Are social phobia and paranoia related, and which comes first?

J. Rietdijk, J van Os, R. de Graaf, Ph. Delespaul, M. van der Gaag

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Social phobia (SPh) and paranoid symptoms (PS) are associated. They may
overlap because they share psychological and behavioural mechanisms such as
selective attention for social threats and avoidance behaviour. Possibly, one leads
to the other. The aim of this study is to explore the association between SPh and
PS in a prospective general population sample.
Adults (7076) from the NEMESIS general population were assessed for SPh
and PS using the Composite International Diagnostic Interview (CIDI) at baseline,
and one and three years later. Odds ratios, dose–response relationships and
confidence intervals were calculated.
Lifetime SPh and PS were associated (OR=3.08; 95% CI=2.49–3.82; p<.001),
with a dose response. SPh emerging after PS was significant (OR=4.07; 95%
CI=2.50–6.63; p<.001), also with a dose response, i.e. more PS symptoms yield
more SPh symptoms. PS emerging after SPh was not significant.
This study confirmed the association of SPh and PS in a general population.
Possibly this is caused by shared underlying psychological and behavioural
processes. There was some indication that paranoid ideation precedes the
development of SPh, but this must be considered with caution. Clinical implications
are discussed.
Keywords: paranoid symptoms; social phobia; comorbidity; general population
Original languageEnglish
Pages (from-to)29-38
Number of pages11
Issue number1
Publication statusPublished - 2009


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