Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-19T11:07:13.221Z Has data issue: false hasContentIssue false
  • English
  • Français

New evidence of heterogeneity in social anxiety disorder: Defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors

Published online by Cambridge University Press:  15 April 2020

C. Binelli ,
A. Muñiz ,
S. Sanches ,
A. Ortiz ,
R. Navines ,
E. Egmond ,
M. Udina ,
A. Batalla ,
C. López-Sola  and
J.A. Crippa
...Show all authors
C. Binelli
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
A. Muñiz
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
S. Sanches
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
A. Ortiz
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
R. Navines
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Human Pharmacology and Clinical Neurosciences Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
E. Egmond
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
M. Udina
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain
A. Batalla
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
C. López-Sola
Affiliation:
Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
J.A. Crippa
Affiliation:
Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
S. Subirà
Affiliation:
Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
R. Martín-Santos*
Affiliation:
Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
*
*Corresponding author. Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, University of Barcelona, CIBERSAM, Villarroel, 150, 08036 Barcelona, Spain. E-mail addresses:[email protected] (R. Martín-Santos).
Get access

Abstract

Purpose:

To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions.

Method:

One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR).

Results:

Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with “high-HA/low-NS”, and a smaller (39%) atypical impulsive subgroup with high–moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P = 0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P < 0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P = 0.005).

Conclusions

Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.

