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Higher- and lower-order personality traits and cluster subtypes in social anxiety disorder

Social anxiety disorder (SAD) is one of the most common psychiatric disorders, characterized by persistent and exaggerated fear in situations of social interaction. It is related to individual suffering, as well as involving emotional discomfort and social withdrawal. The Five Factor Model of Personality shows that this disorder is associated with high levels of neuroticism and low levels of extroversion. Social anxiety can be divided into five categories or types, according to Perugi et al., or six dimensions, based on the studies by Hofmann et al. However, studies relating SAD subtypes to personality models are scarce. For this reason, this study aimed to evaluate these subcategories of the disorder with the dimensions of the Five Factor Model, as well as with other clinical variables.

A total of 429 people took part, 265 of them patients diagnosed with social anxiety disorder and 164 healthy individuals. All participants were volunteers in neuroimaging treatment studies and their data was collected between 1998 and 2018. The instruments that assessed personality were the _Revised NEO Personality Inventory - NEO-PI-R_ and the _Karolinska Scales of Personality - KSP_. The _Liebowitz Social Anxiety Scale - LSAS_ assessed the severity of social anxiety symptoms, the _Social Interaction Anxiety Scale - SIAS_ social interaction anxiety and the _Spielberger's State-Trait Anxiety Inventory - STAI-T_ anxiety traits. Logistic regressions were carried out including the variables of the Five Factor Model of Personality to identify the predictors of the control and patient groups. In addition, two-stage _cluster_ analyses were carried out and the resulting analyses of variance between the groups (_clusters_).

The results showed that participants with social anxiety disorder had higher levels of neuroticism and lower levels of extroversion, openness to experience and conscientiousness compared to healthy participants. Logistic regression showed that neuroticism and extroversion were the strongest predictors of the differences between the two groups. With regard to the _clusters_ analysis, three subtypes of SAD were divided: prototypical, introvert-conscious and unstable-open. The results showed that neuroticism and extroversion are the most important factors in the development and treatment of the disorder, and are predominant in the prototypical group. In the other groups (introverted-conscientious and unstable-open), neuroticism was the most relevant factor for the differences in social anxiety traits.

The study is important for health psychology in terms of identifying different personality traits that are related to the development of social anxiety disorder. It also serves as a basis for differentiating subtypes of social anxiety based on the factors of the Five Factor Model of Personality. Both aspects make it easier to understand the disorder, as well as what management can be done, considering personality, for the treatment of social anxiety. Even so, more research is needed to delve deeper into the implication of personality factors in the etiology and clinical outcomes of social anxiety disorder.

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