اختلال اضطراب اجتماعی زنان به راحتی چهره های ترسناک، غمگین و شاد را می شناسند: تاثیر جنسیتی

Abstract Background It has been suggested that individuals with social anxiety disorder (SAD) are exaggeratedly concerned about approval and disapproval by others. Therefore, we assessed the recognition of facial expressions by individuals with SAD, in an attempt to overcome the limitations of previous studies. Methods The sample was formed by 231 individuals (78 SAD patients and 153 healthy controls). All individuals were treatment naïve, aged 18–30 years and with similar socioeconomic level. Participants judged which emotion (happiness, sadness, disgust, anger, fear, and surprise) was presented in the facial expression of stimuli displayed on a computer screen. The stimuli were manipulated in order to depict different emotional intensities, with the initial image being a neutral face (0%) and, as the individual moved on across images, the expressions increased their emotional intensity until reaching the total emotion (100%). The time, accuracy, and intensity necessary to perform judgments were evaluated. Results The groups did not show statistically significant differences in respect to the number of correct judgments or to the time necessary to respond. However, women with SAD required less emotional intensity to recognize faces displaying fear (p = 0.002), sadness (p = 0.033) and happiness (p = 0.002), with no significant differences for the other emotions or men with SAD. Conclusions The findings suggest that women with SAD are hypersensitive to threat-related and approval-related social cues. Future studies investigating the neural basis of the impaired processing of facial emotion in SAD using functional neuroimaging would be desirable and opportune.

Introduction Social phobia, also known as social anxiety disorder (SAD), is characterized by the excessive fear of humiliation or embarrassment in social or performance situations. The generalized form of the disorder is frequently a chronic, disabling condition (Davidson, 1993) marked by the phobic avoidance of most interaction situations, causing social, educational, professional and personal impairment (Schneier et al., 1994 and Filho et al., 2009). The 12-month and lifetime DSM-IV prevalence rate of this disorder is high, of about 7.1% and 12.1%, respectively (Kessler et al., 2005 and Ruscio et al., 2008). SAD is also associated with high rates of psychiatric comorbidities, the most common being depression and substance abuse, among other anxiety disorders (Filho et al., 2009). One of the major aspects of SAD is the excessive fear of negative evaluation and criticism. Cognitive theories of this anxiety disorder (Beck et al., 1985, Clark and Wells, 1995, Rapee and Heimberg, 1997 and Ito et al., 2008) suggest that the patient in the feared social situation, feel negatively evaluated by others to an exaggerated unrealistic extent, expecting to be negatively evaluated and hence conjuring rejection. Thus, they tend to focus their attention toward themselves, which interferes with normal processing of external social cues. This could lead to attentional and interpretational biases in detecting social threat, resulting in hypervigilance toward negative emotions (Leber et al., 2009). The adequate social functioning is related to the capacity to extract environmental information that is relevant to social outcome (Garner et al., 2006). In this process of evaluating and responding to environmental contingencies, the processing of facial expressions represent an important source of interpersonal information about positive or negative evaluations by others. Among the first systematic studies about the facial expression of emotions are the old reports by Charles Darwin (1872). In his work, Darwin demonstrated the evolutional importance and communicative value of facial expressions. Research in the area has gone a long way since then, dedicating great attention, especially after the 1970s, to the relation between mental disorders and the processing of facial information and particularly emotion. Thus, authors as Beck (1976) and Eysenck (1997) arrived at the concise proposition that the impaired ability to process emotional information from faces plays an important role in the etiology and maintenance of several mental conditions. In respect to the recognition of facial emotions by people with social anxiety, recent evidence suggests that a bias exist in the facial processing abilities of these individuals in the sense of a greater accuracy for recognition of facial expressions of negative emotions and more frequent wrong judgments of faces as negative (Winton et al., 1995; Lundh and Ost, 1996; Veljaca and Rapee, 1998, Mohlman et al., 2007, Yoon and Zinbarg, 2007 and Yoon and Zinbarg, 2008). Also, people with social anxiety seem to take longer to recognize facial displays of happiness (Silvia et al., 2006), at the same that they require less emotional intensity to recognize angry (Joormann and Gotlib, 2006; Leber et al., 2009), sad (Leber et al., 2009), fear (Leber et al., 2009) and disgusted expressions (Montagne et al., 2006). In contrast, Philippot and Douilliez (2005) and Campbell et al. (2009) found no evidence of biased facial emotion recognition in individuals with SAD, and Hunter et al. (2009) reported that people with social phobia have a greater accuracy in the recognition of facial expressions in general, regardless of their emotional valence. Thus, although the majority of the studies suggest that people with SAD have an impaired capacity to recognize facial expressions of emotion; the reported conflicting findings may be due to the fact that most of them included small samples ranging from 12 to 29 subjects included in the experimental group, with most of patients selected from tertiary services (Lundh and Ost, 1996, Foa et al., 2000, Pérez-López and Woody, 2001, Mogg et al., 2004, Horley et al., 2004, Coles and Heimberg, 2005, Philippot and Douilliez, 2005, Joormann and Gotlib, 2006, Montagne et al., 2006, Mohlman et al., 2007, Gilboa-Schechtman et al., 2008, Campbell et al., 2009 and Garner et al., 2009). Also, those studies do not report procedures to prevent the inclusion of patients with psychiatric comorbidities and on medication (Anderson et al., 2007, Arnone et al., 2009 and Kerestes et al., 2009), which might have influenced the results obtained. Moreover, another important caveat of the former studies was that most of them did not take gender into account and there is evidence suggesting that gender-related differences exist in the recognition of facial expressions (Cellerino et al., 2004). Therefore, we assessed the recognition of facial expressions of the six basic emotions (happiness, sadness, disgust, anger, fear, and surprise) by individuals with SAD, in an attempt to overcome the limitations of previous studies.

