Haunting self-images? The role of negative self-images in adolescent social anxiety disorder

Background and objectives: Negative distorted self-images (NSI) allegedly maintain social anxiety in adults suffering from social anxiety disorder (SAD). These NSI are activated in feared social situations and are often linked to past socially traumatic events. However, because empirical evidence on the presence and characteristics of such NSI in adolescents suffering from SAD is limited, the aim of the present study is to examine the nature of NSI in adolescent SAD patients. Methods: Using a semi-structured interview, 31 adolescents with a primary diagnosis of SAD and 31 healthy adolescents (HA) who were matched for age and gender, completed a questionnaire set assessing the characteristics of NSI, social anxiety and depression. Results: Relative to the HA-group, those suffering from SAD reported experiencing NSI significantly more frequently, more vividly, and with greater distress. No significant differences between the groups emerged regarding a link between the NSI and an autobiographical event. However, NSI were reported as more often having an observer-perspective in the SAD as compared to the HA-group. Hierarchical regression analysis revealed that certain characteristics of the NSI predict social anxiety beyond the influence of depression in adolescents with SAD. Discussion: NSI seem to be an important feature of adolescent SAD and phenomenological comparable to NSI in adults suffering from SAD. Conclusions: Specific interventions aiming to correct NSI, which have proven to be highly effective in adults, should be developmentally-adapted and evaluated in future studies. (C) 2012 Elsevier Ltd. All rights reserved.