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. Author manuscript; available in PMC: 2021 Oct 1.
Published in final edited form as: J Anxiety Disord. 2020 Jul 30;75:102275. doi: 10.1016/j.janxdis.2020.102275

Interpersonal Problems in Social Anxiety Disorder Across Different Relational Contexts

Natasha A Tonge a, Michelle H Lim a, Marilyn L Piccirillo a, Katya C Fernandez a, Julia K Langer a, Thomas L Rodebaugh a
PMCID: PMC7755155  NIHMSID: NIHMS1627263  PMID: 32891027

Abstract

People with social anxiety disorder (SAD) frequently report interpersonal problems across various domains; however, it is unclear whether these problems are observable by others or represent negatively biased self-report. We assessed the interpersonal problems of people with and without SAD using self-report, friend, and romantic partner report. We hypothesized that SAD diagnosis would predict self-reported problems across multiple interpersonal domains, but restricted domains of informant report. Additionally, we hypothesized that diagnosis would predict discrepancy between self and informant report either in the form of a bias toward reporting more problems or in the form of lack of concordance between self and informant reporters. Using structural equation and multilevel models, we found evidence for differences between people with and without SAD in terms of domains of impairment observed by self and informants as well as differences in correspondence across relationship types. Results highlight the utility of multi-informant assessment of SAD.

Keywords: social phobia, interpersonal relationships, psychological assessment, informants, self-report

Interpersonal problems are a fundamental criterion for only a handful of psychiatric disorders. For some of those disorders, individuals with social impairment (e.g., autism spectrum disorders) are assumed to have distinctive social skills impairments that can be observed early in development. By contrast, it is generally assumed that people with social anxiety disorder (SAD) either have social skills largely intact or that social skills deficits are secondary contributors to the maintenance of the disorder (see Beidel et al., 2010; also see Rapee & Spence, 2004 for discussion of exceptions). Instead, conceptualizations of SAD emphasize a combination of cognitive biases, such as an increased sensitivity to social evaluation, and maladaptive interpretations of social situations as contributors to the development and maintenance of SAD (see Wong & Rapee, 2016). The cognitive biases that characterize the disorder make it difficult to study the social problems individuals with SAD may experience, however. When people with SAD report interpersonal problems, it may be difficult to discern if problems are the result of real, observable deficits, or are instead due to negatively biased interpretation (Christensen, et al., 2003; Moscovitch et al., 2009; Rapee & Lim, 1992).

Individuals with SAD indicate that they experience more difficulty engaging in or sustaining relationships with others (Kashdan et al., 2007; Rodebaugh, 2009) and may employ maladaptive strategies, particularly in close relationships, that lead to interpersonal distress. Using the Inventory of Interpersonal Problems (IIP; Horowitz et al., 2000), Alden and Phillips (1990) found that undergraduate students with elevated social anxiety scores self-reported having problems with being submissive and cold. Friends reported observing the same problems but rated those problems as being substantially less severe and more centered on submissiveness. However, the conclusions that have been drawn about the interpersonal problems experienced by people with SAD in close relationships have largely been based on retrospective self-report alone (Wenzel, 2002; Davila & Beck, 2002) with a few exceptions.

Although the types of interpersonal problems that people with higher social anxiety or SAD report have been characterized, the impact of the disorder on interpersonal relationships warrants further study. The most practical way to do so would involve use of informants who know the individual with SAD and can corroborate or dismiss self-reported interpersonal problems. There are few studies incorporating self-report and informant partner report of relationship problems experience by people with SAD, however, despite the potentially important insights a multi-informant approach may provide. Studies with undergraduates have provided some initial insights into the impact of social anxiety symptoms on relationship functioning. For example, Porter and Chambless (2013) found that undergraduate women with higher social anxiety symptoms self-reported that they provided less support to romantic partners, but that social anxiety symptoms were not related to romantic partners’ perception of support received. Wenzel et al. (2005) similarly reported that undergraduates with high social anxiety symptoms had deficits in several social skill variables when engaging with romantic partners in conversation. The study highlights the potential limitation of reliance on self-report of interpersonal behavior alone. Individuals were subject to their own interpretations of the relationship dynamics, which were in turn impacted by social anxiety symptoms.

