New evidence of heterogeneity in social anxiety disorder: Defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors - 09/12/14

Doi : 10.1016/j.eurpsy.2014.09.418

C. Binelli ^a,^b, A. Muñiz ^a,^c, S. Sanches ^a,^d, A. Ortiz ^a,^c, R. Navines ^a,^e, E. Egmond ^a,^b, M. Udina ^a, A. Batalla ^a,^c, C. López-Sola ^b, J.A. Crippa ^d, S. Subirà ^b, R. Martín-Santos ^a,^c,^⁎
^a Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain
^b Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
^c Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
^d Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
^e Human Pharmacology and Clinical Neurosciences Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain

^⁎Corresponding author. Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, University of Barcelona, CIBERSAM, Villarroel, 150, 08036 Barcelona, Spain.

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Abstract

Purpose

To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions.

Method

One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR).

Results

Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with “high-HA/low-NS”, and a smaller (39%) atypical impulsive subgroup with high–moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005).

Conclusions

Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.

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Keywords : Social anxiety disorder, Impulsive subtype, Harm avoidance, Novelty seeking, Temperament and character inventory, STin2.VNTR