Social phobics see themselves differently

Magnetic resonance brain imaging reveals that patients with generalized social phobia (social anxiety disorder) respond differently than others to negative comments about themselves, according to a report in the October issue of Archives of General Psychiatry.

"Generalized social phobia is characterized by fear/avoidance of social situations and fear of being judged negatively by others," the authors write. "It is the most common anxiety disorder in the general population, with the lifetime prevalence estimated at 13.3 percent, and it is associated with a high risk for depression, alcohol and drug abuse and suicide."

Previous studies have found differences in the way brains of affected individuals respond to facial expressions, suggesting that the condition involves increased responsiveness to social stimuli in areas linked to emotion.

Karina Blair, PhD, and colleagues at the National Institute of Mental Health, Bethesda, Md., compared functional MRI (fMRI) scans of 17 unmedicated individuals with generalized social phobia to those of 17 controls who were the same age and sex and had the same IQ but did not have the disorder. "During fMRI scans, individuals read positive (e.g., You are beautiful), negative (e.g., You are ugly) and neutral (e.g., You are human) comments that could be either about the self or about somebody else (e.g., He is beautiful)," the authors write.

The patients with generalized social phobia showed increased blood flow in their medial prefrontal cortex and

This "fear gene" is highly concentrated in the amygdala-areas of the brain linked to concepts of self as well as fear, emotion and stress response-when reading negative statements about themselves. However, there were no differences between the two groups in response to negative comments referring to others or neutral or positive comments referring to either self or others.

"Given that medial prefrontal cortex regions are involved in representations of the self, it might be suggested that these regions, together with the amygdala, play a primary role in the development and maintenance of generalized social phobia and that the pathology in the disorder at least partly reflects a negative attitude toward the self, particularly in response to social stimuli-that in generalized social phobia what engages the mind is others' criticism," the researchers conclude. "This highly context-dependent response in generalized social phobia helps constrain existing models of the disorder and may thus guide future therapeutic formulations in the treatment of the disorder."

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Blair K, Geraci M, Devido J, et al. Neural Response to Self- and Other Referential Praise and Criticism in Generalized Social Phobia. Arch Gen Psychiatry 2008 Oct;65(10):1176-1184.   [Abstract]