Personality Functioning in Social Anxiety Disorders Subtypes According to DSM 5

Abstract

The present study aims to investigate the extent to which the newly introduced concept of the Level of Personality Functioning (LPF) affects different subtypes of Social Anxiety Disorder (SAD) as classified by DSM-5. This cross-sectional study comprises a sample of twenty-six patients with SAD not meeting the "performance only" criteria, twenty-one patients with performance-only SAD (PoSAD), and twenty-five healthy controls. The Liebowitz Social Anxiety Scale was used to determine the level of social anxiety, the Short Form-36 (SF-36) was employed to assess impairment in global functioning, and the Level of Personality Functioning Scale (LPFS) was administered to evaluate the level of personality functioning among participants. There were statistically significant differences between the SAD and PoSAD groups across all sub-dimensions of the LPFS, including identity, self-management, empathy, and intimacy. PoSAD patients exhibited better levels of personality functioning compared to SAD patients. This study reveals varying degrees of impairment in personality functioning among subtypes of SAD. Taking these differences into account could be instrumental in devising more tailored treatment plans that cater to the specific needs of patients.

Keywords

• Social anxiety
• personality
• psychosocial functioning
• personality functioning

References

1. 1. American Psychiatric Association. Diagnostic and Statistical Manual. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
2. 2. Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World psychiatry : official journal of the World Psychiatric Association (WPA). 2019 Feb;18(1):3–19.
3. 3. Pines M. Borderline Conditions and Pathological Narcissism. By Otto Kernberg. New York: Jason Aronson. 1975. Pp 361.
4. 4. Kernberg OF. Structural interviewing. The Psychiatric clinics of North America. 1981 Apr;4(1):169–95.
5. 5. Hörz S, Clarkin JF, Stern BL, Caligor E. The Structured Interview of Personality Organization (STIPO): An instrument to assess severity and change of personality pathology. In: Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence. Totowa, NJ, US: Humana Press - Springer; 2012. p. 571–92.
6. 6. Di Pierro R, Preti E, Vurro N, Madeddu F. Dimensions of personality structure among patients with substance use disorders and co-occurring personality disorders: a comparison with psychiatric outpatients and healthy controls. Comprehensive psychiatry. 2014 Aug;55(6):1398–404.
7. 7. Schmeck K, Schlüter-Müller S, Foelsch P, Doering S. The role of identity in the DSM-5 classification of personality disorders. Child and adolescent psychiatry and mental health. 2013 Jul 31;7:27.
8. 8. Yazıcı Güleç M ve ark. Reliability and validity of the Turkish version of level of personality functioning for DSM-5: a preliminary report, Bulletin of Clinical Psychopharmacology 2014;24(Ek 1):174.

9. 9. Ediz L, Hiz O, Toprak M, Tekeoglu I, Ercan S. The validity and reliability of the Turkish version of the Revised Fibromyalgia Impact Questionnaire. Clinical rheumatology. 2011 Mar;30(3):339–46.
10. 10. Soykan C, Ozguven HD, Gencoz T. Liebowitz social anxiety scale: The Turkish version. Psychological Reports 2003;93:1059-69.
11. 11. Demiral Y, Ergor G, Unal B, Semin S, Akvardar Y, Kivircik B, et al. Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population. BMC Public Health. 2006;6:1–8.
12. 12. Schneier FR, Heckelman LR, Garfinkel R, Campeas R, Fallon BA, Gitow A ve ark. Functional impairment in 1. Schneier FR, Heckelman LR, Garfinkel R, Campeas R, Fallon BA, Gitow A ve ark. Functional impairment in social phobia. J Clin Psychiatry 1994; 55: 322.
13. 13. Stein, M. B., Torgrud, L. J., & Walker, J. R. (2000). Social phobia symptoms, subtypes, and severity: Findings from a community survey. Archives of General Psychiatry, 57(11), 1046–1052.
14. 14. Wittchen HU, Stein MB, Kessler RC. Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med 1999; 29: 309-23.
15. 15. Kessler C R, Stein B M, Berglund P. Social phobia subtypes in the National Comorbidity Study. American Journal of Psychiatry. 1998;155(5):613–9.
16. 16. Stein, M. B., & Kean, Y. M. (2000). Disability and quality of life in social phobia: epidemiologic findings. The American Journal of Psychiatry, 157, 1606–1613.
17. 17. Cox, B. J., Clara, I. P., Sareen, J., & Stein, M. B. (2008). The structure of feared social situations among individuals with a lifetime diagnosis of social anxiety disorder in two independent nationally representative mental health surveys. Behaviour Res.
18. 18. Aderka IM, Hofmann SG, Nickerson A, Hermesh H, Gilboa-Schechtman E, Marom S. Functional impairment in social anxiety disorder. Journal of Anxiety Disorders. 2012;26(3):393–400.
19. 19. Hofmann, S. G., Heinrichs, N., & Moscovitch, D. A. (2004). The nature and expression of social phobia: Toward a new classification. Clinical Psychology Review, 24(7), 769–797.
20. 20. Hook, J. N., & Valentiner, D. P. (2002). Are specific and generalized social phobias qualitatively distinct? Clinical Psychology: Science and Practice, 9(4), 379–395.
21. 21. Kizilkurt OK, Gulec MY, Giynas FE, Gulec H. Effects of personality functioning on the global functioning of patients with bipolar disorder I. Psychiatry Research. 2018;266:309–16.
22. 22. Hopwood CJ, Malone JC, Ansell EB, Sanislow CA, Grilo CM, McGlashan TH, Pinto A, Markowitz JC, Shea T, Skodol AE, Gunderson JG, Zanarini MC, Morey LC. Personality assessment in DSM-5. J Personal Disord 2011; 25(3): 305–320.
23. 23. Manes S, Nodop S, Altmann U, Gawlytta R, Dinger U, Dymel W, et al. Social anxiety as a potential mediator of the association between attachment and depression. Journal of affective disorders. 2016 Nov;205:264–8.
24. 24. Manning RPC, Dickson JM, Palmier-Claus J, Cunliffe A, Taylor PJ. A systematic review of adult attachment and social anxiety. Journal of affective disorders. 2017 Mar;211:44–59.
25. 25. Byrow Y, Chen NTM, Peters L. Time Course of Attention in Socially Anxious Individuals: Investigating the Effects of Adult Attachment Style. Behavior therapy. 2016 Jul;47(4):560–71.
26. 26. Notzon S, Domschke K, Holitschke K, et al. Attachment style and oxytocin receptor gene variation interact in influencing social anxiety. World J Biol Psychiatry 2016; 17:76–83.
27. 27. Eikenaes I, Hummelen B, Abrahamsen G, Andrea H, Wilberg T. Personality functioning in patients with avoidant personality disorder and social phobia. Journal of personality disorders. 2013;27(6):746–63.
28. 28. Doering S, Blüml V, Parth K, Feichtinger K, Gruber M, Aigner M, et al. Personality functioning in anxiety disorders. BMC Psychiatry. 2018;18(1):294.
29. 29. Wiedemann A, Vogel D, Voss C, et al. The role of retrospectively perceived parenting style and adult attachment behaviour in music performance anxiety. Psychol Music 2019.
30. 30. Gabbard GO. Stage Fright Int. J Psycho-Anal, 2003, 60:383-392.