Social interaction anxiety and personality traits predicting engagement in health risk sexual behaviors

https://doi.org/10.1016/j.janxdis.2018.05.002Get rights and content

Highlights

  • This study discerned latent classes of social interaction anxiety and personality traits.

  • Discerned classes differed in engagement in health risk sexual behaviors (HRSB).

  • High social interaction anxiety and high levels of personality predicted HRSB.

  • This study supports and extends findings on the heterogeneity of social anxiety.

Abstract

Individuals with social interaction anxiety, a facet of social anxiety disorder, withdraw from or avoid social encounters and generally avoid risks. However, a subset engages in health risk sexual behavior (HRSB). Because sensation seeking, emotion dysregulation, and impulsivity predict engagement in HRSB among adolescents and young adults, the present study hypothesized that latent classes of social interaction anxiety and these personality traits would differentially predict likelihood of engagement in HRSB. Finite mixture modeling was used to discern four classes: two low social interaction anxiety classes distinguished by facets of emotion dysregulation, positive urgency, and negative urgency (Low SIAS High Urgency and Low SIAS Low Urgency) and two high social interaction anxiety classes distinguished by positive urgency, negative urgency, risk seeking, and facets of emotion dysregulation (High SIAS High Urgency and High SIAS Low Urgency). HRSB were entered into the model as auxiliary distal outcomes. Of importance to this study were findings that the High SIAS High Urgency class was more likely to engage in most identified HRSB than the High SIAS Low Urgency class. This study extends previous findings on the heterogeneity of social interaction anxiety by identifying the effects of social interaction anxiety and personality on engagement in HRSB.

Introduction

Social anxiety disorder is a prevalent psychological diagnosis characterized as strong fears of circumstances or interactions in which affected individuals may be evaluated by others; fear of being judged negatively for social behavior or display of anxiety symptoms; avoidance of social encounters; having high levels of anxiety during social encounters; and anxious symptoms above what would be expected for the social experience (American Psychiatric Association [APA], 2013 p. 203). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has a specifier for performance only social anxiety (APA, 2013 p. 203), and literature has supported two presentation categories of social anxiety: Social interaction anxiety, which pertains to fear of encountering or communicating with other people, and social observation or social performance anxiety, relating to situations in which individuals are observed by others, presenting, or performing (e.g., Kashdan, 2004). Individuals with high levels of social interaction anxiety report decreased interest in pleasurable activities, energy, relationship satisfaction, and sexual satisfaction, and increased behavioral inhibition (Kashdan, 2004; Kashdan, Elhai, & Breen, 2008; Kashdan, Adams et al., 2011; Kashdan, Weeks, & Savostyanova, 2011).

When exploring the relation between the broader construct of social anxiety and the key outcome variable of the current study, sexual behavior, research indicates that individuals with high levels of social anxiety report significantly less pleasure and connectedness during partnered sexual encounters (Kashdan, Adams et al., 2011). For women, high levels of social anxiety have been associated with less frequent sexual activity, less daily sexual contact, and avoidance of sexual partners. However, among men, higher levels of social anxiety have been associated with more frequent sexual activity and greater likelihood of sexual encounters, related to augmenting perceived social status. This suggests the use of partnered sexual behavior to increase self-esteem, thereby counteracting fears of judgement or rejection (Kashdan, Adams et al., 2011). However, frequent sexual encounters, especially with multiple partners, can increase the risk of experiencing unwanted or harmful outcomes, such as exposure to sexually transmitted infections.

In addition to social anxiety, adolescents and young adults are vulnerable to unintended consequences of engaging in health risk behaviors (APA, 2013; CDC, 2013). Health risk behaviors are behaviors that increase risk of injury, disability, or death (Steptoe & Wardle, 2004). Health risk sexual behaviors (HRSB) are associated with unintended pregnancy and sexually transmitted infections and include sex with multiple partners, sex with unfamiliar partners, and lacking or incorrect condom use (U.S. Department of Health & Human Services, 2015). HRSB are a particularly salient concern for adolescents and young adults, especially related to the transmission of sexually transmitted infections, which occurs more frequently in adolescents and young adults than any other age group (CDC, 2013). Some adolescents and young adults with social anxiety engage in HSRB despite negative affect profiles and low energy levels – both of which would be expected to relate to non-engagement in sexual risk-taking (Kashdan & McKnight, 2010; Lorian, Mahoney, & Grisham, 2012).

