هراس اجتماعی و کیفیت دوستی ادراک شده

Although it is clear that people with social phobia have interpersonal impairment, evidence that social phobia (as opposed to other mental disorders) affects friendship in particular is lacking. Two large epidemiological datasets were used to test whether diagnosis of social phobia is related to perceived friendship quality above and beyond perceived family relationship quality, diagnosis of other mental disorders, and a variety of demographic variables. After Bonferroni correction, social phobia was the only diagnosis related to perceived friendship quality above and beyond other factors, such that people with social phobia reported more impaired friendship quality. Social phobia's effect was similar in magnitude to demographic characteristics in both samples. The current study demonstrates that social phobia is specifically related to perceived friendship quality, suggesting that this aspect of social phobia's effects is worthy of further study.

Social phobia, a relatively common mental disorder (affecting about 12% of the population across the lifetime: Kessler, Berglund, Demler, Jin, Merikangas & Walters, 2005), is associated with interpersonal impairment (e.g., Ruscio et al., 2007). It is less clear how social phobia impacts specific types of relationships. Relevant studies in adults have focused primarily on strangers (e.g., Creed and Funder, 1998, Hope et al., 1998, Kashdan and Wenzel, 2005 and Meleshko and Alden, 1993) and romantic partners (e.g., Davila and Beck, 2002 and Wenzel, 2002), with little data addressing the friendships of adults with problematic social anxiety. Treatment is largely consistent with the focus of available research, with cognitive behavioral therapy (CBT) treatments for social phobia making no special reference to friendships (e.g., Clark et al., 2006 and Heimberg and Becker, 2002). Evidence that friendship deserves a special focus in the understanding of social phobia and its treatment is equivocal. Some evidence suggests that social phobia has a negative impact on friendships, according to measures of quality of life (Schneier et al., 1994) and perceived social support (Torgrud et al., 2004).1 Yet these data are limited, as the studies did not test for a specific effect for social phobia. Instead, in both studies tendencies toward other mental disorders, perhaps most plausibly depression, might account for much of the observed impairment. Alternatively, neither study ruled out the possibility that interpersonal impairment in general was correlated with social phobia; friendships in particular might suffer no burden beyond a general impairment affecting all interpersonal relationships. Both of these alternative explanations need to be eliminated before researchers would have a compelling rationale for studying (and treating) friendship impairment among people with social phobia. The above concerns are compounded by the fact that the only study to test for a specific link did not find one. Whisman, Sheldon, and Goering (2000) analyzed 4933 participants in the Ontario National Survey Mental Health Supplement (ONS-MHS) and examined satisfaction in marital, family, and friendship relationships in relation to nine disorders, including social phobia. Social phobia did not show a specific link with friendship satisfaction. Taken at face value, these results are most consistent with the argument that if social phobia is associated with interpersonal impairment, this impairment is generalized and may not even be due to social phobia so much as characteristics shared with other mental disorders. This explanation is lent support by the fact that the only available test suggests that CBT, without a special focus on friendships, nevertheless improves quality of life in regard to a factor that includes friendships as an element (Eng, Coles, Heimberg, & Safren, 2001). However, both Whisman et al.’s and Eng et al's studies should be examined in more detail before conclusions are drawn. Inherent weaknesses in the dataset (the ONS-MHS) limit interpretation of Whisman et al.’s (2000) study. The authors found that social phobia was related to having no close friends. Whisman et al. did not include information about participants who had no close friends in their primary analyses because doing so would confound social isolation with relationship satisfaction. In addition, the friendship quality item used was a single, five response option question regarding close friends. Many participants might have friends and yet have no close friends; these participants would have been eliminated from the analyses. Thus, this study cannot address friendship in general; nor (as the authors note) is the use of a single item to measure friendship quality ideal. Similarly, Eng et al. (2001) did not assess friendship separately (i.e., friendship was included in a broader factor), and the measure they used contains only two questions that specifically refer to friendship. 2 Further, Eng et al. note that although participants in their study had improved quality of life at the end of treatment, this improvement still left these participants with lower quality of life than that reported in the literature for people with other mental disorders who have received treatment. It thus appears quite plausible that participants with social phobia might continue to experience impairment of their friendships after completing standard treatments. These studies therefore do not rule out the possibility that social phobia might have a specific, clinically relevant impact on friendship quality. An ideal test of whether social phobia has a unique effect on friendships would utilize a large sample that includes measurement of social phobia and comparison disorders, as well as multiple questions regarding friendships and other types of relationships. No single publicly-available dataset presents all of these elements without attendant drawbacks. For example, although the National Comorbidity Survey Replication (NCS-R) dataset contains a wealth of information, multiple questions about friendship were only asked of a subset of respondents. Although all participants who had a lifetime diagnosis of social phobia were asked a single item about close relationships, this category might excessively conflate romantic relationships and friendships. In contrast, the National Survey of American Life (NSAL; Jackson et al., 2004) included multiple questions regarding friend and family relationships to nearly all respondents, but did not include diagnostic information as far-reaching as the NCS-R. In this study, I examine both the NSAL and NCS-R in an effort to ameliorate their individual weaknesses for the question under consideration. Relationship quality with both friends and family were assessed by multiple items, allowing the estimation of latent variables. The inclusion of family relationship items allows a test of social phobia's relationship with reports of friendship quality above and beyond any general self-reported interpersonal impairment that affects all relationships. That is, if the effects of social phobia on friendship are due merely to general interpersonal dysfunction, this dysfunction should also result in reduced perception of family relationship quality. Therefore, self-reported family relationship quality would fully account for any apparent effects of social phobia in the models tested here. The specific relationship of social phobia to perceived friendship quality, above and beyond general perceived relationship quality, was tested in structural equation modeling (SEM) models, with multiple diagnostic and demographic variables available to test the alternative hypothesis that any apparent relationship would be due to the large number of factors that tend to co-occur with social phobia. It was hypothesized that social phobia would demonstrate a significant, specific relationship with perceived friendship quality above and beyond perceived family relationship quality, other diagnostic variables, and demographic characteristics.