Using informant reports could compensate for the limitations of self-report of interpersonal behavior by generating a more complete portrait of the target person’s problems. Due to symptom profiles that may vary by context and informant, multi-informant approaches have been identified as a best practice for the assessment of mental health concerns in children and adolescents (de los Reyes et al., 2013); however, the multi-informant approach is not often taken with adults with psychopathology. This difference could be explained by the perceived ease of access to informants (i.e., parents): Children’s participation in research is usually contingent on the presence of a parent or guardians. However, as researchers in personality have argued (Vazire, 2006), the perception that adult informant report would be challenging or prohibitively expensive to collect is a misconception, albeit a popular one. A multi-informant approach is not only useful for understanding the presenting problems of people with SAD, but may be especially vital given that people with SAD may be negatively biased in their self-report of interpersonal behavior.

Results of some of the studies utilizing a multi-informant approach to assess adult psychopathology in interpersonal contexts suggest that informant report helps to clarify how much of self-report might consist of negative bias as well as the contexts in which self-report might be more accurate. Rodebaugh and colleagues (2010), for example, obtained peer reports of individuals who self-reported their avoidant personality disorder (AVPD) traits with the rationale that additional and unique information could be obtained via an informant. The authors found that peers and primary participants reported that individuals with higher AVPD traits had problems being too cold, self-sacrificing, and socially inhibited, but only self-report of AVPD traits suggested problems being too domineering. In contrast, when agreement between self and peer was examined, AVPD traits were weakly but inversely related to being too domineering.

Given the similarities between SAD and AVPD symptom presentation (Chambless et al., 2008), it seems plausible that people with SAD evince similarly inaccurate self-perceptions. In a recent study by Shin and Newman (2019), authors investigated self and informant report of students’ generalized anxiety, social anxiety, and depression symptoms. The authors found that self-report but not informant report explained symptom presentation. Students with elevated social anxiety self-reported socially avoidant and non-assertive interpersonal problems; however, informants reported problems with affiliation (warmth).

Incorporating both informant and self-report may lead to unique conclusions about how the interpersonal behavior of the person with SAD changes with context. For example, in a study of participants with SAD examining self-reported and clinician-reported symptoms, de los Reyes and colleagues (2013) found that discordance between self- and clinician-report was related to greater participant variability in social impairment across contexts which, the authors note, has implications for treatment decisions. Taken together, the research conducted by de los Reyes et al., (2013), Shin and Newman (2019), and Rodebaugh et al., (2010) demonstrates that neither self- nor single informant-report can accurately describe the entire picture of the interpersonal problems associated with SAD. Interpersonal problems are potentially manifested uniquely depending on the type of relationship. In other words, the best way to measure interpersonal phenomenon is to use multi-informant interpersonal methodology.

In the current study, we examined interpersonal problems in SAD by using self-report and two specific types of informant reports: friend and romantic partner. Because friends and romantic partners frequently serve as important providers of social support in relationships but differ in the ways they might offer support (Umberson & Montez, 2010), we hoped to capture multiple contexts in which maladaptive interaction styles might manifest. We hypothesized that across all reporter sources (self, friend, and romantic partner), individuals with SAD would display interpersonal problems that were significantly different from individuals without the disorder. More specifically, we hypothesized that self-reported problems would be present across multiple and even conflicting domains, such as being both too interpersonally cold and too interpersonally warm, but informant report would be limited to compatible domains like being too cold and socially inhibited (Hypothesis 1). We were additionally interested in investigating how diagnosis of SAD impacts the unique contribution of each reporting source. We hypothesized that diagnosis would moderate the effect of informant report on self-report of interpersonal problems such that SAD diagnosis would lead to decreased correspondence between self and informant reports relative to individuals without a SAD diagnosis (NOSAD; Hypothesis 2). We defined decreased correspondence as a weaker relationship between self and informant reports (Figure 1B) due to diagnosis. This result would indicate that different informant reports uniquely contribute to understanding the interpersonal problems experienced by individuals with SAD compared to those without SAD.

Figure 1.

Figure 1.

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Hypothesized effect of diagnosis moderating the slope between informant and self-report. Panel A depicts the effect of diagnosis leading to identical slopes but a shifted intercept for GSAD participants, indicating similar correspondence with informants across diagnoses but that diagnosis has an effect on the intercept. Panel B depicts the effect of diagnosis leading to a more shallow slope, indicating decreased correspondence with informant ratings relative to NOSAD. GSAD = Generalized Social Anxiety Disorder; NOSAD = No Social Anxiety Disorder. Notably, observed results did not conform exactly to either pattern (see Figure 3).

