بررسی تفاوت جنسیتی در هراس اجتماعی

The present study was an exploratory investigation of gender differences in a large sample of persons with social phobia. Potential differences in demographic characteristics, comorbidity, severity of fear, and situations feared were examined. No differences were found on history of social phobia, social phobia subtype, or comorbidity of additional anxiety disorders, mood disorders, or avoidant personality disorder. However, women exhibited more severe social fears as indexed by several assessment instruments. Some differences between men and women also emerged in their report of severity of fear in specific situations. Women reported significantly greater fear than men while talking to authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others are already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they do not know very well, giving a report to a group, and giving a party. Men reported significantly more fear than women regarding urinating in public bathrooms and returning goods to a store. Additionally, there were some differences in the proportion of men and women reporting fear in different situations. Specifically, more women than men reported fear of going to a party, and more men than women reported fear of urinating in a public restroom. Gender differences among patients with social phobia are discussed in the context of traditional sex-role expectations. In recent years, research has increasingly focused on gender differences in the anxiety disorders (e.g., Bekker 1996, Castle et al. 1995 and Oei et al. 1990). Gender differences in demographic characteristics, comorbidity, symptom presentation, and severity may influence the selection of target behaviors and the course and outcome of therapeutic interventions. Agoraphobia has been the focus of the most research and theoretical work regarding gender differences because of the disproportionate number of women suffering from the disorder (see Bekker, 1996, for a review). However, few gender differences among patients with agoraphobia have been found, and the differences that have emerged have been small in magnitude Chambless & Mason 1986, Cox, Swinson, Shulman, Kuch, & Reichman 1993, Mavissakalian 1985 and Oei et al. 1990. Specific phobias also appear to be more prevalent among women than men. In a recent survey, more women than men had animal (snakes, spiders) and situational phobias (lightning, closed spaces, darkness, heights), but no gender differences were found in the prevalence of mutilation phobias (injections, dentists, injuries) (Fredrikson, Annas, Fischer, & Wik, 1996). Among patients with obsessive-compulsive disorder, women were more likely to be married, have children, and develop the disorder later in life than men Castle et al. 1995 and Noshirvani, Kasvikis, Marks, Tsakiris, & Monteiro 1991. Despite the data accumulating about gender differences in the anxiety disorder, little is known about gender differences in the manifestation of social phobia. Epidemiological studies suggest that social phobia is among the most prevalent of mental health problems and that in community samples it is more commonly observed among women than men. Based on the responses of over 13,000 people in four communities who participated in the Epidemiological Catchment Area (ECA) study, the lifetime prevalence rate of social phobia was reported to be 2.0% for men and 3.1% for women (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). Given that respondents in the ECA study were asked about impairment resulting from only three situations relevant to social phobia, these data may underestimate the prevalence of the disorder. The more recent National Comorbidity Survey (NCS), based on a stratified, multistage probability sample of over 8,000 individuals throughout the United States, inquired about fear and impairment in six social situations. The NCS, which utilized the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised (DSM-III-R; American Psychiatric Association, 1987) criteria, revealed a lifetime prevalence rate of 11.1% for men and 15.5% for women (Kessler et al., 1994). Although women are more likely to receive a diagnosis of social phobia in epidemiological studies, men and women present for treatment of social phobia in roughly equal proportions. In a recent review of 35 social phobia treatment studies, which included a total of 1,514 patients, 48% of participants were men (Heimberg & Juster, 1995). Thus, social phobia stands in contrast to the other anxiety disorders, for which greater proportions of women seek treatment (Rapee, Sanderson, & Barlow, 1988). Sex-role socialization processes may contribute to gender differences in the development and manifestation of social phobia. Bruch and Cheek (1995) note that shyness is incompatible with the traditional male sex role. They point out that shy boys are less likely to behave in accordance with traditional male sex-role expectations (e.g., dominance, self-confidence) and may be more likely to experience conflict and negative feedback over the course of their social development. In fact, parents, particularly fathers, are more likely to consider shy behavior and poor peer adjustment to be greater problems for sons than for daughters (Bacon & Ashmore, 1985). It has been suggested that the life of a man with social phobia may be more disrupted than the life of a woman with social phobia in the context