Keywords

Social anxiety disorderImpulsive subtypeHarm avoidanceNovelty seekingTemperament and character inventorySTin2.VNTR
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 1 , January 2015 , pp. 160 - 165
Copyright
Copyright © European Psychiatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kessler, RC, Petukhova, M, Sampson, NA, Zaslavsky, AM, Wittchen, H.-U.. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 2012;21(3):169–184.CrossRefGoogle ScholarPubMed
Diagnostic, APAStatistical Manual of Mental Disorders, 4th ed, Washington, DC: American Psychiatric Association; 2000.Google Scholar
Filho, AS, Hetem, LAB, Ferrari, MCF, Trzesniak, C, Martín-Santos, R, Borduqui, T, et al.Social anxiety disorder: what are we losing with the current diagnostic criteria?. Acta Psychiatr Scand 2010;121(3):216–226.CrossRefGoogle ScholarPubMed
Marteinsdottir, I, Svensson, A, Svedberg, M, Anderberg, UM, von Knorring, L. The role of life events in social phobia. Nord J Psychiatry 2007;61(3):207–212.CrossRefGoogle ScholarPubMed
Stein, M, Stein, D. Seminar Social anxiety disorder. Lancet 2008;371:1115–1125.CrossRefGoogle Scholar
Kampman, O, Viikki, M, Järventausta, K, Leinonen, E. Meta-analysis of anxiety disorders and temperament. Neuropsychobiology 2014;69(3):175–186.CrossRefGoogle ScholarPubMed
Grant, B, Hasin, D, Blanco, C, Stinson, F, Chou, S, Goldstein, R, et al.The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2005;66(11):1351–1361.CrossRefGoogle ScholarPubMed
Cloninger, C, Svrakic, D, Przybeck, T. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50(12):975–990.CrossRefGoogle ScholarPubMed
Cloninger, C. A systematic method for clinical description and classification of personality variants: A proposal. Arch Gen Psychiatry 1987;44(6):573–588.CrossRefGoogle ScholarPubMed
Chatterjee, S, Sunitha, T, Velayudhan, A, Khanna, S. An investigation into the psychobiology of social phobia: personality domains and serotonergic function. Acta Psychiatr Scand 1997;95(6):544–550.CrossRefGoogle ScholarPubMed
Pélissolo, A, André, C, Pujol, H, Yao, SN, Servant, D, Braconnier, A, et al.Personality dimensions in social phobics with or without depression. Acta Psychiatr Scand 2002;105(2):94–103.CrossRefGoogle ScholarPubMed
Hofmann, SG, Loh, R. The Tridimensional Personality Questionnaire: changes during psychological treatment of social phobia. J Psychiatr Res 2006;40(3):214–220.CrossRefGoogle ScholarPubMed
Marteinsdottir, I, Tillfors, M, Furmark, T, Anderberg, UM, Ekselius, L. Personality dimensions measured by the Temperament and Character Inventory (TCI) in subjects with social phobia. Nord J Psychiatry 2003;57(1):29–35.CrossRefGoogle ScholarPubMed
Birbaumer, N, Grodd, W, Diedrich, O, Klose, U, Erb, M, Lotze, M, et al.fMRI reveals amygdala activation to human faces in social phobics. Neuroreport 1998;9(6):1223–1226.CrossRefGoogle ScholarPubMed
Faytout, M, Tignol, J, Swendsen, J, Grabot, D, Aouizerate, B, Lépine, JP. Social phobia, fear of negative evaluation and harm avoidance. Eur Psychiatry 2007;22(2):75–79.CrossRefGoogle ScholarPubMed
Lochner, C, Hemmings, S, Seedat, S, Kinnear, C, Schoeman, R, Annerbrink, K, et al.Genetics and personality traits in patients with social anxiety disorder: a case control study in South Africa. Eur Neuropsychopharmacol 2007;17(5):321–327.CrossRefGoogle ScholarPubMed
Mörtberg, E, Bejerot, S, Aberg Wistedt, A. Temperament and character dimensions in patients with social phobia: patterns of change following treatments?. Psychiatry Res 2007;152(1):81–90.CrossRefGoogle ScholarPubMed
Kachin, KE, Newman, MG, Pincus, AL. An interpersonal problem approach to the division of social phobia subtypes. Behav Ther 2001;32(3):479–501.CrossRefGoogle Scholar
Kashdan, TB, Hofmann, SG. The high-novelty-seeking, impulsive subtype of generalized social anxiety disorder. Depress Anxiety 2008;25(6)|:535–541.CrossRefGoogle ScholarPubMed
Kashdan, TB, McKnight, PE, Richey, JA, Hofmann, SG. When social anxiety disorder co-exists with risk-prone, approach behavior: investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication. Behav Res Ther 2009;47(7):559–568.CrossRefGoogle ScholarPubMed
Kashdan, TB, Elhai, JD, Breen, WE. Social anxiety and disinhibition: an analysis of curiosity and social rank appraisals, approach-avoidance conflicts, and disruptive risk-taking behavior. J Anxiety Disord 2008;22(6):925–939.CrossRefGoogle ScholarPubMed
Mörtberg, E, Tillfors, M, van Zalk, N, Kerr, M. An atypical anxious-impulsive pattern of social anxiety disorder in an adult clinical population. Scand J Psychol 2014;55(4):350–356.CrossRefGoogle Scholar
Miskovic, V, Schmidt, LA. Social fearfulness in the human brain. Neurosci Biobehav Rev 2012;36(1):459–478.CrossRefGoogle ScholarPubMed
Savitz, JB, Ramesar, RS. Genetic variants implicated in personality: a review of the more promising candidates. Am J Med Genet Part B 2004;131B(1):20–32.CrossRefGoogle ScholarPubMed
Serretti, A, Calati, R, Mandelli, L, De Ronchi, D. Serotonin transporter gene variants and behavior: a comprehensive review. Curr Drug Targets 2006;7(12):1659–1669.CrossRefGoogle ScholarPubMed
Heils, A, Teufel, A, Petri, S, Stöber, G, Riederer, P, Bengel, D, et al.Allelic variation of human serotonin transporter gene expression. J Neurochem 1996;66(6):2621–2624.CrossRefGoogle ScholarPubMed
Fiskerstrand, CE, Lovejoy, EA, Quinn, JP. An intronic polymorphic domain often associated with susceptibility to affective disorders has allele-dependent differential enhancer activity in embryonic stem cells. FEBS Lett 2014;458(2):171–174.CrossRefGoogle Scholar
MacKenzie, A, Quinn, J. A serotonin transporter gene intron 2 polymorphic region, correlated with affective disorders, has allele-dependent differential enhancer-like properties in the mouse embryo. Proc Natl Acad Sci 1999;96(26):15251–15255.CrossRefGoogle ScholarPubMed