Methods

Participants

Participants were recruited as part of two studies conducted between 2007 and 2012 (see Rodebaugh, 2013 and Rodebaugh et al., 2014 for overall study descriptions). The studies examined the effects of SAD on interpersonal relationships using a behavioral economics task and reports of friendship quality, respectively. The two samples in this study correspond to Rodebaugh and colleagues’ (2014) Sample 1 and Sample 2. It should be noted, however, that the current samples do not completely overlap with the previous samples because (a) in this sample we included all participants in Sample 2 who reported that they either had a current friend or romantic partner, whereas in the previous studies only those who reported having a current friend were included and (b) we included report of romantic partners from Sample 2, which were not examined in the previous studies.

Sample demographics can be found in Table 1. In both studies, primary participants with SAD were recruited from the St. Louis community using print, television, and Internet advertisements. Primary participants with no diagnosis of social anxiety disorder (NOSAD) were recruited via a volunteer registry. NOSAD participants were recruited to be similar to participants with SAD in terms of age, gender, and race. Individuals (including friends and romantic partners) were excluded from the study if they were intoxicated or exhibiting symptoms of psychosis, mania, or suicidality during the time of the study session. Additionally, primary participants in Sample 1 with reported symptoms of alcohol or substance abuse within one month of the study session were disqualified from participation whereas primary participants in Sample 2 with alcohol or substance abuse within two months of the study were disqualified.

Table 1.

Frequencies and Descriptive Statistics from Sample 1 and Sample 2 for GSAD and NOSAD Primary Participants, Their Friends, and their Romantic Partners

  Primary Participants   Friendsb   Romantic Partnersb
 
  GSAD NOSAD GSAD NOSAD GSAD NOSAD
  (n = 102) (n = 83) (n = 48) (n = 39) (n = 31) (n = 28)
Age. M (SD) 39.04(13.40) 35.10(12.36) 38.10(15.46) 40.38 (15.22) 43.32(13.15) 37.04(13.12)
Women, n (%) 73 (71.60%) 57 (68.67%) 34 (70.83%) 24 (61.54%) 22 (68.75%) 19 (65.52%)
Race, n (%)
 American Indian 1 (.98%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%)
 Asian/Pacific Islander 2(1.96%) 7 (8.43%) 2(4.17%) 1 (2.56%) 0 (0.00%) 2(7.14%)
 Black 34 (33.33%) 20 (24.10%) 20 (41.67%) 16 (41.02%) 15 (48.39%) 10 (35.71%)
 Multiracial 8 (7.84%) 2 (2.40%) 1 (2.08%) 2(5.13%) 2 (6.45%) 0 (0.00%)
 White 56 (54.90%) 53 (63.86%) 23 (47.92%) 19 (48.72%) 14 (45.16%) 16 (57.14%)
 Not listed racial minority/not reported 1 (.98%) 1 (1.20%) 2(4.17%) 1 (2.56%) 0 (0.00%) 0 (0.00%)
Ethnicity, n (%)
 Hispanic 2(1.96%) 3 (3.61%) 2(4.17%) 1 (2.56%) 2 (6.45%) 2(10.71%)
 Not listed 1 (0.98%) 0 (0.00%) 0 (0.00%) 2(5.13%) 0 (0.00%) 0 (0.00%)
Relationship length (years). M (SD)a - - 11.68(10.49) 8.93 (7.66) 7.86 (10.37) 7.99 (9.90)
Diagnoses, n (%)
GSAD 102 (100%) 0 (0.00%) 7 (14.58%) 1 (2.56%) 4 (12.90%) 1 (3.57%)
MDD 41 (40.19%) 1 (1.20%) 4 (8.33%) 0 (0.00%) 2 (6.45%) 0 (0.00%)
LSAS. M (SD) 90.38 (18.81) 13.47 (9.59) - - - -
BDI - II. M (SD) 21.63 (12.05) 4.79 (5.35) - - - -
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Note. GSAD = Generalized Social Anxiety Disorder; NOS AD = No Social Anxiety Disorder; MDD = Major Depressive Disorder; LSAS = Liebowitz Social Anxiety Scale; BDI-II = Beck Depression Inventory.

a

Relationship length is the estimate of relationship duration reported by primary participants from Sample 2 only

b

Demographic data for friends and romantic partners is only reported for participants who provided informant report.

