 yielded no good evidence that lower-class patients need, expect, or want treatments incongruent with those of upper-middle-class therapists. An experimental study of the requests for help made by 278 walk-in clinic patients confirmed this observation. Patient requests, as measured by an 84-item, self-rated questionnaire, were largely independent of social class. It was concluded that social class differences in treatment disposition and outcome cannot be attributed to social class differences in patients' treatment conceptions. The possibility that methodological and sociological factors can account for the discrepancies between the findings of this study and past studies is discussed. Strategies for minimizing treatment biases against lower-class patients and for maximizing treatment effectiveness with higher-class patients are also suggested.     

How should we measure social disadvantage in clinic settings?

Abstract. Background: Despite a large research literature supporting their validity, deprivation indices derived from census data have not been routinely applied to clinic populations. Method: A case-note sample of 201 cases was examined, to identify whether such data (Jarman indices) predicted presenting disability separately from diagnostic class (behaviour, emotional, mixed, other, and no diagnosable disorder), or conventional clinic measures of social adversity (ICD-10 psychosocial diagnostic codes). Results: Jarman index scores predicted disability in behaviour disorders or other disorders. Conventional clinic measures of adversity predicted disability in mixed disorders. For emotional disorders, and those cases with no diagnosed disorder, clinically measured adversity and Jarman scores interacted. Conclusions: Postcode related census data capture information about clinic childrens presenting disability that is not available from routine clinic assessment of psychosocial adversity. It should therefore be collected as part of the routine clinical child psychiatry assessment.