Past research on social interaction anxiety and risk-taking has identified two distinct subgroups of social interaction anxiety. The first subgroup reflects typical diagnostic criteria of social anxiety disorder, wherein individuals experience elevated social fears, avoid risky and novel situations, and withdraw from social interactions (Kashdan, McKnight, Richey, & Hofmann, 2009). Individuals in the second subgroup approach novel and risky experiences, including more frequent social and sexual encounters, unprotected sex, substance use, and aggression, despite social fears or as a way to cope with anxiety (Kashdan et al., 2008, Kashdan et al., 2009; Kashdan & Hofmann, 2008). Up to 21% of individuals with social anxiety disorder can be classified in the risk-approach subgroup (see Kashdan & McKnight, 2010). However, key demographic factors, including sexual orientation, may impact the relation between social anxiety and engagement in HRSB. For example, Hart and Heimberg (2005) with a sample of 100 gay and bisexual males ages 16–21 found that anxiety pertaining to social observations, but not social interaction anxiety, was related to increased insertive anal intercourse. Further, neither social interaction anxiety nor social observation anxiety were related to increased receptive anal intercourse. Additionally, among HIV seropositive men who have sex with men (MSM), social observation anxiety, and not social interaction anxiety, was associated with increased risk of sexually transmitting HIV through unprotected insertive anal sex (Hart, James, Purcell, & Farber, 2008). However, Pachankis and Goldfried (2006) supported previous findings that, compared to heterosexual men, gay men experienced increased social interaction anxiety. Thus, it could be that if social interaction anxiety is generally higher for sexual minority individuals, especially men, it may have less of an impact than other factors, including social observation anxiety.

To better understand why some individuals with social anxiety engage in health risk behaviors, several factors have been explored (Kashdan et al., 2009). Compared to the risk-avoidant group, most individuals in the risk-approach social anxiety subgroup tend to be younger, less healthy men with poorer socioeconomic status. Previous studies have identified processes related to sensation seeking, impulsivity, and emotion dysregulation to account for differences between the majority group of socially anxious individuals who withdraw from risk and the minority subgroup who approach risk (Kashdan & Hofmann, 2008). Thus, individual differences in these traits may account for distinctions between the risk-approach and risk-avoidant subgroups.

Sensation seeking, “the seeking of varied, novel, complex, and intense sensations and experiences, and the willingness to take physical, social, legal, and financial risks for the sake of such experiences” (Zuckerman, 1994, p. 27), is associated with risky behavior (Knorr, Jenkins, & Conner, 2013). College students high in sensation seeking report engaging in HSRB more than those low in sensation seeking (Gullette & Lyons, 2005). In their meta-analysis of studies evaluating personality traits predicting engagement in HRSB, Hoyle, Fejfar, and Miller (2000) identified sensation seeking to be positively correlated with all forms of sexual risk taking, especially number of sexual partners and unprotected sexual encounters. However, sensation seeking had a significantly greater effect on number of partners than on condom use. Further, sensation seeking was a significantly stronger predictor of risky sexual behavior among college students than people not in college. Deriving reward from novel and risky experiences may account for some of the relation between social anxiety and HRSB among adolescents and young adults (Kashdan & Hofmann, 2008); however, as noted, other personality traits may be involved.

Individuals with social anxiety may engage in risky behavior related to poor emotion regulation, the process by which individuals experience and respond to emotions (Gross, 1999). Individuals with social anxiety may experience distress about their emotional experiences (Turk, Heimberg, Luterek, Mennin, & Fresco, 2005). People with social anxiety also express both negative and positive emotions less than those without social anxiety, but express negative emotions more than positive emotions. Additionally, individuals with social anxiety are less attentive to their emotions than people without social anxiety and have reported difficulty discerning between feelings and labeling them (Turk et al., 2005). Both social anxiety and emotion dysregulation are predicted by experiential avoidance, wherein individuals criticize and refuse to experience their own personal thoughts, feelings, and perceptions. In doing so, they may engage in safety behaviors aimed at emotional avoidance (Hayes, 1994; Hayes, Strosahl, & Wilson, 1999; Kashdan, Barrios, Forsyth, & Steger, 2006). Safety behaviors include avoiding anxiety-provoking situations, withdrawing from interactions with others, and suppressing emotional expressions (Kashdan, Adams et al., 2011; Spokas, Luterek, & Heimberg, 2009). Thus, emotion dysregulation related to experiential avoidance may be an underlying mechanism of symptomology.

Emotion dysregulation has been associated with impairments in impulse control, goal-directed behaviors, and use of coping skills (Donahue, Goranson, McClure, & Van Male, 2014). Social anxiety and emotion dysregulation have been associated with engaging in risky sexual encounters (see Kashdan & McKnight, 2010). HSRB might function as a coping strategy for socially anxious individuals experiencing emotion dysregulation. Specifically, HSRB might function as an avoidance strategy by distracting individuals from anxiety, fear of rejection, and rumination (Kashdan, Weeks et al., 2011). This negatively reinforces engagement in HSRB, integrating it into a coping repertoire (Reynolds et al., 2013). However, engaging in risky behavior may cause more negative self-evaluations and fear of perceived judgement, maintaining symptoms of social interaction anxiety and increasing the likelihood of further engaging in risky behaviors to distract from ongoing symptomology (Kashdan et al., 2008; Kashdan, Weeks et al., 2011).

Previous studies have associated social anxiety with risky behavior through impulsivity, especially via depletion of self-regulation resources (Reynolds et al., 2013). Individuals with social anxiety utilize self-regulatory resources to frequently and intensely self-monitor, predict others’ evaluations of themselves, suppress emotional experiences and expressions, and ruminate on past and expected social encounters in an attempt to enhance self-presentation (Vohs, Baumeister, & Ciarocco, 2005). Further, individuals with social anxiety may self-regulate more when there is a greater risk of judgement or rejection by others or when they feel unclear about how to present themselves to others. Coping with such social stress may divert self-regulation resources away from controlling impulsivity, resulting in engaging in risky behavior (Reynolds et al., 2013).

