Culturally validated rating scales for social anxiety disorder (SAD) are of significant importanc... more Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal...
Journal of psychopharmacology (Oxford, England), Jan 17, 2016
It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by sero... more It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by serotonin over- or underactivity. Here, we evaluated whether our recent finding of elevated neural serotonin synthesis rate in patients with social anxiety disorder could be reproduced in a separate cohort, and whether allelic variation in the tryptophan hydroxylase-2 (TPH2) G-703T polymorphism relates to differences in serotonin synthesis assessed with positron emission tomography. Eighteen social anxiety disorder patients and six healthy controls were scanned during 60 minutes in a resting state using positron emission tomography and 5-hydroxy-L-[β -(11)C]tryptophan, [(11)C]5-HTP, a substrate of the second enzymatic step in serotonin synthesis. Parametric images were generated, using the reference Patlak method, and analysed using Statistical Parametric Mapping (SPM8). Blood samples for genotyping of the TPH2 G-703T polymorphism were obtained from 16 social anxiety disorder patients (T car...
j Abstract Background The aim of this study was to investigate the prevalence of self-reported so... more j Abstract Background The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Methods Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Results Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs.
Using a validated and DSM-IV compatible questionnaire, the present study related family history o... more Using a validated and DSM-IV compatible questionnaire, the present study related family history of excessive social anxiety to social phobia and avoidant personality disorder (APD) in epidemiologically identified probands in the general population. Probands met diagnostic criteria for social phobia with or without APD and APD with or without social phobia. A two-to three-fold increased relative risk of social anxiety was observed for all diagnostic groups. Increasing severity in probands by varying diagnostic criteria did not affect the relative risk. Because familial aggregation of social anxiety was not modulated by Axis I or II diagnosis or diagnostic cut-off levels, data imply that social phobia and APD may represent a dimension of social anxiety rather than separate disorders. Thus, having an affected family member is associated with a two-to three-fold risk increase for both social phobia and APD.
The present study used scores from Seligman's Attribution Style Questionnaire and [15O] w... more The present study used scores from Seligman's Attribution Style Questionnaire and [15O] water positron emission tomographic measurements of regional cerebral blood flow (rCBF) to investigate the relation between individual differences in dispositional pessimism and amygdala activity. During scanning 13 healthy non-snake-phobic females passively viewed a snake videotape. Using one-tailed tests, significant negative correlations were evident between pessimism scores, with low scores reflecting relatively more pessimism, and right (r=-0.60; p=0.014) and left amygdala rCBF (r=-0.53; p=0.032). These results extend previous neuroimaging findings in healthy subjects indicating a role for the amygdala in transient negative emotional states, and suggest that this multimodal brain region also is involved in more durable negative affects such as dispositional pessimism.
The Israel Journal of Psychiatry and Related Sciences, Feb 1, 2009
The Axis I disorder social phobia and the Axis II disorder avoidant personality disorder were fir... more The Axis I disorder social phobia and the Axis II disorder avoidant personality disorder were first introduced in the DSM nomenclature in 1980. Since then a major nosological theme in research has concerned whether or not social phobia and avoidant personality disorder represent distinct clinical categories. Our main aim was to summarize both the current situation regarding this conceptual debate, as well as what we still do not know. In the present review we describe the evolution of these disorders as they have been addressed over time, from their introduction in the DSM-III system to their current descriptions in the DSM-IV. Thereafter, earlier empirical literature concerning this conceptual debate is evaluated, with the main focus on comorbidity between social phobia and avoidant personality disorder. The PsycINFO and PubMed electronic databases were searched for studies, and complementary searches of references in articles and books were conducted. To conclude, the studies summarized provide support for the view that social phobia and avoidant personality disorder are more than arbitrary cutoffs along a continuum of social anxiety.
Social Psychiatry and Psychiatric Epidemiology, 2009
The aim of this study was to investigate the prevalence of self-reported social phobia in a commu... more The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class" and "calling someone unfamiliar on the phone" were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.
