Putative clinical subtypes of social phobia: a factor-analytical study.

OBJECTIVE: To examine symptomatological subtypes of social phobia (SP) and their relationships with a number of feared situations and avoidant personality disorder (APD). METHOD: In 153 out-patients with SP according to DSM-III-R criteria, clinical subtypes were investigated by means of principal component factor analysis of the Liebowitz Social Anxiety Scale (LSAS). We compared the various SP subtypes on the basis of the highest Z-scores obtained on each LSAS factor. RESULTS: Five factors (interpersonal anxiety, formal speaking anxiety, stranger-authority anxiety, eating and drinking while being observed, anxiety of doing something while being observed) emerged, accounting for 64.7% of the total variance. When the dominant LSAS factor groups were compared, the highest values in the numbers of feared situations and the presence of APD were observed in the "interpersonal anxiety" dominant group and the lowest in the "anxiety of doing something while being observed". The "interpersonal anxiety" dominant group was the most likely to present a positive family history for SP and a lifetime comorbidity with mood disorders. CONCLUSION: The emerging multidimensional structure of phobia is congruent with, and further enriches, the existing literature.

Avoidant personality in social phobia and panic-agoraphobic disorder: a comparison.

BACKGROUND: Avoidant personality disorder (APD) is generally believed to be related to social phobia (SP), especially to generalized subtype. However, it has also been reported to be prevalent in panic disorder-agoraphobia (PDA). In the present investigation, we wished to explore whether APD in each of these disorders has discriminatory features. METHOD: We studied 71 SP and 119 PDA patients with state-of-the-art clinical instruments based on DSM-III-R. RESULTS: The pattern of social avoidance in SP was more pervasive: it was characterized by a higher level of interpersonal sensitivity and greater severity, associated with psychopathology as well as a higher rate of Axis I comorbidity. By contrast, avoidance of non-routine situations characterized APD occurring in the setting of PDA. LIMITATIONS: Differences in inclusion criteria and comorbidity rates, as well as overlap between different operational disorders, may have influenced our findings. CONCLUSION: ADP is operationally broad, and 'avoidant' as a specifier of a personality type is insufficiently precise. ADP captures avoidant traits --which appear secondary to a core dimension such as interpersonal sensitivity--but is basically a heterogeneous condition influenced by the nature of comorbid Axis I disorders.

Depressive comorbidity of panic, social phobic, and obsessive-compulsive disorders re-examined: is there a bipolar II connection?

Utilizing the DSM-III-R schema, we have investigated lifetime comorbidity between panic disorder with or without agoraphobia (PD), social phobia (SP) and obsessive-compulsive disorder (OCD) on the one hand, and mood disorder on the other. Compared with PD, the results for SP and OCD showed significantly higher numbers of comorbid anxiety and mood disorders. In addition, SP and OCD were significantly more likely to cooccur with each other than with PD. The complexity of these comorbid patterns is underscored by the finding of significantly higher numbers of anxiety disorders in those with lifetime comorbidity with bipolar (especially bipolar II) disorder. We conclude that the comorbidity between anxiety and mood disorders - conventionally conceived as the relationship between anxiety and unipolar depressive states -- might very well extend into the domain of bipolar spectrum disorders in a subset of these disorders. Among the latter, the spontaneous or antidepressant-induced switches into brief disinhibited (hypomanic) behavior can be conceptualized to lie on a dimensional continuum with the temperamental inhibition (or constraint) underlying the anxiety disorders under discussion. These findings and theoretical considerations have important therapeutic implications.