Interpersonal problems in social anxiety disorder across different relational contexts
Introduction
Interpersonal problems are a fundamental criterion for only a handful of psychiatric disorders. For some of those disorders, individuals with social impairment (e.g., autism spectrum disorders) are assumed to have distinctive social skills impairments that can be observed early in development. By contrast, it is generally assumed that people with social anxiety disorder (SAD) either have social skills largely intact or that social skills deficits are secondary contributors to the maintenance of the disorder (see Beidel, Rao, Scharfstein, Wong, & Alfano, 2010; also see Rapee & Spence, 2004 for discussion of exceptions). Instead, conceptualizations of SAD emphasize a combination of cognitive biases, such as an increased sensitivity to social evaluation, and maladaptive interpretations of social situations as contributors to the development and maintenance of SAD (see Wong & Rapee, 2016). The cognitive biases that characterize the disorder make it difficult to study the social problems individuals with SAD may experience, however. When people with SAD report interpersonal problems, it may be difficult to discern if problems are the result of real, observable deficits, or are instead due to negatively biased interpretation (Christensen, Stein, & Means-Christensen, 2003; Moscovitch, Orr, Rowa, Reimer, & Antony, 2009; Rapee & Lim, 1992).
Individuals with SAD indicate that they experience more difficulty engaging in or sustaining relationships with others (Kashdan, Volkmann, Breen, & Han, 2007; Rodebaugh, 2009) and may employ maladaptive strategies, particularly in close relationships, that lead to interpersonal distress. Using the Inventory of Interpersonal Problems (IIP; Horowitz, Alden, Wiggins, & Pincus, 2000), Alden and Phillips (1990) found that undergraduate students with elevated social anxiety scores self-reported having problems with being submissive and cold. Friends reported observing the same problems but rated those problems as being substantially less severe and more centered on submissiveness. However, the conclusions that have been drawn about the interpersonal problems experienced by people with SAD in close relationships have largely been based on retrospective self-report alone (Davila & Beck, 2002; Wenzel et al., 2002) with a few exceptions.
Although the types of interpersonal problems that people with higher social anxiety or SAD report have been characterized, the impact of the disorder on interpersonal relationships warrants further study. The most practical way to do so would involve use of informants who know the individual with SAD and can corroborate or dismiss self-reported interpersonal problems. There are few studies incorporating self-report and informant partner report of relationship problems experience by people with SAD, however, despite the potentially important insights a multi-informant approach may provide. Studies with undergraduates have provided some initial insights into the impact of social anxiety symptoms on relationship functioning. For example, Porter and Chambless (2013) found that undergraduate women with higher social anxiety symptoms self-reported that they provided less support to romantic partners, but that social anxiety symptoms were not related to romantic partners’ perception of support received. Wenzel, Graff-Dolezal, Macho, and Brendle (2005) similarly reported that undergraduates with high social anxiety symptoms had deficits in several social skill variables when engaging with romantic partners in conversation. The study highlights the potential limitation of reliance on self-report of interpersonal behavior alone. Individuals were subject to their own interpretations of the relationship dynamics, which were in turn impacted by social anxiety symptoms.
Using informant reports could compensate for the limitations of self-report of interpersonal behavior by generating a more complete portrait of the target person’s problems. Due to symptom profiles that may vary by context and informant, multi-informant approaches have been identified as a best practice for the assessment of mental health concerns in children and adolescents (de Los Reyes, Bunnell, & Beidel, 2013); however, the multi-informant approach is not often taken with adults with psychopathology. This difference could be explained by the perceived ease of access to informants (i.e., parents): Children’s participation in research is usually contingent on the presence of a parent or guardian. However, as researchers in personality have argued (Vazire, 2006), the perception that adult informant report would be challenging or prohibitively expensive to collect is a misconception, albeit a popular one. A multi-informant approach is not only useful for understanding the presenting problems of people with SAD, but may be especially vital given that people with SAD may be negatively biased in their self-report of interpersonal behavior.
Results of some of the studies utilizing a multi-informant approach to assess adult psychopathology in interpersonal contexts suggest that informant report helps to clarify how much of self-report might consist of negative bias as well as the contexts in which self-report might be more accurate. Rodebaugh, Gianoli, Turkheimer, and Oltmanns (2010), for example, obtained peer reports of individuals who self-reported their avoidant personality disorder (AVPD) traits with the rationale that additional and unique information could be obtained via an informant. The authors found that peers and primary participants reported that individuals with higher AVPD traits had problems being too cold, self-sacrificing, and socially inhibited, but only self-report of AVPD traits suggested problems being too domineering. In contrast, when agreement between self and peer was examined, AVPD traits were weakly but inversely related to being too domineering.
