Are social phobia and paranoia related, and which comes first?

Abstract

To cite this Article Rietdijk, J. , van Os, J. , Graaf, R. de , Delespaul, Ph. and Gaag, M. van der(2009) Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. Social phobia (SPh) and paranoid symptoms (PS) are associated. They may overlap because they share psychological and behavioural mechanisms such as selective attention for social threats and avoidance behaviour. Possibly, one leads to the other. The aim of this study is to explore the association between SPh and PS in a prospective general population sample.Adults (7076) from the NEMESIS general population were assessed for SPh and PS using the Composite International Diagnostic Interview (CIDI) at baseline, and one and three years later. Odds ratios, dose-response relationships and confidence intervals were calculated.Lifetime SPh and PS were associated (OR=3.08; 95% CI=2.49-3.82; p<.001), with a dose response. SPh emerging after PS was significant (OR=4.07; 95% CI=2.50-6.63; p<.001), also with a dose response, i.e. more PS symptoms yield more SPh symptoms. PS emerging after SPh was not significant.This study confirmed the association of SPh and PS in a general population. Possibly this is caused by shared underlying psychological and behavioural processes. There was some indication that paranoid ideation precedes the development of SPh, but this must be considered with caution. Clinical implications are discussed.

The association between social phobia, social anxiety cognitions and paranoid symptoms

“…The present general population study found a nonrandom co-occurrence of social phobia and paranoid symptoms, which is in accordance with the high rates of social phobia reported in patients with a diagnosis of schizophrenia (94)(95)(96) and with associations between social anxiety and paranoid thinking previously found in clinical (1-3) and epidemiological studies (59). Moreover, the present results consistently showed that paranoid symptoms were associated with social phobia both at the DSM-IV criterion level and at the symptomatic level, whereas other delusions did not show such associations.…”

“…Social anxiety, on the other hand, has been found to be correlated with feeling hostile towards others, and with hostile perceptions of others (97). Furthermore, the study confirmed the prospective association between paranoid symptoms and later onset of social phobia, as previously reported in the NEMESIS study (59). Furthermore, the study confirmed the prospective association between paranoid symptoms and later onset of social phobia, as previously reported in the NEMESIS study (59).…”

“…Based on the above psychological models (4, 5), one would hypothesize that social phobia precedes paranoid thinking, which is thought to build on emotional concerns (58). However, recently, the longitudinal population-based NEMESIS study (59) found an association between paranoid symptoms and later onset of social phobia, suggesting that paranoid thinking precedes the development of social phobia. With regard to the natural course of both conditions, this also appears counterintuitive at first sight, given the early onset of social phobia in late childhood ⁄ early adolescence (60)(61)(62) and onset of psychotic disorders in late adolescence ⁄ early adulthood.…”

When does jumping-to-conclusions reach its peak? The interaction of vulnerability and situation-characteristics in social reasoning

“…Social anxiety is an interesting comparison because it has a number features in common with paranoid delusions, such as selective attention to and overestimation of threat in social situations (Birchwood et al, 2006;Hirsch & Clark, 2004) and the tendency to perceive oneself as the centre of peoples' attention and to be judged negatively by others. In the light of these similarities and the rather substantial correlation of symptom scores of social anxiety and paranoid ideation (Gilbert, Boxall, Cheung, & Irons, 2005;Rietdijk, van Os, De Graaf, Delespaul, & van der Gaag, 2009) the absence of an association of social anxiety and JTC clearly seems to support the assumption that the JTC-bias is delusion specific and not largely explicable by anxiety. The lack of impact of trait-anxiety is also confirmed by other studies that found no indication of JTC in patients with panic disorder (Fraser et al, 2006), anxiety problems (Brankovic & Paunovic, 1999) or patients with OCD who even tended towards more cautious decisions (Fear & Healy, 1997).…”

Cognitive behaviour therapy for first episode psychosis: Good for nothing or fit for purpose?

“…This would suggest that social anxiety would be a valuable treatment target (Rietdijk, van Os, de Graaf, Delespaul & van der Gaag, 2009), and there is evidence that CBT is a highly effective treatment of social phobia (Clark et al, 2006).…”