Background. Epidemiological data on subtypes of social phobia are scarce and their defining featu... more Background. Epidemiological data on subtypes of social phobia are scarce and their defining features are debated. Hence, the present study explored the prevalence and descriptive characteristics of empirically derived social phobia subgroups in the general population.
Personality and Individual Differences, Jan 19, 2001
Prevalence and sociodemographic characteristics of DSM-IV and ICD-10 de®ned personality disorders... more Prevalence and sociodemographic characteristics of DSM-IV and ICD-10 de®ned personality disorders were examined in a Swedish community sample. Data were obtained by means of the DSM-IV and ICD-10 personality questionnaire (DIP-Q) postal survey administered to 1000 randomly selected adults from the Isle of Gotland. A total of 557 individuals responded to the questionnaire. The prevalence of any ICD-10 de®ned personality disorder was 11.0% and 11.1% when using DSM-IV criteria. Comorbidity between personality disorders were common. Prevalence similarities between DSM and ICD de®nitions were obtained for paranoid, schizotypal, borderline/emotionally unstable, histrionic, avoidant, dependent, and obsessive-compulsive/anancastic but not schizoid and antisocial/dissocial personality disorders. Personality disorders were signi®cantly more often diagnosed in the younger subjects, students and unemployed/ homemakers had the highest rates. Individuals with personality disorders more often received psychiatric treatment and lacked social support. In addition, they reported signi®cantly more psychosocial and environmental problems in the past year. Thus, personality disorders are relatively common in the community and aected individuals are more impaired than subjects without personality disorders. #
Brain imaging of tinnitus has suggested central correlates of tinnitus perception. This study pre... more Brain imaging of tinnitus has suggested central correlates of tinnitus perception. This study presents positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF) in a female tinnitus patient with bilateral left dominant tinnitus. Lidocaine infusion (75 mg during 5 min (0.2 mg/kg/min)) resulted in a 75% reduction of tinnitus and a temporary abolition of the dominant tinnitus in her left ear. Regional CBF was measured in four conditions: i) at rest while concentrating on tinnitus, ii) following maximum effect of lidocaine, iii) during sound stimulation, and iv) the following day at rest while concentrating on tinnitus. Subtraction analyses showed that tinnitus was associated with increased rCBF in the left parieto-temporal auditory cortex, including the primary and secondary auditory cortex with a focus in the parietal cortex (Brodmann areas 39, 41, 42, 21, 22). Activations were also found in right frontal paralimbic areas (Brodmann areas 47, 49 and 15). Sound stimulation resulted in bilateral activation of auditory areas. It is suggested that tinnitus is processed in primary, secondary and integrative auditory cortical areas. Tinnitus perception may involve areas related to auditory attention, while emotional processing relates to temporofrontal paralimbic areas.
It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by sero... more It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by serotonin over- or underactivity. Here, we evaluated whether our recent finding of elevated neural serotonin synthesis rate in patients with social anxiety disorder could be reproduced in a separate cohort, and whether allelic variation in the tryptophan hydroxylase-2 (TPH2) G-703T polymorphism relates to differences in serotonin synthesis assessed with positron emission tomography. Eighteen social anxiety disorder patients and six healthy controls were scanned during 60 minutes in a resting state using positron emission tomography and 5-hydroxy-L-[β -(11)C]tryptophan, [(11)C]5-HTP, a substrate of the second enzymatic step in serotonin synthesis. Parametric images were generated, using the reference Patlak method, and analysed using Statistical Parametric Mapping (SPM8). Blood samples for genotyping of the TPH2 G-703T polymorphism were obtained from 16 social anxiety disorder patients (T carriers: n=5, GG carriers: n=11). A significantly elevated [(11)C]5-HTP accumulation rate, indicative of enhanced decarboxylase activity and thereby serotonin synthesis capacity, was detected in social anxiety disorder patients compared with controls in the hippocampus and basal ganglia nuclei and, at a more lenient (uncorrected) statistical threshold, in the amygdala and anterior cingulate cortex. In patients, the serotonin synthesis rate in the amygdala and anterior cingulate cortex was significantly elevated in TPH2 T carriers in comparison with GG homozygotes. Our results support that social anxiety disorder entails an overactive presynaptic serotonergic system that, in turn, seems functionally influenced by the TPH2 G-703T polymorphism in emotionally relevant brain regions.
Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symp... more Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symptomatology in a comorbid sample through a randomised controlled trial with a 6 month follow-up.
In an acceptance-based model of what maintains social anxiety, the focus is on counterproductive ... more In an acceptance-based model of what maintains social anxiety, the focus is on counterproductive attempts to control unpleasant internal experiences through avoidance of them. An example of such an avoidance strategy, especially prominent among socially anxious women, is rumination. According to this model, the road to recovery for people suffering from social anxiety is through increased acceptance of internal experiences. This process is also referred to as decreasing an individual's 'psychological inflexibility'. The overall aim of the current study was to examine the relationship between psychological inflexibility and social anxiety in a non-clinical population. We used cluster analysis to examine subgroups with different individual profiles of symptoms of social anxiety/avoidance and psychological inflexibility. The clusters were examined in relation to depressive symptoms, rumination, and the moderating effect of gender. The design was crosssectional and consisted of 219 university students (101 men, 118 women; M age = 23 years). Four clusters were generated, whereof two (the Multidimensional Problem cluster and the No Problem cluster) reflected a strong positive relationship between social anxiety/avoidance and psychological inflexibility, however in different ways. Gender did not act as a moderator. However, people in the Multidimensional Problem cluster reported higher degree of depressive symptoms as well as higher levels of rumination compared to the other clusters. To conclude, psychological inflexibility seems to be related not only to symptoms of ill-health such as social anxiety and depressive symptoms but also to control strategies such as rumination
Culturally validated rating scales for social anxiety disorder (SAD) are of significant importanc... more Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal...
Journal of psychopharmacology (Oxford, England), Jan 17, 2016
It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by sero... more It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by serotonin over- or underactivity. Here, we evaluated whether our recent finding of elevated neural serotonin synthesis rate in patients with social anxiety disorder could be reproduced in a separate cohort, and whether allelic variation in the tryptophan hydroxylase-2 (TPH2) G-703T polymorphism relates to differences in serotonin synthesis assessed with positron emission tomography. Eighteen social anxiety disorder patients and six healthy controls were scanned during 60 minutes in a resting state using positron emission tomography and 5-hydroxy-L-[β -(11)C]tryptophan, [(11)C]5-HTP, a substrate of the second enzymatic step in serotonin synthesis. Parametric images were generated, using the reference Patlak method, and analysed using Statistical Parametric Mapping (SPM8). Blood samples for genotyping of the TPH2 G-703T polymorphism were obtained from 16 social anxiety disorder patients (T car...
j Abstract Background The aim of this study was to investigate the prevalence of self-reported so... more j Abstract Background The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Methods Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Results Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs.
Using a validated and DSM-IV compatible questionnaire, the present study related family history o... more Using a validated and DSM-IV compatible questionnaire, the present study related family history of excessive social anxiety to social phobia and avoidant personality disorder (APD) in epidemiologically identified probands in the general population. Probands met diagnostic criteria for social phobia with or without APD and APD with or without social phobia. A two-to three-fold increased relative risk of social anxiety was observed for all diagnostic groups. Increasing severity in probands by varying diagnostic criteria did not affect the relative risk. Because familial aggregation of social anxiety was not modulated by Axis I or II diagnosis or diagnostic cut-off levels, data imply that social phobia and APD may represent a dimension of social anxiety rather than separate disorders. Thus, having an affected family member is associated with a two-to three-fold risk increase for both social phobia and APD.