Given the similarities between SAD and AVPD symptom presentation (Chambless, Fydrich, & Rodebaugh, 2008), it seems plausible that people with SAD evince similarly inaccurate self-perceptions. In a recent study by Shin and Newman (2019), authors investigated self and informant report of students’ generalized anxiety, social anxiety, and depression symptoms. The authors found that self-report but not informant report explained symptom presentation. Students with elevated social anxiety self-reported socially avoidant and non-assertive interpersonal problems; however, informants reported problems with affiliation (warmth).
Incorporating both informant and self-report may lead to unique conclusions about how the interpersonal behavior of the person with SAD changes with context. For example, in a study of participants with SAD examining self-reported and clinician-reported symptoms, de los Reyes et al. (2013) found that discordance between self- and clinician-report was related to greater participant variability in social impairment across contexts which, the authors note, has implications for treatment decisions. Taken together, the research conducted by de Los Reyes et al. (2013), Shin and Newman (2019), and Rodebaugh et al. (2010) demonstrates that neither self- nor single informant-report can accurately describe the entire picture of the interpersonal problems associated with SAD. Interpersonal problems are potentially manifested uniquely depending on the type of relationship. In other words, the best way to measure interpersonal phenomenon is to use multi-informant interpersonal methodology.
In the current study, we examined interpersonal problems in SAD by using self-report and two specific types of informant reports: friend and romantic partner. Because friends and romantic partners frequently serve as important providers of social support in relationships but differ in the ways they might offer support (Umberson & Montez, 2010), we hoped to capture multiple contexts in which maladaptive interaction styles might manifest. We hypothesized that across all reporter sources (self, friend, and romantic partner), individuals with SAD would display interpersonal problems that were significantly different from individuals without the disorder. More specifically, we hypothesized that self-reported problems would be present across multiple and even conflicting domains, such as being both too interpersonally cold and too interpersonally warm, but informant report would be limited to compatible domains like being too cold and socially inhibited (Hypothesis 1). We were additionally interested in investigating how diagnosis of SAD impacts the unique contribution of each reporting source. We hypothesized that diagnosis would moderate the effect of informant report on self-report of interpersonal problems such that SAD diagnosis would lead to decreased correspondence between self and informant reports relative to individuals without a SAD diagnosis (NOSAD; Hypothesis 2). We defined decreased correspondence as a weaker relationship between self and informant reports (Fig. 1B) due to diagnosis. This result would indicate that different informant reports uniquely contribute to understanding the interpersonal problems experienced by individuals with SAD compared to those without SAD.
Section snippets
Participants
Participants were recruited as part of two studies conducted between 2007 and 2012 (see Rodebaugh et al., 2013, 2014 for overall study descriptions). The studies examined the effects of SAD on interpersonal relationships using a behavioral economics task and reports of friendship quality, respectively. The two samples in this study correspond to Rodebaugh et al.s’ (2014) Sample 1 and Sample 2. It should be noted, however, that the current samples do not completely overlap with the previous
Sample characteristics
As shown in Table 1, primary participants largely identified as either White or Black and were primarily female. As expected, GSAD and NOSAD groups had significantly different LSAS scores (p < .001). We found no differences between participants on race or gender (ps > .16); however, groups differed as a function of age wherein participants with GSAD were older (p = .039). Subsequent analyses therefore tested age as an additional predictor and moderator, but effects for age are reported only
Discussion
Social anxiety disorder is associated with clear interpersonal impairment, but how those interpersonal problems manifest across multiple relational contexts has not been previously explored. Through analysis of self, friend, and romantic partner reports, we examined how self and informant views of interpersonal problems differed between reporters and were moderated by a GSAD diagnosis. We found evidence to suggest that GSAD diagnosis generally predicted more interpersonal problems, particularly
Acknowledgements
We would like to thank the research assistants who helped conduct this research. All of the authors, and especially Thomas Rodebaugh, would also like to thank Dianne Chambless for her direct and indirect mentorship. We would also like to thank the National Institutes of Health (UL1 RR024992 to Thomas Rodebaugh) and the National Institute of Mental Health (R21-MH090308 to Thomas Rodebaugh and F31 MH 115641-01 to Marilyn L. Piccirillo) for funding this research.
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2022, Journal of Affective DisordersCitation Excerpt :SAD is characterized by a fear of evaluation and avoidance of social situations, which can negatively affect social functioning (American Psychiatric Association, 2013; Clark and Wells, 1995). Indeed, individuals with SAD report having more interpersonal problems and difficulty maintaining relationships (Davila and Beck, 2002; Kashdan et al., 2007; Tonge et al., 2020). These issues extend beyond close relationships and can have a substantial negative impact on occupational and educational functioning (Schneier et al., 1994; Wittchen et al., 2000) above and beyond the effects of comorbidities including depression (Aderka et al., 2012).
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- 1
M.H. Lim is now at the Iverson Health Innovation Institute and Centre for Mental Health, Swinburne University of Technology.
- 2
Katya C. Fernandez is now at the Center for Creative Leadership, Americas.
- 3
Julia K. Langer is now at the Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.