The Appraisal of Social Trauma among Outpatients with Social Anxiety Disorder Compared to Individuals with No Mental Disorders

Abstract

Trauma has mostly been researched in relation to posttraumatic stress disorder (PTSD). Cognitive theories of how PTSD develops place a key emphasis on the appraisal of the traumatic event. However, trauma may be too narrowly defined in the Diagnostic and Statistical Manual (DSM) of mental disorders and there may be other types of traumatic experiences, such as social trauma (being severely rejected, ridiculed and humiliated). In this study we explored whether the same types of appraisal that have been implicated in the development of PTSD play a role in the development of social anxiety disorder (SAD). The appraisals of social trauma were assessed by the Posttraumatic Cognition Inventory (PTCI). The PTCI has three subscales (Negative Cognitions about Self, Negative Cognitions about the World and Self-Blame) and has been found to discriminate well between people who have experienced trauma and either develop PTSD or cope effectively. We also conducted content analyses of how participants responded to questions about the meaning of the social trauma, to determine if we could identify appraisal processes that may be specific to the development of SAD, and to what we termed social PTSD (meeting criteria for PTSD in response to a socially traumatic event). Participants were 25 adult outpatients at the Icelandic Center for Treatment of Anxiety Disorders with SAD as a primary diagnosis and 20 individuals with no mental disorders, all of which had experienced at least one socially traumatic event or experience. The results suggest that the PTCI subscales of Negative Cognitions about Self and Self-Blame is associated with a SAD diagnosis, indicating that beliefs previously thought to be specific to the development of PTSD may play a role in the development of SAD. The results of the content analyses of appraisals indicate that individuals with SAD appraise social trauma in a more negative fashion than people with no psychiatric diagnoses. More specifically, among individuals with SAD, 80% of the appraisals were classified in the appraisal categories drawn from cognitive models of how SAD is maintained, especially Flawed and/or weak self (n = 13, 52%) followed with Others are critical and/or cruel (n = 6, 24%). These two categories were endorsed by almost all individuals with social PTSD or clinically significant post-traumatic symptoms in response to the social trauma. Implications for theoretical models of SAD, and for how SAD and PTSD may be related, in addition to treatment considerations, are discussed.