Elsevier

Biological Psychiatry

Volume 65, Issue 5, 1 March 2009, Pages 374-382
Biological Psychiatry

Archival Report
Fearful Imagery in Social Phobia: Generalization, Comorbidity, and Physiological Reactivity

https://doi.org/10.1016/j.biopsych.2008.09.023Get rights and content

Background

Social phobia has been characterized as a disorder of exaggerated fear of social threat and heightened sensitivity to imagery of social failure.

Methods

To assess the physiological basis of this description, social phobia patients (n = 75) and demographically matched control participants (n = 75) imagined neutral and fearful events while acoustic startle probes were occasionally presented and eye-blink responses (orbicularis occuli) recorded. Changes in heart rate, skin conductance level, and facial expressivity were also indexed. In addition to comparing control participants and social phobia patients, the influences of diagnostic subtype (circumscribed, generalized), comorbid depression, and chronicity were assessed.

Results

Patients exceeded control participants in startle reflex and autonomic responding during imagery of social threat, whereas the groups evinced commensurate reactivity to contents depicting commonly shared fears (survival threat). Individuals with circumscribed performance phobia were similar to control participants, with the exception of more robust reactions to idiographic, performance fear imagery. In contrast, generalized phobic patients were characterized by longer disorder chronicity and demonstrated heightened sensitivity to a broader range of fear contents. Those with generalized phobia plus comorbid depression showed attenuation of fear-potentiated startle and reported the most protracted social anxiety.

Conclusions

Subtypes of social phobia can be objectively distinguished in patterns of physiological reactivity. Furthermore, subtypes vary systematically in chronicity and defensive engagement with the shortest disorder duration (circumscribed phobia) associated with the most robust and focal physiological reactivity, followed by broader defensive sensitivity in more chronic generalized phobia, and finally attenuation of the formerly exaggerated fear potentiation in the comorbidly depressed, the most chronic form.

Section snippets

Participants

Participants (81% Caucasian) were assessed at the University of Florida Fear and Anxiety Disorders Clinic: 75 treatment-seeking adults with principal diagnoses of social phobia and 75 community control participants matched for gender, age, race, and education, all without psychosis or major physical disease.

Diagnostic Classification

Diagnostic groups were established using the Anxiety Disorder Interview Schedule for DSM-IV (ADIS-IV) (36). In cases of multiple Axis I disorders, diagnostic primacy was determined according

Baseline Physiology

No reliable differences emerged between patients and control participants in blink magnitude for intertrial startle probes or for SCL or orbicularis EMG activity in the 1-second baseline prior to script onset. However, patients showed greater baseline corrugator EMG tension, F(1,148) = 9.00, p < .001, and more rapid heart rate (nearly 8 beats per minute [bpm] faster than control participants), F(1,148) = 18.29, p < .001.4

Evaluative Judgments

Ratings of unpleasantness (Table 2) varied over imagery contents, F(3,145)

Discussion

Patients diagnosed with social phobia as a whole exceeded control participants in defensive reactivity when imagining either idiographic fear or standard social threat scenes but did not differ when imagining contents presumed to be fearful for all participants. This pattern emerged in startle potentiation and in autonomic responding implicating a concordant, general hypersensitivity of the defense system to clinically relevant imagery. This psychophysiological pattern is consistent with

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