Informed consent was obtained from all participants, and the study was conducted in compliance with the institutional Internal Review Board. In total, 102 primary participants diagnosed with the generalized form of SAD (GSAD) according to the Diagnostic and Statistical Manual, revised 4th edition criteria (DSM-IV-TR; American Psychiatric Association, 2000) and 83 NOSAD participants took part in the study.1 Participants in Sample 1 were asked if they had a current friend, but data were not collected from friends. Primary participants in Sample 2 were invited to bring their friends and romantic partners for a second and third study session occurring at one and two weeks following the primary participant’s diagnostic session. The sample for analysis included 87 friends of primary participants (48 friends of participants with GSAD) and 59 of their romantic partners (31 partners of participants with GSAD). Data from romantic partners was obtained entirely from Sample 2. An additional four friends and two romantic partners did not provide any informant report of interpersonal problems, were excluded from analysis and are thus not reported in Table 1. All participants received monetary compensation for their participation in the study. Missing data were handled using structural equation modeling with the maximum likelihood estimator with robust standard errors.

Measures

Diagnostic and symptom measures

Diagnosis of primary participants was conducted using two diagnostic interview measures: either the Mini International Neuropsychiatric Interview Version 5.0.0 (MINI; Sheehan et al., 1998) in Sample 1 or the Structured Clinical Interview for DSM-IV (SCID-IV-TR; First et al., 1995) in Sample 2 and the Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987). Diagnostic interviews were conducted by study staff with PhDs in clinical psychology as well as those who were advanced graduate students, including several authors of the current manuscript (MHL, KCF, JKL, and TLR); all assessments were overseen by the senior author (TLR). The LSAS is a 48-item clinical administered measure used to assess fear and avoidance of a variety of social situations. Internal consistency for the present study was excellent (α = .99). In addition to the LSAS, diagnosis was confirmed using the MINI (Sample 1) or the SCID-IV-TR (Sample 2). The MINI is a brief diagnostic instrument that compares favorably to lengthier diagnostic measures (Sheehan et al., 1998); the version used for this study was modified to comply with DSM-IV-TR diagnostic criteria. The SCID-IV-TR similarly assesses current and lifetime psychiatric disorders utilizing DSM-IV-TR diagnostic criteria; however, in this sample it was abridged to primarily assess mood- and anxiety-related psychopathology.

Inter-rater reliability for the SCID-IV-TR has been found to be adequate to excellent (Zanarini et al., 2000); in the present study, inter-rater reliability established using 10% of interviews resulted in 100% assignment to diagnostic group (see Rodebaugh, 2013, Rodebaugh et al., 2014). Inter-rater reliability for participants in Sample 1 who were assessed with the MINI was likewise 100%. Primary participants were included in the GSAD group only if responses to the LSAS were at or above a cutoff of 60 and if diagnostic criteria for GSAD were met on the MINI (Sample 1) or SCID (Sample 2), whereas participants were included in the NOSAD group if their LSAS scores were below 30 and they did not meet for GSAD.

Inventory of Interpersonal Problems-32 item version (IIP-32; Horowitz et al., 2000)

The IIP-32 is a self-report questionnaire of interpersonal problems based on the interpersonal circumplex model (Leary, 1957, Wiggins, 1957). According to the model, interpersonal personality traits can be mapped onto a Cartesian plane: Traits related to warmth and affiliation are represented along the x-axis, whereas dominance and assertiveness are represented along the y-axis. Trait-like interaction styles can then be represented by varying degrees of endorsement along one or both axes (e.g., very cold and very dominant) but can also be divided into octants created by the axes (e.g., moderately warm, very submissive). The IIP questionnaire is comprised of eight subscales representing the octants that describe interpersonal problems; these are depicted in Figure 2. Sample 1 participants (n = 71) were assessed with the 64-item version of the IIP questionnaire so their scores were converted to the shortened 32-item version of the scale using instructions published in the manual (Horowitz, et al., 2000).

Figure 2.

Figure 2.

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Depiction of the interpersonal circumplex and its octants.

Prior examination of the internal consistency for the subscales of the IIP-32 revealed a range of αs from .66 to .81 in a clinical sample (Vanheule et al., 2006); our sample yielded similar αs that can be seen in Table 2 along with subscale descriptions. The internal consistency of the Domineering scale was merely adequate at .66, with the rest of the scales ranging from .72 to .92 for primary participants, above the satisfactory range (Nunnally, 1978). Ranges for friends were all above satisfactory range (.70 - .90) as were ranges for romantic partners (.71- .90).

Table 2.

