RESEARCH WEEKLY: Psychotic disorders and social anxiety
(March 5, 2019) Approximately 21% of individuals with a psychotic disorder may also be living with social anxiety disorder, according to a review and analysis of prior research released in February.
Social anxiety disorder can pose a debilitating battle for people living with the condition. Those affected experience significant distress in social situations, worrying that they will be judged or humiliated when performing tasks in front of others. Distress can be compounded by a fear that the resulting symptoms of anxiety, such as blushing or sweating, may reveal themselves.
To mitigate feelings of discomfort, individuals with social anxiety disorder often avoid social environments, leading them to struggle with meaningful relationships, forgo career opportunities, or experience other negative outcomes associated with quality of life. Over 12% of adults in the United States experience social anxiety disorders at some point in their lives, and global lifetime prevalence rates have been cited as high as 13.3%.
Based on new systematic review and meta-analysis from researchers at Swinburne University of Technology, The University of Melbourne, and the National Centre of Excellence in Youth Mental Health in Australia, the effects of social anxiety disorder can also be found in a substantial, and perhaps greater, percentage of the population living with a psychotic disorder. The researchers analyzed 25 studies conducted between 1980 and 2019, which profiled a total of more than 92,500 participants from 13 countries. Each study examined populations aged 15 and older diagnosed with both a psychotic disorder and either social anxiety disorder or another established measure of social anxiety.
After pooling results from all studies included in the analysis, the researchers found a prevalence rate of 21% for social anxiety disorder among individuals with a psychotic disorder. Reported prevalence rates from each study ranged from as low as 8% to as high as 36%, illustrating the benefit that more consistent, agreed-upon measurement tools and additional research may have on understanding this population.
The researchers also found a significant difference in the pooled prevalence rate of social anxiety disorders depending on whether the population surveyed was participating in inpatient or outpatient treatment programs for psychotic symptoms. Inpatient populations yielded a pooled prevalence rate of social anxiety disorders at just 9%, compared to a prevalence rate of 25% for outpatient populations.
The authors offer some potential explanations for the notable difference. Individuals in outpatient programs may have less severe psychotic symptoms overall, and consequently be better able to recognize the presence of other symptoms affecting their daily lives, such as those of social anxiety. Indeed, individuals in the studies who had social anxiety disorder displayed greater levels of insight—a characteristic associated with increased self-awareness and the understanding that one is sick.
Clinicians may also find it difficult to accurately assess anxiety symptoms in patients exhibiting high levels of paranoia and distrust of others due to their existing psychotic disorder. Additionally, individuals treated for psychotic disorders in an outpatient setting may be more likely to develop social anxiety due to social isolation or experiences of stigma while living in the community, according to the authors.
A clear finding of the review is the effect of social anxiety disorders on overall well-being for individuals with a psychotic disorder. The presence of a social anxiety disorder was associated with higher levels of depression, more negative self-evaluations, and lower subjective quality of life. For these individuals, the effects of mental illness go beyond the debilitating symptoms of a psychotic disorder, such as hallucinations or delusions, to extreme fear about the very real world around them. The authors recommend more consistent assessment strategies for identifying individuals with a psychotic disorder and social anxiety disorder, and evidence-based treatment catered to the challenges presented by the interaction between the two disorders.
References
McEnery, C. et al. (2019, February). Prevalence rate of social anxiety disorder in individuals with a psychotic disorder: A systematic review and meta-analysis. Schizophrenia Research.
