ترس اجتماعی در دوران بلوغ: آیا افزایشی در پریشانی و اجتناب وجود دارد؟
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34068||2009||7 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Anxiety Disorders, Volume 23, Issue 7, October 2009, Pages 897–903
Mid-adolescence is considered as the time of onset for social phobia and is assumed to be related to a normative increase of social fears. People diagnosed with social phobia, however, do not only experience high levels of fear or distress, but also report avoidance behavior. Little attention has been paid to the development of avoidance behavior during adolescence. In the current study, a community sample with 9–17 year olds (n = 260) completed a questionnaire derived from the Anxiety Disorders Interview Schedule for Children (ADIS-C) [Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV child version, child interview schedule. San Antonio: The Psychological Corporation]. They rated their levels of distress and avoidance in a variety of social situations. The results showed an age related increase for formal speaking and interaction situations in both avoidance and distress, with a stronger increase in avoidance than in distress. The same pattern was found for girls for situations regarding observation by others. No effects were observed for informal speaking and interaction situations.
Mid-adolescence is considered as the time of onset for social phobia. Most studies report an age of onset for this disorder of 10 years or older (Rapee & Spence, 2004). Prevalence rates of social phobia during adolescence exceed those during childhood and continue to increase throughout adolescence. Essau, Conradt, and Petermann (1999) conducted an epidemiological study among 1035 adolescents from a community sample and found the diagnosis of social phobia to increase from .5% for 12–13 years olds to 2% among 14–17 year olds. Wittchen, Stein, and Kessler (1999) showed that this increase continued into late adolescence and young adulthood. In their sample the prevalence rate for the 14–17 year olds was 4.0%, the prevalence rate for the oldest age group, i.e. 18–24 years olds, was 8.7%. 1.1. Social phobia and social fears Increase in the prevalence of social phobia with age has been ascribed to an increase in social fears during adolescence. However, this assumption has not always been supported by studies on social fear (e.g., Gullone et al., 2001 and Gullone and Lane, 2002). Although some studies report an increase during adolescence (e.g., Weems and Costa, 2005 and Westenberg et al., 2004), other studies report that levels of social fear are stable (e.g., Gullone et al., 2001) or even diminish during this time period (e.g., Gullone & Lane, 2002). Previous research has demonstrated that use of subtypes can be very enlightening when studying developmental pathways. Within social fears it has been possible to distinguish different clusters or subtypes of fears which show different age patterns. It appears that while fears for certain social situations do not change over the course of development, other social fears do show an increase with age. Westenberg et al. (2004), for example, studied three subtypes of fears within the Fear of Failure and Criticism scale of the Fear Survey Schedule for Children-Revised (FSSC-R; Ollendick, 1983). They observed an increase for items with a clear social evaluative component (i.e. Fear of Social evaluation and Fear of Achievement evaluation), whereas a decrease was found for Fear of Punishment where the social evaluative component is less strong. When these items were combined in the total Failure and Criticism scale, no age differences were found. This finding demonstrates that the study of specific subtypes of social fears separately might better the understanding of the development of social phobia. 1.2. Social phobia and avoidance People diagnosed with social phobia do not only experience high levels of distress, but also report avoidance behavior. Avoidance has been mentioned as a factor that contributes to a worsening of the disorder (Chartier, Hazen, & Stein, 1998), to the maintenance of anxiety disorders (Muris, 2006) and is a crucial element of a social phobia diagnosis, see DSM IV-TR (American Psychiatric Association, 2000). Hence, increase of social phobia diagnoses during adolescence might be related to increasing levels of distress, but also to a general increase in avoidance behavior. Rapee and Spence (2004) propose that it is exactly this behavioral part, i.e. avoidance, that changes most during adolescence, rather than a further increase in distress. They argue that “the apparent onset of social phobia during early adolescence may perhaps have more to do with the increase in life interference caused by social anxiety at this developmental stage than with an increase in actual levels of social distress” (Rapee & Spence, 2004, p. 741). This suggests that inclination to avoid social situations that are experienced as stressful, increases more with age than the level of distress. In a clinical sample preliminary evidence has been provided for this increase in avoidance