Inventory of Interpersonal Problems (IIP) Subscale Descriptions and Internal Consistency for Primary Participants, Friends, and Romantic Partners

Subscale Description Self-Report Internal Consistency Friend-Report Internal Consistency Romantic-Partner Internal Consistency
Domineering Problems with assertiveness; tendency toward being contr olling .66 .85 .85
Vindictive Hostile, suspicious, or slow to trust .87 .90 .90
Cold Difficulty with affiliation and connecting to others .84 .88 .85
Socially Inhibited Socially anxious, avoidant, or shy .92 .89 .86
Nonasseitive Problems with submissiveness .89 .82 .87
Overly Accommodating Permissive, too trusting, and yielding .79 .70 .71
Self-Sacrificing Excessively warm and eager to please others .83 .86 .82
Intrusive Attention-seeking and needy .72 .79 .81
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Note. Subscale descriptions adapted from Horowitz et al. (2000) and Vanliuele et al. (2006).

Beck Depression Inventory-II (BDI-II; Beck et al., 1996)

The BDI-II is a widely-used self-report measure of depressive symptoms consisting of 21 questions representing different facets of depression. The measure assesses multiple domains of depressive symptoms including both cognitive and behavioral facets of the disorder (Dozois et al., 1998). The BDI-II has been demonstrated to have excellent internal consistency in clinical samples (α = .91; Dozois et al., 1998) and we found that internal consistency was also excellent in our sample (α = .94).

Data Analytic Procedure

Upon examination of the patterns of missingness, we determined that data were not missing completely at random (MCAR) because missingness in self, but not friend or romantic partner report, was related to social anxiety severity in Sample 2. When missingness is high and data cannot be assumed MCAR, multiple imputation represents the best statistical method for accounting for missingness and reducing statistical bias that might result from pairwise or listwise deletion (van Ginkel et al. 2019). To account for the missing data, we used multiple imputation and included LSAS score, BDI score, and their interaction as part of the estimation procedure. We generated 10 imputations using the package mice (van Buuren & Groothuis-Oudshoorn, 2011) in R (R Core Team, 2017) and followed suggestions by the package authors to evaluate the suitability of the imputations.

After imputation, we then prepared the IIP data for analysis. Following guidelines by Zimmerman and Wright (2017), we used the R package multicon (Sherman, 2015) to apply the structural summary method (Gurtman, 2003) to the eight subscales of the IIP. The structural summary method allowed us to condense each profile into four meaningful components: dominance, warmth (affiliation), distress (elevation), and prototypicality, which captures how well the interpersonal profile conforms to a circumplex pattern. Low prototypicality (R2 < .70; Wright et al., 2009) could be found if, for example, high scores on a subscale like dominance were associated with high scores on submissiveness, violating the expected circumplex pattern (e.g., strong negative correlation between opposing scales). The inclusion of prototypicality provided us with an additional way of investigating Hypothesis 1 that interpersonal problems would be reported in conflicting domains by individuals with SAD.

Data were analyzed using the program Mplus (version 6; Muthén & Muthén, 1998–2016), which pooled estimates across the 10 imputations. We used a structural equation model analogue of a multivariate analysis of variance (SEM-MANOVA; Green & Thompson, 2006) to investigate Hypothesis 1 that individuals with GSAD would be seen by themselves and others as having more interpersonal problems and across conflicting domains compared to those without the disorder. The four structural summary components of the IIP were regressed on diagnosis. Model fit was expected to be perfect for this type of model (i.e., the model has no degrees of freedom) and is thus not reported separately. We report effect sizes from partially standardized estimates of dichotomous predictors (STDY in Mplus, reported as Cohen’s d) and fully standardized estimates of continuous predictors (STDYX in Mplus, reported as b*).

To investigate Hypothesis 2, that diagnosis would moderate the effect of informant report on self-report, we used a multilevel model. We conceptualized the data as having a nested structure with dominance, warmth, and distress scores obtained from the structural summary method at the lowest level of analysis and the primary participant (i.e., the person being rated) as clusters or contexts. Self-reported problems were the outcome variable and friend and romantic partner scores from the structural summary method were entered as predictors at level 1 (within-subscales). Diagnosis was then entered as a level 2 (between individuals) moderator. By using multilevel models, we were able to partition within- and between-level variance while also accounting for the nested structure of the data. We use problem domains (warmth, dominance, distress) on level 1 to account for the effect of informant report on variance in within-person observations. On level 2, we additionally account for the effect of diagnosis on between-person variance.