Reinforcement sensitivity theory (RST) posits that learning and behavioral responding are driven by individual differences in reward and punishment sensitivity (Gray, 1982, Gray, 1991). These individual differences underlie key personality traits, including anxiety and impulsivity (Gray, 1982, Gray, 1991). Three distinct neurobiological systems are involved in reward and punishment sensitivity and responding: the Behavioral Approach System, Behavioral Inhibition System (BIS), and Fight/Flight/Freeze System (FFFS). The BAS encourages approach behavior toward rewarding or punishment-relieving stimuli (Gray, 1990; Gray & McNaughton, 2000). The BIS is a conflict detection system that prompts behavioral inhibition or activation of the FFFS in response to novel stimuli. Lastly, the FFFS responds to threats, triggering flight away from threats perceived as far away, fight if threats cannot be escaped, or freezing.

Individuals with high BAS and low BIS sensitivity are prone to seek out rewards, be more impulsive, and more likely to experience positive affect. Individuals with low BAS and high BIS reactivity are sensitive to punishment, behaviorally inhibited, more anxious, and more likely to experience negative affect (Corr, 2001, Corr, 2002; Kambouropoulos & Staiger, 2004). Further, differences in BIS and BAS sensitivity are related to the development and presentation of psychopathology. Specifically, higher BIS reactivity has been associated with rumination and anxiety disorders, including social anxiety, while facets of BAS measurement have been associated with engagement in health-risk behaviors, including HRSB (Braddock et al., 2011; Voigt et al., 2009).

While the majority of individuals with social interaction anxiety are behaviorally inhibited, a sub-group of individuals engages in risky behaviors, indicating heterogeneity of social interaction anxiety. Individual differences in sensation seeking, emotion regulation, and impulsivity have been associated with engagement in HRSB and may identify individuals with social interaction anxiety who engage in HRSB.

The present study addressed two goals. First, to extend previous findings regarding the heterogeneity of social interaction anxiety by identifying personality traits which may account for engagement in HRSB. Second, to examine how social interaction anxiety and personality traits differentially predict engagement in HRSB. To address these goals, two broad hypotheses and related sub-hypotheses were tested.

We hypothesized that distinct latent classes of social interaction anxiety and personality traits would be discerned. Previous studies have identified heterogeneity in social interaction anxiety by identifying a risk-approach subgroup of individuals with social interaction anxiety. However, little is known about underlying mechanisms explaining the differentiation between risk-approach versus risk-avoidant individuals with social interaction anxiety. By including personality traits which have been implicated in engagement in risky behaviors, we sought to discern thresholds of social interaction anxiety and personality traits for class membership, thereby identifying underlying mechanisms of the heterogeneity of social interaction anxiety.

Previous studies have identified a subgroup of individuals with social interaction anxiety which engages in HRSB. Further, the personality traits sensation seeking, emotion dysregulation, impulsivity, and behavioral approach relate to increased HRSB while behavioral inhibition relates to decreased HRSB. Thus, we hypothesized that the discerned latent classes of social interaction anxiety and included personality traits would differ in their likelihood of engagement in HRSB. Specifically, we hypothesized that a class indicated by higher levels of social interaction anxiety, sensation seeking, emotion dysregulation, impulsivity, and behavioral approach would be more likely to engage in HRSB than a class with higher levels of social interaction anxiety and lower levels on these personality traits.

Section snippets

Participants and procedures

Participants were 1005 undergraduate students (Mage = 18.92, SD = 1.69) recruited from introductory psychology courses who received class credit for participating. Participants self-reported their sex, sexual orientation, race, and ethnicity, as shown in Table 1.

Risky Behavior Inventory

Engagement in HSRB was assessed with the Risky Behavior Inventory (RBI; Conner & Henson, 2013). The RBI inquires about engagement in, and frequency of, several types of risky behaviors. We operationalized HRSB as behaviors which may

Overall model fit

The four-class solution provided the best overall model fit to the data (see Table 2). First, examination of the LMR indicated that the two-class model was an improvement over the one-class model; the three-class model was an improvement over the two-class model; and the four-class model was an improvement over the three-class model. The five-class model was not an improvement over the four-class model. Because the LMR indicated the five-class solution was not a significant improvement over the

Discussion

The two goals of the present study were to discern latent classes of social interaction anxiety and personality traits, and to explore how these classes relate to engagement in health risk sexual behaviors (HRSB). The personality traits of interest are ones that have been implicated in engagement in risky behaviors: sensation seeking, emotion dysregulation, impulsivity (measured by positive urgency and negative urgency), behavioral approach, and behavioral inhibition.

Finite mixture modeling was

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Note

From a thesis submitted to the Academic Faculty of Colorado State University in partial fulfillment of the requirements for the degree of Master of Science in Psychology.

The current study was approved by the Colorado State University Institutional Review Board (“Behavioral Assessment of Sensation Seeking,” study number 068-17H).

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