with increasing age. Rao et al. (2007) found that children and adolescents diagnosed with social anxiety disorder (SAD) differed in how they rated their level of avoidance. From the diagnostic interview it emerged that socially anxious adolescents were more eager to avoid social situations than their younger counterparts. Some examples of the situations are “musical or athletic performance” and “speaking to adults.” In addition, they reported more distress in these situations compared to children, and in half of the situations there were more adolescents than children who reported moderate to severe levels of distress. This study shows that at least for a clinical population it appears that with age both levels of avoidance and levels of distress increase. It is unclear whether this also happens within a non-clinical sample. The exact characteristic of the relationship between avoidance and anxiety has received limited attention (Heimberg, 2003). One reason for this might be that in clinical populations anxiety and avoidance are often difficult to distinguish, because at a clinical level avoidance and anxiety will most often be highly correlated. For example, Heimberg et al. (1999) report a correlation of .91 between avoidance and anxiety in their clinical sample. To study the relationship between the two, it seems necessary to include non-clinical participants as well, where the range in avoidance and distress might be much larger. There is some evidence that avoidance is related to non-clinical levels of social fear. Essau et al. (1999) found that the majority of the 12–17-year-old adolescents in their community study who reported some social fears also indicated avoidance of the accompanying social situations. Although this study showed that social fears and avoidance are related, they did not investigate whether age related changes in avoidance could be observed in their sample. In conclusion, although avoidance is recognized as an important element of social anxiety disorder and social fears in general, little information is available on the age pattern of avoidance. 1.3. Current study In summary, to better understand the increase in prevalence of social anxiety disorder during adolescence, it seems important to investigate the age pattern of distress and avoidance in an adolescent community sample with a broad age range. The study focuses on three main issues. 1.3.1. Age differences in reported distress and avoidance On the basis of previous findings (Westenberg et al., 2004) we expect that for some situations (i.e. highly evaluative situations) distress will show a clear increase, but not for social fears in general. For this reason the age patterns will be studied for three different social domains, which vary in the centrality of the social evaluative component. The three domains that will be investigated are based on Hofmann et al.’s (1999) categories and include: (1) formal speaking and interaction, (2) informal speaking and interaction, and (3) observation by others. The use of these three subtypes has been validated in a recent study by Cox, Clara, Sareen, and Stein (2008). Their two nationally representative mental health surveys revealed the three factor solution for social situational domains as described above. The ‘formal speaking and interaction’ category seems to have the strongest social evaluative part. Therefore, one would expect age differences in distress to be most pronounced for this category. Whereas age differences in distress are mainly expected to occur in formal social situations, age differences in avoidance are expected for all social situation with the strongest increase for formal situations (Rapee & Spence, 2004). 1.3.2. Comparisons between distress and avoidance within each age group Furthermore, we will test the hypothesis proposed by Rapee and Spence (2004) that the inclination to avoid will show a steeper increase than reported levels of distress during adolescence. These divergent age patterns might result in an increasing discrepancy between reported levels of avoidance and distress for each of the three domains. Because younger children might not have the opportunity to avoid, due to strict parental guidance, the willingness to avoid might already be present. Thus the children are instructed that in the current study avoidance also reflects their willingness to avoid. The willingness to avoid might actually be crucial in the final step from fear to phobia and might be viewed as a risk factor for developing social anxiety disorder. 1.3.3. Salience of formal fears in different age groups Finally, to investigate whether formal social (evaluative) fears do not merely show an increase with age, but also become more salient than the other fears, the relative importance of social fears within each age group will be tested. It is expected that within the youngest age group the reported levels of distress and avoidance for the different social situations are comparable. In contrast, the older children are expected to report more distress and avoidance for formal situations than informal or observation situations.