Variables were left uncentered such that a score of 0 was indicative of no distress and no problems being too warm, cold, dominant, or submissive. Modelling the relationships in this way, the intercept would indicate self-report of interpersonal problems when both informants reported no problems related to extremes of warmth or dominance (i.e., including being problematically cold or submissive). Whereas the effect of diagnosis on the overall intercept would indicate the effect of diagnostic group on self-report bias when informants reported no problems, the effect of diagnosis on the slope between self and informant report would indicate moderation of the relationship. Slope terms represent the concordance between primary participant-friend and primary participant-romantic partner dyads, controlling for the other informant type. Positive moderation would indicate increased correspondence, whereas negative moderation would indicate the hypothesized decreased correspondence between self and informant report due to diagnosis. Simplified examples of the hypothesized effects are depicted in Figures 1A and 1B. In final models, the intercept is not easily interpretable with the three structural summary method parameters and thus we focused our interpretations of model results on whether moderation of the slope indicated increased or decreased correspondence.

We additionally tested depression as an alternative moderator at level 2 and we tested for its interaction with GSAD. We did so because depression frequently co-occurs with GSAD (see Langer & Rodebaugh, 2014 for a review) and we wanted to rule out the possibility that differences in correspondence were due to depression and not social anxiety. To make interactions between depression and social anxiety more easily interpretable in these interactions, we used the BDI-II as a dimensional measure of depression and the LSAS scores as a dimensional measure of social anxiety. We initially tested uncentered variables, but additionally tested the interaction with variables centered to account for possible multicollinearity. Results did not differ; thus, we report only results of the uncentered tests for ease of interpretation.

Results

Sample characteristics

As shown in Table 1, primary participants largely identified as either White or Black and were primarily female. As expected, GSAD and NOSAD groups had significantly different LSAS scores (p < .001). We found no differences between participants on race or gender (ps > .16); however, groups differed as a function of age wherein participants with GSAD were older (p = .039). Subsequent analyses therefore tested age as an additional predictor and moderator, but effects for age are reported only when statistically significant.

Effect of diagnosis on overall report

In line with Hypothesis 1, we found a general effect of diagnosis on overall report of interpersonal problems, χ2 (12, N = 179) = 156.91, p < .001. Examining each reporting source, diagnosis significantly predicted self-reported, χ2 (4, N = 179) = 126.70, p < .001, and romantic partner reported, χ2 (4, N = 179) = 14.06, p = .007, problems; however, friend reported, χ2 (4, N = 179) = 5.98, p = .20 problems were not predicted significantly. Primary participants with GSAD reported significantly more severe interpersonal problems (d = .70, p < .001), and reported themselves as less dominant (d = −.59, p < .001) and less warm (d = −.32, p < .001) compared to NOSAD participants. Against hypothesis, their profiles were also more prototypical (d = .20, p < .001) suggesting that GSAD participants’ self-report were better matches for a circumplex profile pattern than profiles of NOSAD participants. Self-report means for prototypicality did not suggest adequate fit to the expected profile pattern for both groups (MNosad = .53, MGsad = .65), indicating possible reporting in incompatible domains in both groups. Friends of primary participants reported only marginal differences between participants with a GSAD diagnosis and those without (dominance: d = −.17, p = .086; warmth: d = .19, p = .06), reported no differences in distress (d = .16, p = .110), and had no differences in profile prototypicality (d = .09, p = .39). Romantic partner report indicated no differences between groups on observed dominance (d = −.06, p = .584) or in terms of prototypicality (d = .07, p = .560); however, partners of GSAD participants reported that their partners were significantly less warm (d = −.25, p = .026) and more distressed (d = .36, p = .001).

Concordance between friend and romantic partner report

Support for Hypothesis 2 was mixed. In our multilevel model, diagnosis was a significant level 2 predictor moderating the intercept and slope of the relationships between both informant reports and self-report. On average, individuals with GSAD were predicted to self-report more problems compared to those with NOSAD even when friend and romantic partner reported no problems (β = .883, p < .001). This result supported the expected decreased correspondence between diagnostic groups by demonstrating differences in the intercept. Using NOSAD diagnosis as the reference group (i.e., no diagnosis coded as 0), we investigated the effect of diagnosis on the slope of relationships between self and informant report. We found that diagnosis of GSAD significantly positively moderated the slope of friend and self-report (β = .280, p = .014), and romantic partner and self-report (β = .398, p < .001). As can be seen in Figures 3 and 4, diagnosis was related to a steeper slope of the relationship between friend and self-report, suggesting greater concordance between friend and self-report for GSAD compared to people with NOSAD. Against hypothesis, the positive slope indicated that the more symptoms friends and romantic partners noticed, the more problems people with GSAD reported.

Figure 3.

Figure 3.

