Social Anxiety Disorder and Depression

Analyze etiologies (in terms of biological, cognitive, and/or sociocultural factors) of two disorders.

Social Anxiety Disorder (SAD) and Depression

Sunday, February 16, 14

Anxiety Disorders

• one of the most common psychiatric disorders; prevalence of anxiety disorders from 87 studies across 44 countries show a prevalence range between 0.9% and 28.3% (Baxter AJ, Scott KM, Vos T, Whiteford HA


Social Anxiety Disorder: Symptoms

• excessive blushing

• sweating

• trembling

• palpitations (rapid or irregular heartbeat due to stress or tension)

• nausea

• stammering and/or rapid speech

• panic attacks


Social Anxiety Disorder: BLOA Etiology• Hypersensitive amygdala:

Furmark et al. (2004) found that social phobia patients with a short allele of the serotonin transporter polymorphism had greater amygdala responses during public speaking than ones with long alleles.

• Other parts: media prefrontal cortex, insular cortex, stratium

• Jerome Kagan (Harvard) found evidence that people are born with SAD.

• “Exact neuroanatomical region that stores fear memory traces, or the exact role of a particular process still debated”


Social Anxiety Disorder: CLOA Etiology

• previous negative social experience can trigger already existing genetic predisposition

• secondary experience such as hearing or observing negative experiences of others can also contribute to social anxiety

• Sternberg et al. (1995), Beidel and Turner (1998)

• There are “core” or “unconditional” negative beliefs and “conditional beliefs”. These develop according to personality, and anxiety interferes with social performance which creates more social problems, strengthening the schema.

• Are these factors simply a result of the biological factors or can certain experience cause SAD to anyone?


Social Anxiety Disorder: SCLOA Etiology

• society’s attitude towards shyness and avoidance (Refer to Hoffmann with Uncertainty Avoidance measurements across cultures)

• parenting across culture: American children more likely to develop SA if their parents emphasize importance of others’ opinions (Leung et al, 1994). Chinese children, on the other hand, are more accepted by their peers if they are shy-inhibited.

• emphasis on assertiveness and competitiveness is making social anxiety problems more common

• The family unit is the first social structure the child receives from birth. Parenting is then a big part of SAD, and cultural considerations or the way parents implement them can cause SAD.

• With globalization, are we going down the path towards a society with more prevalence of SAD?


Depression

• affects around 15% of people at some time in their life (Charney and Weismann 1988)


Depression: Symptoms

• insomnia

• appetite disturbances

• feelings of worthlessness

• thoughts of suicide

• difficulty concentrating

• irritability or anxiety

• aches and pain that have no physical explanation

• lethargy and lack of energy


Depression: BLOA Etiology

• Nurnberger and Gershon (1982) found that the concordance rate for major depressive disorder was consistently higher for MZ twins than for DZ twins.

• Researcher Duenwald (2003) claimed that a short variant of the 5-HTT gene may be associated with a higher risk of depression.

• This seems to support the hypothesis that genetics play a role in the prevalence of depression, and that biological factors strongly dictate if one will have depression.

• However, Caspi et al. (2003) says that genetic factors might only play a part in controlling the responses to environmental factors.

• The data might also be simply correlational and show no causal relation.


Depression: BLOA Etiology

• Catecholamine hypothesis (Schildkraut, 1965) is about low levels of noradrenaline. This has been developed into the “serotonin hypothesis”. Low levels of adrenaline might result into depression.

• Rampello et al. (2000) claims imbalance of neurotransmitters such as noradrenaline, serotonin, dopamine, and acetylcholine are present with patients.

• Cortisol Hypothesis: higher levels of this stress hormone may lower density of serotonin receptors and impair function of receptors for noradrenaline.

• Again, this data can simply be correlational and there shows no clear causal relationship.

• Researchers such as Burns (2003) or Lacasse and Leo (2005) criticize these causes as reductionist and a leading factor to the use of drugs.


Depression: CLOA Etiology

• Irrational and illogical thinking results into depression. People may have unrealistic expectations or false conclusions. (Ellis, 1962).

• Beck (1976) based a theory on cognitive distortions and biases in information processing. The schema processing of these patients may include overgeneralization based on negative events, non-logical inference about the self, and dichotomous thinking. Depressed patients’ attributional style, and pessimism.

• It is clear that people with depression do not think as “normal people” do. There is a pattern of thinking that leads to unrealistic or pessimistic perception of the world.

• We do not know if that is a symptom or a cause of depression.

• Establishing something as a “norm” goes back to Jahoda’s set of characteristics. It may not be accurate.


Depression: SCLOA Etiology

• Brown and Harris (1978): a vulnerability model of depression including life events such as lacking employment away from home, absence of social support, having several young children at home, lost of mother at an early age, or history of childhood abuse.

