ویژگی های روان سنجی اندازه گیری حساسیت بین فردی در اختلال اضطراب اجتماعی

The Interpersonal Sensitivity Measure (IPSM) was developed to assess hypersensitivity to interpersonal rejection, a suggested trait of depression-prone personality (Aust NZ J Psychiatry 23 (1989) 341). Although studies of the IPSM and interpersonal rejection sensitivity have primarily been conducted in depressed populations, it is important to investigate interpersonal rejection sensitivity as a relevant construct in the assessment of social anxiety. This study examined the psychometric properties of the IPSM in treatment-seeking individuals with social anxiety disorder. The results of this investigation support the convergent and divergent validity and internal consistency of the IPSM in socially anxious individuals. An exploratory factor analysis of the scale was also conducted after the original factor and subscale structure was shown to be a poor fit for the present data. Three factors emerged (Interpersonal Worry and Dependency, Low Self-Esteem, and Unassertive Interpersonal Behavior), and 29 items were retained. Because they demonstrated negative factor loadings on Factor 2, it is suggested that the scoring for four items of the original IPSM be reversed. In summary, the revised IPSM assesses three aspects of interpersonal rejection sensitivity and appears to be a valid and reliable instrument for its assessment in social anxiety disorder.

The Interpersonal Sensitivity Measure (IPSM) was developed by Boyce & Parker (1989) as a self-report measure of the construct of interpersonal sensitivity, which they defined as “undue and excessive awareness of and sensitivity to, the behavior and feelings of others” (p. 342). This construct has also been described as a general sensitivity to social feedback, vigilance with regard to others' reactions, increased concern about the behavior and statements of others, and fear of perceived or actual criticism by others (Boyce, Hickie, Parker, & Mitchell, 1993). Interpersonal sensitivity is characterized by a sense of personal inadequacy and frequent misinterpretation of others' interpersonal behavior and results in discomfort in the presence of others as well as interpersonal avoidance and non-assertive behavior (Boyce & Parker, 1989; Davidson, Zisook, Giller, & Helms, 1989). Although the authors of the IPSM refer to this construct as ‘interpersonal sensitivity’, we suggest the more descriptive label of ‘interpersonal rejection sensitivity’ to avoid confusion with the common conception of interpersonally sensitive/aware individuals and better describe the fear and discomfort associated with perceived interpersonal rejection. The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV; American Psychiatric Association, 1994) describes a subtype of major depressive disorder, atypical depression, which was first discussed 30 years ago as resistant to antidepressant medication (Rabkin et al., 1996). The current definition of atypical depression includes the frequent symptom of interpersonal rejection sensitivity, which is conceived of as a persistent personality characteristic. This personality attribute may be exacerbated by depressive episodes, may be a reflection of the sensitivity to rejection induced by depressive episodes, or may represent a vulnerability to depressive episodes. Given these connections between depression and interpersonal rejection sensitivity, Boyce and Parker (1989) proposed that interpersonal rejection sensitivity is a characteristic of the ‘depression-prone’ personality and consequently developed the IPSM to assess this risk factor for the development of depressive disorders. The initial studies of the scale yielded good evidence in support of the psychometric properties of the IPSM (Boyce & Parker, 1989). In a clinical sample of depressed patients and a non-clinical student sample, internal consistency estimates for the total score were 0.86 and 0.85, respectively. Further, the six-week retest reliability of the IPSM in the student sample was 0.70. A high correlation with a measure of neuroticism (r=0.66), a moderate correlation with a measure of self-esteem (r=0.39), and a low correlation with a measure of emotional arousability (r=0.11) provided evidence for both the convergent and divergent validity of the IPSM. The internal consistency estimates for four of the five IPSM subscales (Interpersonal Awareness, Separation Anxiety, Timidity, and Fragile Inner Self) were comparable to those reported for the total score. However, this initial investigation yielded lower six-week retest reliability for the Need for Approval subscale (r=0.55) as well as relatively low alpha coefficients of 0.67 in the patient sample and 0.55 in the student sample ( Boyce & Parker, 1989). Since its development, the IPSM has been used primarily in studies of interpersonal rejection sensitivity as a risk factor for depression. Interpersonal rejection sensitivity appears to be associated with depressive disorders, especially non-melancholic depressive episodes (Boyce et al., 1993 and Boyce et al., 1990). Although the IPSM is somewhat sensitive to mood states, interpersonal rejection sensitivity represents a more enduring personality characteristic (Boyce & Parker, 1989). Prospective studies have demonstrated the ability of the IPSM to predict the development of initial depressive episodes, the recurrence of depression six months following childbirth, and non-remission of depressive symptoms among depressed inpatients (Boyce et al., 1991 and Boyce et al., 1992). Further, among college students, the IPSM was associated with low social and academic self-esteem, depressive symptoms and poorer academic performance (McCabe, Blankstein, & Mills, 1999). This study also assessed the reliabilities of the IPSM subscales and obtained results comparable to the original investigation, including an alpha of 0.56 for the Need for Approval subscale, markedly lower than the other subscales (αs>0.75). Interpersonal rejection sensitivity also appears to be a central feature of social anxiety disorder (Liebowitz, Gorman, Fyer, & Klein, 1985). Social anxiety disorder, also known as social phobia (Liebowitz, Heimberg, Fresco, Travers, & Stein, 2000), is characterized by persistent fears of embarrassment in social interaction or performance situations (American Psychiatric Association, 1994). Characteristics of social anxiety correspond to many aspects of the definition of interpersonal rejection sensitivity: interpersonal vigilance, fear of rejection, misinterpretations of others' behavior, thoughts of inferiority, non-assertive behavior, and avoidance of interpersonal situations (Rapee, 1995; Turk, Lerner, Heimberg, & Rapee, 2001). These parallels are especially evident in the generalized subtype of social anxiety disorder. Although individuals with social anxiety disorder may have circumscribed fears of, for example, public speaking, patients with generalized social anxiety disorder experience social anxiety and fear of embarrassment in a broad range of social situations. Therefore, interpersonal rejection sensitivity may represent an underlying personality trait of individuals with social anxiety disorder, particularly the generalized subtype. The current study investigated the psychometric properties of the IPSM among patients with social anxiety disorder. The current investigation addressed several questions with regard to the psychometric attributes of the IPSM among patients with social anxiety disorder: (1) the internal consistency of the IPSM and its subscales; (2) the factor structure of the scale; (3) differences in IPSM scores between social anxiety disorder patients and non-anxious community participants; (4) its convergent (e.g. high interpersonal rejection sensitivity was expected to be associated with high anxiety about social interactions, more severe impairment, lack of expression of negative emotions such as anger towards others for fear of rejection, and an anxious attachment style) and divergent (e.g. the IPSM was expected to be only weakly related to anxiety sensitivity and to non-anxious insecure attachment styles and less related to observational fears than social interaction anxiety) validity; and (5) the sensitivity of the IPSM to treatment-related change among patients receiving cognitive-behavioral group therapy for social anxiety disorder. Important to the present context, research has demonstrated high rates of comorbidity between social anxiety disorder and depressive disorders (Kessler, Stang, Wittchen, Stein, & Walters, 1999; Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). Therefore, the relationship of the IPSM to various external indicators of validity in social anxiety disorder patients above and beyond the influence of depressive symptoms was investigated.