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The cross-level interaction between diagnosis and the slope of friend report predicting self-report of interpersonal problems in a multilevel model. Note that because the figure refers to slope across three variables, the intercept is not easily interpretable and should not be compared to the specific findings for the hypothesized effect of the intercept (Figure 1). The slope for both GSAD and NOSAD are significant Friend report reflects dominance, warmth, and distress scored using the structural summary method. The effect of diagnosis is also significant. GSAD = Generalized Social Anxiety Disorder; NOSAD = No Social Anxiety Disorder.

Figure 4.

Figure 4.

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The cross-level interaction between diagnosis and the slope of romantic partner report predicting self-report of interpersonal problems in a multilevel model. Note that because the figure refers to slope across three variables, the intercept is not easily interpretable and should not be compared to the specific findings for the hypothesized effect of the intercept (Figure 1). The slopes and the effect of diagnosis on slope are significant. Romantic Partner report reflects dominance, warmth, and distress scored using the structural summary method. GSAD = Generalized Social Anxiety Disorder; NOSAD = No Social Anxiety Disorder.

Finally, we examined the effect of depression severity and the interaction between depression and social anxiety severity on the relationship between self and informant report. Depression as a single level 2 predictor had a significant effect on self-report of problems overall, β = −.027, p = .049, indicating more depressive symptoms corresponded with fewer self-reported problems; however, this effect became nonsignificant when social anxiety severity, depression, and the interaction of social anxiety severity and depression were added as predictors, β = −.022, p = .099. There was no interaction between depression and social anxiety severity, β = .000, p = .411 in predicting self-report of problems; nor were effects on the slope of self and informant report significant (ps >.081).

Discussion

Social anxiety disorder is associated with clear interpersonal impairment, but how those interpersonal problems manifest across multiple relational contexts has not been previously explored. Through analysis of self, friend, and romantic partner reports, we examined how self and informant views of interpersonal problems differed between reporters and were moderated by a GSAD diagnosis. We found evidence to suggest that GSAD diagnosis generally predicted more interpersonal problems, particularly related to distress, consistent with Hypothesis 1. Participants with GSAD diagnoses reported themselves to be less warm, less dominant, and more distressed than NOSAD counterparts. Although individuals with GSAD perceived themselves more negatively compared to their friends’ perception (as hypothesized), we found that romantic partners perceived their partners with GSAD as having specific problems with coldness and overall distress. Friends observed no differences between those with and without a diagnosis.

Against hypothesis, we did not find evidence that people with GSAD were more prone to reporting across conflicting domains than NOSAD counterparts. We found mixed support for Hypothesis 2, which examined correspondence between informant and self-report of problems. Diagnosis of GSAD compared to NOSAD diagnosis was associated with stronger correspondence between self, friend, and romantic partner report, despite differences in the baseline level of distress reflected across types of report.

Although Hypothesis 1 and Hypothesis 2 approached the question of the effect of GSAD on report of interpersonal problems from different perspectives (i.e., type of problem vs correspondence between reporting sources), interpreting the results of each hypothesis together suggests a more complex picture than previously assumed. It appears that some form of negative self-bias does exist for people with GSAD but is highly contextual. Presence of a diagnosis of GSAD increases correspondence between friend and romantic partner report (H2), indicating that such informants are more aware of the problems that people with GSAD experience compared to NOSAD participants. However, friends did not perceive primary participants with GSAD as being significantly more impaired than NOSAD counterparts, whereas romantic partners perceived more problems with warmth and distress (H1). In other words, informants differed in whether they observed symptoms setting those with GSAD apart from those without the disorder but informants’ awareness of problems nevertheless tracked self-report. The general impression is that friends see the shape of the problems people with GSAD report, but give a smaller estimate of the overall size of the problem, whereas the romantic partners see the problem as having about the same overall size, but with a somewhat different shape.

One explanation for the difference in results between informant reports found in results from Hypothesis 1 relates to the difference in intimacy of a romantic relationship compared to a friendship. The frequency of contact between partners compared to friends, particularly when partners cohabitate, could make it more difficult to disguise the distress associated with interpersonal difficulties and create additional opportunities wherein interpersonal problems might directly impact the romantic relationship. A romantic relationship might result in greater awareness on the part of an informant how distressed participants with GSAD are about their interpersonal behavior, as well as which interpersonal problems are noticed. It also seems plausible that romantic partners might be particularly sensitive to issues of warmth, as reflected in the difference romantic partners see in GSAD versus NOSAD participants in terms of problems related to coldness.

