The Relationship of Theory of Mind and Attachment Characteristics with Disease Severity in Social Anxiety Disorder

Performance in emotion recognition and theory of mind tasks in social anxiety and generalized anxiety disorders: a systematic review and meta-analysis

Social cognition impairments may be associated with poor functional outcomes, symptoms, and disability in social anxiety disorder (SAD) and generalized anxiety disorder (GAD). This meta-analysis aims to determine if emotion recognition and theory of mind (ToM) are impaired in SAD or GAD compared to healthy controls. A systematic review was conducted in electronic databases (PubMed, PsycNet, and Web of Science) to retrieve studies assessing emotion recognition and/or ToM in patients with SAD or GAD, compared to healthy controls, up to March 2022. Meta-analyses using random-effects models were conducted. We identified 21 eligible studies: 13 reported emotion recognition and 10 ToM outcomes, with 585 SAD patients, 178 GAD patients, and 753 controls. Compared to controls, patients with SAD exhibited impairments in emotion recognition (SMD = -0.32, CI = -0.47 - -0.16, z = -3.97, p < 0.0001) and ToM (SMD = -0.44, CI = -0.83 -0.04, z = -2.18, p < 0.01). Results for GAD were inconclusive due to the limited number of studies meeting the inclusion criteria (two for each domain). Relevant demographic and clinical variables (age, sex, education level, and anxiety scores) were not significantly correlated with emotion recognition or ToM impairments in SAD and GAD. Further studies employing ecological measures with larger and homogenous samples are needed to better delineate the factors influencing social cognition outcomes in both SAD and GAD.

Comparison of Social-Evaluative Anxiety and Theory of Mind Functions in Social Anxiety Disorder, Schizophrenia, and Healthy Controls

INTRODUCTION

Despite the similarities in poor social competence and clinical manifestations of poor social behavior, no study has compared the theory of mind performance between social anxiety disorder (SAD) and schizophrenia, considering the effect of social-evaluative anxiety and neurocognitive functions. In our study, we aimed to compare the theory of mind functions and social-evaluative anxiety between patients with SAD and schizophrenia and healthy controls and to examine the relationship between the theory of mind, neurocognitive skills, and social-evaluative anxiety.

METHODS

Thirty-four consecutive patients with schizophrenia, 29 patients with SAD, and 30 controls matched by age, education level, and sex were enrolled in the study. Structured Clinical Interview for DSM, Beck Depression Inventory, Liebowitz Social Anxiety Scale, Theory of Mind measures (Reading the Mind in the Eyes Test, Hinting Task, Faux Pas Test), Social Appearance Anxiety Scale, Fear of Positive Evaluation Scale, Fear of Negative Evaluation Scale-Short Form, and neuropsychological tests were administered to all participants.

RESULTS

A greater significant deterioration in theory of mind and neurocognitive functions was found in patients with schizophrenia compared to those with SAD and healthy controls. Social evaluation anxiety was highest in patients with SAD. Although social-evaluative anxiety was associated with the theory of mind function in schizophrenia, only fear of positive evaluation was associated with SAD. In all groups, neither theory of mind nor neurocognitive ability measures were correlated with social anxiety levels and related symptoms.

CONCLUSIONS

The impaired theory of mind functioning detected in our study is more prominent in the schizophrenia group and largely independent of anxiety in schizophrenia and SAD. Although social evaluation anxiety, as a transdiagnostic concept, seems to be independent of theory of mind function in general, fear of positive evaluation seems to be associated with hinting in both disorders.

Is There a Difference in Parental Attitudes and Attachment for ADHD-Social Phobia Comorbidity?

OBJECTIVE

Social phobia (SP) is one the commonest of comorbid anxiety disorders seen with ADHD. It is also known that Social phobia and ADHD patients have some differences in parental attitudes and attachment styles. We aimed to investigate the effects attachment status and parental attitudes in ADHD-social phobia comorbidity.

METHOD

66 children and adolescents with ADHD were included for the study. the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (KSADS-PL-DSM5-T) was used for evaluating diagnosis. Socioeconomic status (SES) was scored with Hollingshead Redlich Scale. Sosyodemografic and clinical data were recorded. Adult Attachment Scale (AAS) and Parental Attitudes Research Instrument (PARI) were completed by the parents. The patients filled Kerns Security Scale (KSS). We compared the ADHD patients with and without SAD comorbidity in terms of scales used and sociodemographic-clinical variables.

RESULTS

There were no differences between ADHD + SP group and ADHD without SP group in terms of age, gender, SES, family structure and family history of diagnosed psychiatric disease (p>0.05). Rate of inattentive subtype of ADHD (p=0.05) and comorbid psychiatric disease frequency (p=0.00) was higher in ADHD+SP group compared to ADHD without social phobia group. However, the groups did not differ according to their attachment styles, their parent's attachment styles and parental attitudes (p>0.05).

CONCLUSION

Parental attitudes and attachment styles may not play a role in the development of SP comorbidity in children and adolescents with ADHD. Other biological and environmental factors should be kept in mind when evaluating and treating children with ADHD who have SP. Biological treatments and individualized interventions such as CBT may be chosen as a first line treatment rather than psychotherapies targeting attachment and parenting styles in those children.