of Western society’s expectations that men should initiate dating relationships and be more career-oriented (Rapee, 1995). There is some research supporting this notion. For example, unlike women with a history of shyness, men with a history of shyness have been found to marry and become parents later in life than their nonshy counterparts Caspi et al. 1988 and Kerr, Lambert, & Bem 1996. Additionally, men with a history of childhood shyness have been shown to enter a stable career later than other men (Caspi et al., 1988). In contrast, shyness is viewed as consistent with the traditional female sex role (Bem, 1974). Thus, women with social phobia may receive less negative feedback about inhibited social behavior and may more easily avoid some of the negative consequences experienced by men with the disorder. Different factors may influence the decisions of men and women with social phobia to seek treatment, with more men being motivated to seek help for this problem. Very few studies have specifically examined gender differences among individuals suffering from clinical levels of social anxiety. One exception is Edelmann (1985), who examined gender differences among socially anxious patients and nonsocially anxious adults in how they deal with embarrassing events. Patients were described as individuals seeking treatment for interpersonal difficulties and attaining high scores on a measure of social anxiety. Interestingly, the pattern of anxiety related to social behavior differed in the clinical and nonclinical samples. Nonsocially anxious men reported less embarrassment than nonsocially anxious women, while socially anxious men reported more embarrassment than socially anxious women in four of six potentially embarrassing situations. A similar interaction effect was observed for self-perception of ability to cope with embarrassing situations. Flynn, Markway, and Pollard (1992) examined gender differences among 41 patients with DSM-III-R social phobia. Patients rated their fear that others might view 26 different descriptors (e.g., weak, talks funny) as applying to them. More women (43%) than men (15%) feared that others might view them as “crazy.” Women also reported greater severity of five fears (being judged as crazy, a bad parent, too fat, making no sense, too tall). These results suggest that men and women with social phobia share many fears but that women may experience more intense fear in certain domains. This study, however, is limited by a small sample and the use of a single measure to examine gender differences. There are mixed and inconclusive data from nonclinical samples examining gender differences on constructs that are conceptually related to social phobia (e.g., social anxiety, assertiveness). Although a complete review of this literature is beyond the scope of this paper, a few relevant examples are noted. The results of a telephone survey of 526 randomly selected community respondents were generally suggestive of greater social anxiety among women (Stein, Walker, & Forde, 1994). Women were significantly more likely than men to report being anxious in at least one social situation and in at least one non–public-speaking situation. When specific situations were examined, women reported significantly greater anxiety about public speaking, speaking in front of a small group of familiar people, speaking to strangers or meeting new people, and dealing with people in authority. Men and women did not differ in their degree of anxiety while writing in front of others, eating in front of others, or attending social gatherings. Bridges, Sanderman, Breukers, Ranchor, and Arrindell (1991) examined gender differences in situational assertiveness among 216 male and 327 female university students. The authors concluded that, while male and female students were comparable on most dimensions of assertiveness, they did differ in a few potentially important ways. Compared to men, women reported less reluctance to display behavior related to expression of and dealing with personal limitations (e.g., admitting ignorance about a topic, dealing with criticism, asking for help). Men reported less distress displaying negative feelings (e.g., requesting change in another person’s irritating behavior, ability to refuse requests) than women. Snell (1989) examined gender differences in undergraduate men’s and women’s reported willingness to self-disclose to female and male friends. Socially anxious women were more willing to discuss expressive-feminine behavioral information (e.g., “how often you tell people you like their friendship”) with their female friends and less willing to discuss instrumental-masculine behavioral information (e.g., “how strongly you defend your opinion”) with their male friends. The opposite pattern was found for men. Overall, socially anxious individuals reported presenting themselves in a gender-role consistent manner, especially with opposite gender friends. Taken together, these studies suggest that some situational differences in social behavior may exist between men and women. Therefore, in examining gender differences in social phobia, it may be important to look beyond differences in overall severity of fear. The present study was an exploratory investigation of gender differences in a large sample of patients with social phobia. Potential differences in demographics, comorbidity, severity of fear, and situations feared were examined.