Results No significant differences were found between patients and controls in terms of their sociodemographic profile (gender, age, educational level and socioeconomic status), which attests to the adequacy of the matching procedure between the groups (Table 1). As expected, subjects with SAD presented higher scores than Controls on the self- (SPIN) and hetero- (BSPS) assessment social anxiety symptom scales, higher current (LSRDS) and lifetime (LSRDS) functional impairment, as well as higher frequency of depressed mood and anhedonia over two weeks (PHQ-2). 3.1. Facial emotion recognition The MANOVA for the intensity required for recognition showed significant differences for interaction (F3227 = 2.139; p = 0.050), but not for group (F3227 = 1.922; p = 0.078) and gender (F3227 = 1.337; p = 0.242). Therefore, a MANOVA was separately performed for gender. Women with SAD required less emotional intensity to recognize fear (F1146 = 10.210; p = 0.002), happiness (F1146 = 10.130; p = 0.002) and sadness (F1146 = 4.611; p = 0.033) ( Fig. 1), but no differences were found in males ( Fig. 2). There were no significant effects for group (F3227 = 1.242; p = 0.286), gender (F3227 = 0.870; p = 0.517), and interaction (F3227 = 0.839; p = 0.541) for judgment accuracy or group (F3227 = 1.306; p = 0.256), gender (F3227 = 0.468; p = 0.831), and interaction (F3227 = 0.677; p = 0.669) for time spent to perform the task. The gender of the stimulus presented in the task also did not affect performance in terms of accuracy, time, and intensity required for recognition. Mean number of frames advanced by women (intensity of emotion) to respond to ... Fig. 1. Mean number of frames advanced by women (intensity of emotion) to respond to each emotion. ∗Significant difference (MANOVA; p < 0.05). Figure options Mean number of frames advanced by men (intensity of emotion) to respond to each ... Fig. 2. Mean number of frames advanced by men (intensity of emotion) to respond to each emotion. ∗Significant difference (MANOVA; p < 0.05). Figure options Additionally, no statistical differences between the groups were found when the emotions were divided in two blocks according to their valence (positive and negative facial expressions), either in the time spent or emotional intensity. There were no differences for time spent (t = 0.235; p = 0.815), accuracy (t = 0.942; p = 0.351) or emotional intensity (t = 1.210; p = 0.233) when we compared SAD patients with or without depression. No correlations were found between the variables of the facial emotion recognition task and the clinical and subjective measures of social anxiety or depression. Finally, the results have shown that the recognition of facial emotion is unaffected by the gender of the stimulus.