Public and private self-consciousness as specific psychopathological features

Abstract

Public self-consciousness (PUBSC) and private self-consciousness (PRISC) represent aspects of dispositional self-directed attention. The aim of the present study was to investigate whether four clinical groups, namely patients with a diagnosis of social phobia, panic disorder, obsessive–compulsive disorder or bulimia nervosa, and normal controls differentiated on the basis of their PUBSC and PRISC scores. Results indicated that both PUBSC and PRISC are extremely elevated in patients with social phobia. Patients with panic disorder and patients with obsessive–compulsive disorder score somewhere between social phobics and normal controls on PUBSC and PRISC scales. Bulimics had significantly higher PUBSC values than both controls and patients with panic disorder, but had lower values than social phobics. Compared to normal controls, bulimics showed no elevated PRISC scores. In addition, contrary to the other groups, PUBSC and PRISC seem to be unrelated in bulimics. Thus, PUBSC and PRISC appear to be specific psychopathological features for German females when comparing groups with different mental disorders and normal controls.

Introduction

Fenigstein, Scheier and Buss (1975) proposed a distinction between self-consciousness and self-awareness. Self-awareness refers to a state of self-directed attention, while self-consciousness refers to dispositional self-directed attention. The dispositional tendency of a person to direct attention to the self can be further divided into public self-consciousness (PUBSC) and private self-consciousness (PRISC). PUBSC refers to the concern with self-presentation and with others’ view of oneself (e.g., worrying about making a good impression). In contrast, PRISC refers to the thoughts and feelings about oneself (e.g., constantly examining one’s motives).

Ingram (1990a) supposed that self-consciousness is—like self-focused attention in general—a non-specific psychopathological feature. In accordance with this view, no differences between agoraphobic patients, patients with affective disorders, patients with anorexia and patients with bulimia were found with respect to PUBSC in a study by Belfer and colleagues (cf. Striegel-Moore, Silberstein & Rodin, 1993). Results from a study by Belfer and Glass (1992) lent no support to the assumption that self-consciousness is a psychopathological feature at all. In this study, no differences were found for either PUBSC or PRISC between agoraphobics, simple phobics and normal controls.

This finding is contrary to the results of Sanz and Avia (1994) who compared extreme groups selected from a sample of male and female Spanish students. In this study four groups were formed: (1) socially anxious subjects, (2) depressed subjects, (3) both socially anxious and depressed subjects and (4) controls having low scores for social anxiety and depression. No difference was found between groups with respect to PUBSCS, although controls showed lower values of PRISC than the other three groups. Ingram (1990b) used an analogue design to compare four groups consisting of male and female students from the USA. Each group showed a different pattern of anxiety and depression scores: (1) high anxiety, (2) high depression, (3) both high anxiety and high depression and (4) both low anxiety and low depression. Compared to the fourth group, the first three groups showed higher scale values for both PRISC and PUBSC.

The association of PUBSC and PRISC to different forms of anxiety was not only investigated in studies comparing clinical groups or extreme groups. In some studies quantitative features of anxiety disorders were set in relation to PUBSC and PRISC. Belfer and Glass (1992) found weak correlations between PRISC and fear of losing control and between PRISC and fear of negative social reactions when anxious for both controls and agoraphobics. In addition, for agoraphobics PRISC was also correlated weakly with the level of perceived autonomic arousal. Agoraphobic fears were also found to be correlated with both PUBSC and PRISC in a Swedish study (Saboonchi & Lundh, 1997). In an Icelandic study (Smári, Clausen, Hardarson & Arnarsln, 1995), however, no correlation above r=0.20 was found between agoraphobic fears and both PUBSC and PRISC.

Hope and Heimberg (1988) carried out a correlational study with a total of 44 male and female patients who received the primary diagnosis of social phobia according to DSM-III (American Psychiatric Association, 1980). Although restrictions of variance for the anxiety measures used have to be considered in this highly selected sample, the authors were able to identify correlations between social anxiety and PUBSC and PRISC, respectively. Overall, this study indicated that PUBSC seems to be more relevant for social phobia than PRISC. Correlational studies with non-clinical samples, however, revealed inconsistent results with respect to the association between PRISC and social anxiety. An Australian (Monfries & Kafer, 1993) and a Swedish study (Saboonchi & Lundh, 1997) investigating males and females revealed an association between social anxiety and both PUBSC and PRISC. In contrast, both an Icelandic (Smári et al., 1995) and a Dutch study (Bögels, Alberts & de Jong, 1996), also investigating males and females, showed a correlation between social anxiety and PUBSC, but no association between social anxiety and PRISC.

There are few studies investigating the association between features of eating disorders and PUBSC and PRISC, respectively. Here, studies comparing clinical groups or extreme groups to healthy controls yielded results similar to those of studies correlating eating related cognitions to PRISC and PUBSC. Striegel-Moore et al. (1993) compared bulimic patients, non-clinical subjects with elevated levels of disturbed eating and normal controls with respect to PRISC and PUBSC. Bulimic patients and subjects with high scores on eating disorder scales had significantly higher scores of PUBSC than normal controls. No differences between groups were found with respect to PRISC. A study by Geissner, Bauer and Fichter (1997) indicated that compared to normative data, PUBSC is also elevated in anorexic patients. In this study PRISC was not assessed. Blanchard and Frost (1983) found in a sample of female students that concern about dieting was correlated only weakly with PUBSC (r=0.30, p<0.001) and was not correlated to PRISC (r=0.10, not significant). In addition, assuming a positive intercorrelation between PUBSC and PRISC and using formulae according to Steiger (1980), a reanalysis of this data revealed that PUBSC is correlated significantly higher with regard to dieting than PRISC. A study by Striegel-Moore et al. (1993) revealed similar findings for scales assessing body dissatisfaction or pathological eating attitudes in a non-clinical sample of females.

To summarise, there is some evidence that PUBSC is relevant in patients with eating disorders, but not PRISC. In reviewing the results, it remained unclear, however, to what extent features of PUBSC and PRISC are characteristic of patients with different anxiety disorders. Since clear empirical findings are essential for the development of theoretical concepts about cognitive specificity in mental disorders, it was the aim of the present study to investigate whether four clinical groups, namely patients with a diagnosis of social phobia, panic disorder, obsessive–compulsive disorder or bulimia nervosa, and normal controls might be differentiated on the basis of their PUBSC and PRISC scores. In order to minimise variability within groups, only women were included in the present study.