An atypical anxious‐impulsive pattern of social anxiety disorder in an adult clinical population

Abstract

An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self-directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self-directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self-directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.

Outside the typical anxiety disorder definition: Characterizing the role of impulsivity in comorbid substance use disorder

“…This atypical group also displayed increased functional impairment, lower education and income, and more psychiatric comorbidities. Mörtberg et al also identified these two subgroups in 84 SAD adults, finding that 24% of patients displayed anxious-impulsive traits, and additionally showed that this atypical group had low self-directedness and high levels of depressive symptoms [68]. This anxious-impulsive personality has also been shown to be elevated in stimulant-dependent individuals and their nonaffected siblings, thus supporting this trait as a risk factor for drug abuse [69].…”

The Relationships Among Impulsivity, Anxiety Sensitivity Characteristics, and Severity of Social Anxiety Disorder

“…It seems that impulsivity and anxiety sensitivity have a complex function in SAD. However, according to our knowledge, there is no study in the literature that examined the relationships between these two characteristics and severity of SAD concurrently (6)(7)(8)(9)(10)(11)(12)(16)(17)(18). Thus, the aim of this study is to investigate impulsivity and anxiety sensitivity characteristics in SAD patients and to investigate the relationships between these characteristics and the severity of SAD symptoms.…”

“…Past research has shown that most of the psychiatric disorders including anxiety disorders, mood disorders, and Attention Deficit and Hyperactivity Disorder (ADHD) may have some impulsivity characteristics, which make treatment and progress of the disorders poorer than those, which do not have impulsivity characteristics (13)(14)(15). Some studies in the literature also have shown that some subgroups of patients with SAD can display impulsive behaviors instead of the avoidance behaviors that we often expect to observe in patients with SAD (16)(17)(18). Kashdan et al examined the behavior patterns and socio-demographic characteristics of a sample of 1,832 individuals in their study and, found that 79% of the SAD samples exhibited typical behavioral patterns such as behavioral inhibition and submission, whereas 21% of displayed more anger and impulsivity characteristics than individuals with typical behaviors (16).…”

“…Examining impulsivity and anxiety sensitivity characteristics of patients with SAD can lead the way to administer treatment better for clinicians. Several studies in the literature proposed that different levels of impulsivity and anxiety sensitivity also might have affected the severity of SAD (6)(7)(8)(9)(10)(11)(12)(16)(17)(18). Interestingly the results of some of the studies related SAD and impulsivity suggest that impulsivity may have an indirect effect in relation to the severity of disorder symptoms, as well as other individual predisposing factors such as personality traits or anxiety sensitivity (16)(17)(18).…”

“…Impulsivity can also affect symptom severity and treatment outcomes of patients with any kind of mental disorders (16)(17)(18)26). Therefore, one main purpose of the present study was to investigate the relationship between impulsivity and symptom severity levels of patients with SAD.…”