The present study used scores from Seligman's Attribution Style Questionnaire and [15O] w... more The present study used scores from Seligman's Attribution Style Questionnaire and [15O] water positron emission tomographic measurements of regional cerebral blood flow (rCBF) to investigate the relation between individual differences in dispositional pessimism and amygdala activity. During scanning 13 healthy non-snake-phobic females passively viewed a snake videotape. Using one-tailed tests, significant negative correlations were evident between pessimism scores, with low scores reflecting relatively more pessimism, and right (r=-0.60; p=0.014) and left amygdala rCBF (r=-0.53; p=0.032). These results extend previous neuroimaging findings in healthy subjects indicating a role for the amygdala in transient negative emotional states, and suggest that this multimodal brain region also is involved in more durable negative affects such as dispositional pessimism.
The Israel Journal of Psychiatry and Related Sciences, Feb 1, 2009
The Axis I disorder social phobia and the Axis II disorder avoidant personality disorder were fir... more The Axis I disorder social phobia and the Axis II disorder avoidant personality disorder were first introduced in the DSM nomenclature in 1980. Since then a major nosological theme in research has concerned whether or not social phobia and avoidant personality disorder represent distinct clinical categories. Our main aim was to summarize both the current situation regarding this conceptual debate, as well as what we still do not know. In the present review we describe the evolution of these disorders as they have been addressed over time, from their introduction in the DSM-III system to their current descriptions in the DSM-IV. Thereafter, earlier empirical literature concerning this conceptual debate is evaluated, with the main focus on comorbidity between social phobia and avoidant personality disorder. The PsycINFO and PubMed electronic databases were searched for studies, and complementary searches of references in articles and books were conducted. To conclude, the studies summarized provide support for the view that social phobia and avoidant personality disorder are more than arbitrary cutoffs along a continuum of social anxiety.
Social Psychiatry and Psychiatric Epidemiology, 2009
The aim of this study was to investigate the prevalence of self-reported social phobia in a commu... more The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class" and "calling someone unfamiliar on the phone" were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.
Background. Epidemiological data on subtypes of social phobia are scarce and their defining featu... more Background. Epidemiological data on subtypes of social phobia are scarce and their defining features are debated. Hence, the present study explored the prevalence and descriptive characteristics of empirically derived social phobia subgroups in the general population.
Personality and Individual Differences, Jan 19, 2001
Prevalence and sociodemographic characteristics of DSM-IV and ICD-10 de®ned personality disorders... more Prevalence and sociodemographic characteristics of DSM-IV and ICD-10 de®ned personality disorders were examined in a Swedish community sample. Data were obtained by means of the DSM-IV and ICD-10 personality questionnaire (DIP-Q) postal survey administered to 1000 randomly selected adults from the Isle of Gotland. A total of 557 individuals responded to the questionnaire. The prevalence of any ICD-10 de®ned personality disorder was 11.0% and 11.1% when using DSM-IV criteria. Comorbidity between personality disorders were common. Prevalence similarities between DSM and ICD de®nitions were obtained for paranoid, schizotypal, borderline/emotionally unstable, histrionic, avoidant, dependent, and obsessive-compulsive/anancastic but not schizoid and antisocial/dissocial personality disorders. Personality disorders were signi®cantly more often diagnosed in the younger subjects, students and unemployed/ homemakers had the highest rates. Individuals with personality disorders more often received psychiatric treatment and lacked social support. In addition, they reported signi®cantly more psychosocial and environmental problems in the past year. Thus, personality disorders are relatively common in the community and aected individuals are more impaired than subjects without personality disorders. #
Brain imaging of tinnitus has suggested central correlates of tinnitus perception. This study pre... more Brain imaging of tinnitus has suggested central correlates of tinnitus perception. This study presents positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF) in a female tinnitus patient with bilateral left dominant tinnitus. Lidocaine infusion (75 mg during 5 min (0.2 mg/kg/min)) resulted in a 75% reduction of tinnitus and a temporary abolition of the dominant tinnitus in her left ear. Regional CBF was measured in four conditions: i) at rest while concentrating on tinnitus, ii) following maximum effect of lidocaine, iii) during sound stimulation, and iv) the following day at rest while concentrating on tinnitus. Subtraction analyses showed that tinnitus was associated with increased rCBF in the left parieto-temporal auditory cortex, including the primary and secondary auditory cortex with a focus in the parietal cortex (Brodmann areas 39, 41, 42, 21, 22). Activations were also found in right frontal paralimbic areas (Brodmann areas 47, 49 and 15). Sound stimulation resulted in bilateral activation of auditory areas. It is suggested that tinnitus is processed in primary, secondary and integrative auditory cortical areas. Tinnitus perception may involve areas related to auditory attention, while emotional processing relates to temporofrontal paralimbic areas.