• WHO (1983) found universal symptoms between sad affect, loss of enjoyment, anxiety, tension, lack of energy, loss of interest, inability to concentrate, and ideas of insufficiency, inadequacy, and worthlessness

• Prince (1968) claimed that there was no depression in Africa and various regions of Asia, but found that rates of reported depression rose with westernization in the former colonial countries.

• Different societies may expression depression differently, making it complicated to judge causes across the world or record depressive rates.


Depression: Diathesis-stress Model

• interactionist approach to explain psychological disorders, saying that depression may be the result of a hereditary predisposition, with precipitating events in the environment.


Discuss cultural and gender variations in prevalence of disease.

Social Anxiety Disorder (SAD) and Depression


• “Emotions can be considered as essentially cultural since no human response or experience occurs in the absence of culturally defined situations or meanings.” -Cross-Cultural Studies of Depression.

• The Ifaluk people of Micronesia (Lutz 1985, 1988). They believe emotions are not located in persons but in relationships between persons or within events and situations. However, they do acknowledge that sometimes it can be “about our inside”.


0

2.5

5

7.5

10

US Brazil Korea Japan Europe

Prevalence of Social Anxiety Disorder in Adults (%)

Chile Taiwan China Mexico


Social Anxiety Disorder: Cultural Considerations

• Prevalence ranges from 5.3% in African cultures to 10.4% in Euro/Anglo cultures

• onset to occur around ages 12-15 and usually affects 3 to 5% of youths

• Asian cultures typically shows the lowest rates, whereas Russian and US samples show the highest rates. Defining feature is the fear of negative evaluation by others -> social standards and role expectations

• Some cultures have different variations of SA, such as the Taijin Kyufusho prevalent in Japan and Korea or the aymat zibur - “fear of the community” - in ultra-orthodox Jews


Social Anxiety Disorder: Gender Factors

• Girls had higher anxiety than boys. (Garcia-Lopez, Ingles, Garcia-Fernandez)

• In a cross-cultural study, women (50.7%) had higher rates than men (35.6%).

• Schwartz et al. explored temperament or personality characters in different genders and found that as SAD can be more noticeable in boys, they receive treatment faster.

• Behavior inhibition is manifested differently.

• While causes of SAD for girls include parental conflicts, childhood physical abuse, maternal mania, and failure to complete high school, causes of SAD for boys are just absence of a parent or adult confidant. Thus, there are many more risk factors for girls.


Depression: Cultural Considerations

• “Based on detailed interviews with over 89,000 people, the results showed that 15% of the population from high-income countries (compared to 11% for low/middle-income countries) were likely to get depression over their lifetime with 5.5% having had depression in the last year (2010).” -BioMed Central

• Conceptions of emotions are embedded within notions of the self - egocentric versus sociocentric. The nature of collectivist/individualist society can influence this. Depression, as a disorder related to loneliness, may be more prevalent in individualistic societies.

• social stress is seen as a trigger for depression

• If depression can be experienced differently, is it correct to label it as abnormal? How has this raised the use OR misuse of drugs?


Depression: Gender Factors

• Women are two to three times more likely to become clinically depressed than men (Williams and Hargreaves, 1995).

• Women are more naturally emotional than men. Is that submitting to the fundamental error of attribution? If we look at situational factors instead, perhaps society is more favorable towards men.


Bibliography

• Shin, Lisa M. Liberzon, Israel. “The Neurocircuitry of Fear Stress, and Anxiety Disorders.” US National Library of Medicine Institutes of Health. ncbi.nlm.nih. 22 July 2009. web. 16 Feb 2014.

• Baxter, AJ. KM, Scott. Vos, T. Whiteford, HA. “Global prevalence of anxiety disorders: a systematic review and meta-regression.” US National Library of Medicine Institutes of Health. ncbi.nlm.nih. May 2013. web. 12 Feb 2014.

• Hofmann, Stefan G. Asnaani, Anu. “Cultural Aspects in Social Anxiety and Social Anxiety Disorder.” US National Library of Medicine Institutes of Health. ncbi.nlm.nih. 1 Dec 2011. web. 16 Feb 2014.

• Jenkins, Janis H.; Kleinman, Arthur; Good, Byron J. “Cross-Cultural Studies of Depression.”

• Garcia-Lopez, Luis-Joaquin; Ingles, Candido J.; Garcia-Fernandez, Jose M. “Exploring the Relevance of Gender and Age Differences in the Assessment of Social Fears in Adolescence.”

• Wardy, Adrienne. “The Science of Shyness: The Biological Cause of Social Anxiety Disorder.” Bryn Mawr College. serendip.brynmawr. 2002. web. 16 Feb 2014.

• BioMed Central. “Global depression statistics.” Science Daily: your source for the latest research news. sciencedaily. 26 July 2011. web. 16 Feb 2014.


Social Anxiety Disorder and Depression

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