Furmark, T, Tillfors, M, Garpenstrand, H, Marteinsdottir, I, Långström, B, Oreland, L, et al.Serotonin transporter polymorphism related to amygdala excitability and symptom severity in patients with social phobia. Neurosci Lett 2004;362(3):189–192.CrossRefGoogle ScholarPubMed
Furmark, T, Henningsson, S, Appel, L, Ahs, F, Linnman, C, Pissiota, A, et al.Genotype over-diagnosis in amygdala responsiveness: affective processing in social anxiety disorder. J Psychiatry Neurosci 2009;34(1):30–40.Google ScholarPubMed
Klumpp, H, Fitzgerald, DA, Cook, E, Shankman, SA, Angstadt, M, Phan, KL. Serotonin transporter gene alters insula activity to threat in social anxiety disorder. Neuroreport 2014;25(12):926–931.CrossRefGoogle ScholarPubMed
Rytwinski, NK, Fresco, DM, Heimberg, RG, Coles, ME, Liebowitz, MR, Cissell, S, et al.Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale. Depress Anxiety 2009;26(1):34–38.CrossRefGoogle ScholarPubMed
Liebowitz, M. Social phobia. Mod Prob Pharmacopsychiatry 1987;22:141–173.CrossRefGoogle ScholarPubMed
Bobes, J, Badía, X, Luque, A, García, M, González, M, Dal-Ré, R. Validación de las versiones en español de los cuestionarios Liebowitz Social Anxiety Scale. Social Anxiety and Distres Scale y Sheehan Disability Inventory para la evaluación de la fobia social. Med Clin 1999;112(14):14–16.Google Scholar
First, MB, Spitzer, RL, Gibbon, MWJStructured Clinical Interview for DSM-IV-RS Axis 1 Disorders. New York: Biometrics; 2007.Google Scholar
Gutiérrez, F, Torrens, N, Boget, T, Martín-Santos, R, Sangorrín, J, Pérez, G, et al.Psychometric properties of the Temperament and Character Inventory (TCI) questionnaire in a Spanish psychiatric population. Acta Psychiatr Scand 2001;103(2):143–147.CrossRefGoogle Scholar
Svrakic, DM, Draganic, S, Hill, K, Bayon, C, Przybeck, TR, Cloninger, CRTemperament, character, and personality disorders: etiologic, diagnostic, treatment issues. Acta Psychiatr Scand 2002;106(3):189–195.CrossRefGoogle ScholarPubMed
Stevens, S, Cludius, B, Bantin, T, Hermann, C, Gerlach, ALInfluence of alcohol on social anxiety: an investigation of attentional, physiological and behavioral effects. Biol Psychol 2014;96(0):126–133.CrossRefGoogle ScholarPubMed
Csorba, J, Dinya, E, Ferencz, E, Steiner, P, Bertalan, G, Zsadon, ANovelty seeking: difference between suicidal and non-suicidal Hungarian adolescent outpatients suffering from depression. J Affect Disord 2014;120(1):217–220.CrossRefGoogle Scholar
Krysinska, K, Heller, TS, De Leo, DSuicide and deliberate self-harm in personality disorders. Curr Opin Psychiatry 2006;19(1):95–101.CrossRefGoogle ScholarPubMed
Gutiérrez, F, Navinés, R, Navarro, P, García-Esteve, L, Subirá, S, Torrens, M, et al.What do all personality disorders have in common? Ineffectiveness and uncooperativeness. Compr Psychiatry 2008;49(6):570–578.CrossRefGoogle ScholarPubMed
Erwin, B, Heimberg, R, Liebowitz, M, Schneir, FAnger experience and expression in social anxiety disorder: pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behav Ther 2003;34(3):331–350.CrossRefGoogle Scholar
Kazantseva, AV, Gaysina, DA, Faskhutdinova, GG, Noskova, T, Malykh, SB, Khusnutdinova, EKPolymorphisms of the serotonin transporter gene (5-HTTLPR, A/G SNP in 5-HTTLPR, and STin2 VNTR) and their relation to personality traits in healthy individuals from Russia. Psychiatr Genet 2008;18(4):167–176.CrossRefGoogle ScholarPubMed
Ohara, K, Suzuki, Y, Ochiai, M, Tan, K, Ohara, K, Tsukamoto, T, et al.A variable number tandem repeat of the serotonin transporter gene and anxiety disorders. Prog Neuropsychopharmacol Biol Psychiatry 1999;23(1):55–65.CrossRefGoogle ScholarPubMed
Baca-Garcia, E, Vaquero-Lorenzo, C, Diaz-Hernandez, M, Rodriguez-Salgado, B, Dolengevich-Segal, H, Arrojo-Romero, M, et al.Association between obsessive-compulsive disorder and a variable number of tandem repeats polymorphism in intron 2 of the serotonin transporter gene. Prog Neuropsychopharmacol Biol Psychiatry 2007;31(2):416–420.CrossRefGoogle Scholar
Rees, M, Norton, N, Jones, I, McCandless, F, Scourfield, J, Holmans, P, et al.Association studies of bipolar disorder at the human serotonin transporter gene (hSERT; 5HTT). Mol Psychiatry 1995;2(7):398–402.CrossRefGoogle Scholar
Fan, JB, Sklar, PMeta-analysis reveals association between serotonin transporter gene STin2 VNTR polymorphism and schizophrenia. Mol Psychiatry 2005;10(10):928–938. [891].CrossRefGoogle Scholar
Florez, G, Saiz, P, Garcia-Portilla, P, Alvarez, S, Nogueíras, L, Morales, B, et al.Association between the Stin2 VNTR polymorphism of the serotonin transporter gene and treatment outcome in alcohol-dependent patients. Alcohol Alcohol 2008;43(5):516–522.CrossRefGoogle ScholarPubMed
Pizzo de Castro, M, Maes, M, Guembarovski, R, Ariza, C, Reiche, EM, Vargas, H, et al.SLC6A4 STin2 VNTR genetic polymorphism is associated with tobacco use disorder, but not with successful smoking cessation or smoking characteristics: a case control study. BMC Genet 2014;15(1):78.CrossRefGoogle ScholarPubMed
Bah, J, Lindström, M, Westberg, L, Mannerås, L, Ryding, E, Henningsson, S, et al.Serotonin transporter gene polymorphisms: effect on serotonin transporter availability in the brain of suicide attempters. Psychiatry Res Neuroimaging 2014;162(3):221–229.CrossRefGoogle Scholar
Kluger a, N, Siegfried, Z, Ebstein, RPA meta-analysis of the association between DRD4 polymorphism and novelty seeking. Mol Psychiatry 2002;7(7):712–717.CrossRefGoogle ScholarPubMed
Kyeong, S, Kim, E, Park, H.-J., Hwang, D.-U.Functional network organizations of two contrasting temperament groups in dimensions of novelty seeking and harm avoidance. Brain Res 2014;1575:33–44.CrossRefGoogle ScholarPubMed
Adolphs, RThe biology of fear review. Curr Biol 2013;23(2):R79–R93.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.