It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by sero... more It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by serotonin over- or underactivity. Here, we evaluated whether our recent finding of elevated neural serotonin synthesis rate in patients with social anxiety disorder could be reproduced in a separate cohort, and whether allelic variation in the tryptophan hydroxylase-2 (TPH2) G-703T polymorphism relates to differences in serotonin synthesis assessed with positron emission tomography. Eighteen social anxiety disorder patients and six healthy controls were scanned during 60 minutes in a resting state using positron emission tomography and 5-hydroxy-L-[β -(11)C]tryptophan, [(11)C]5-HTP, a substrate of the second enzymatic step in serotonin synthesis. Parametric images were generated, using the reference Patlak method, and analysed using Statistical Parametric Mapping (SPM8). Blood samples for genotyping of the TPH2 G-703T polymorphism were obtained from 16 social anxiety disorder patients (T carriers: n=5, GG carriers: n=11). A significantly elevated [(11)C]5-HTP accumulation rate, indicative of enhanced decarboxylase activity and thereby serotonin synthesis capacity, was detected in social anxiety disorder patients compared with controls in the hippocampus and basal ganglia nuclei and, at a more lenient (uncorrected) statistical threshold, in the amygdala and anterior cingulate cortex. In patients, the serotonin synthesis rate in the amygdala and anterior cingulate cortex was significantly elevated in TPH2 T carriers in comparison with GG homozygotes. Our results support that social anxiety disorder entails an overactive presynaptic serotonergic system that, in turn, seems functionally influenced by the TPH2 G-703T polymorphism in emotionally relevant brain regions.
Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symp... more Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symptomatology in a comorbid sample through a randomised controlled trial with a 6 month follow-up.
In an acceptance-based model of what maintains social anxiety, the focus is on counterproductive ... more In an acceptance-based model of what maintains social anxiety, the focus is on counterproductive attempts to control unpleasant internal experiences through avoidance of them. An example of such an avoidance strategy, especially prominent among socially anxious women, is rumination. According to this model, the road to recovery for people suffering from social anxiety is through increased acceptance of internal experiences. This process is also referred to as decreasing an individual's 'psychological inflexibility'. The overall aim of the current study was to examine the relationship between psychological inflexibility and social anxiety in a non-clinical population. We used cluster analysis to examine subgroups with different individual profiles of symptoms of social anxiety/avoidance and psychological inflexibility. The clusters were examined in relation to depressive symptoms, rumination, and the moderating effect of gender. The design was crosssectional and consisted of 219 university students (101 men, 118 women; M age = 23 years). Four clusters were generated, whereof two (the Multidimensional Problem cluster and the No Problem cluster) reflected a strong positive relationship between social anxiety/avoidance and psychological inflexibility, however in different ways. Gender did not act as a moderator. However, people in the Multidimensional Problem cluster reported higher degree of depressive symptoms as well as higher levels of rumination compared to the other clusters. To conclude, psychological inflexibility seems to be related not only to symptoms of ill-health such as social anxiety and depressive symptoms but also to control strategies such as rumination
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