Our results converge with prior research: existing studies examining self and romantic partner report (Porter & Chambless, 2013, 2017), self and friend report pairs (Rodebaugh et al., 2014, using a largely overlapping sample), or self-report alone (e.g., Sparrevohn & Rapee, 2009) have suggested that higher social anxiety or GSAD is associated with viewing oneself as being less supportive or interpersonally warm (although some of these effects may be gender specific: see Porter & Chambless, 2013). We also found evidence that the informants observe a distinct set of interpersonal problems from each other: interpersonal problems in more than one domain were reported by romantic partners, whereas friends of individuals with GSAD did not observe specific impairments. An extension of our findings might investigate the degree to which individuals with GSAD are aware of how their problematic interpersonal behaviors are perceived by their friends and romantic partners. In other words, how aware are people with GSAD of their bias towards reporting more severe problems and their lack of agreement with the romantic partners as to what those problems are? Such cognitive distortions could be a worthwhile treatment target. Also worth consideration is whether participant and informant report might be more consistent if participants had been asked to rate themselves as they are in specific types of relationships, rather than in general.

This study is not without limitations. We utilized two samples, but participants in the first sample were not asked to provide friend or romantic partner report and were only asked whether they had a friend they could ask to be involved in a study. The missing data were handled by multiple imputation procedures rather than casewise or pairwise deletion to prevent biasing the sample; however, complete data would, of course, have been preferable. Another limitation of this study is that we were able to determine whether correspondence between reporters was present or absent, but unable to pinpoint exactly why.

Despite these limitations, our study is the first to provide insight into the interpersonal problems of people with GSAD using a multi-informant approach to distinguish between self-report and two types of informant report and further characterize the self-report bias observed among people with GSAD. An additional strength of our study can be found in the diversity of our study sample: the racial and ethnic diversity of our study sample (45% non-white) reflected the racial and ethnic makeup of the surrounding community (“U.S. Census Bureau QuickFacts selected: St. Louis City, Missouri (County),” 2016). Although we are not the first to argue the importance of multi-informant reports (Alexander et al., 2017), the current study is one of few to empirically test and draw insights from multi-informant method that has implications for research and therapy.

Our results indicate that the impact of interpersonal impairment depends on the relational context for people with GSAD. Friends and romantic partners were not oblivious to these problems; however, cold interpersonal behaviors might be more apparent when individuals with GSAD are among romantic partners and other problems may not be readily apparent to friends. For this reason, we encourage researchers and clinicians to assess and aim to treat interpersonal problems as dependent on type of relationship. Researchers should attempt to expand the number of different types of relationships assessed (e.g., family, coworkers) to better reflect how role expectations (e.g., as a child, as a parent, as an employee) interact with behavioral problems. Clinicians could take these findings into account when assessing the relational contexts in which clients with social anxiety disorder struggle the most, and when designing interventions focused on improving interpersonal functioning. For example, interventions that address perceived interpersonal problems in friendships may not be indicative of actual problems in that relationship context but may appear as observable problems in a romantic relationship. With careful attention to when, where, and with whom interpersonal difficulties arise, a more complete picture of social anxiety disorder can emerge.

Table 3.

Inventory of Interpersonal Problems (IIP) Subscale Descriptions and Internal Consistency for Primary Participants, Friends, and Romantic Partners

  Self-Report
(M,SD)
 Friend Report
(M,SD)
 Romantic Partner Report
(M,SD)
Octant
 GSAD
 NOSAD
 GSAD
 NOSAD
 GSAD
 NOSAD
Dominance 2.82 (3.76) 2.17(4.21) 2.23 (3.12) 3.96 (4.21) 4.13(3.96) 3.96 (4.21)
Vindictiveness 5.51 (4.39) 2.61 (3.97) 3.71 (4.24) 3.78 (3.97) 5.77 (3.78) 3.78 (3.97)
Cold 7.45 (3.95) 2.43 (3.83) 5.17 (4.42) 3.21 (3.83) 6.35 (3.21) 3.21 (3.83)
Socially Inhibited 10.04 (4.36) 1.95 (4.02) 6.33 (4.82) 3.89 (4.02) 6.45 (3.89) 3.89 (4.02)
Non-assertive 9.74 (4.57) 3.7 (3.77) 5.6 (3.88) 3.46 (3.77) 5.76 (3.46) 3.46 (3.77)
Overly-Accommodating 8.98 (3.23) 4.34 (3.41) 6.00 (3.84) 3.82 (3.41) 4.74 (3.82) 3.82 (3.41)
Self-Sacrificing 7.86 (3.97) 4.3 (3.67) 4.94 (4.01) 3.71 (3.67) 5.42 (3.71) 3.71 (3.67)
Needy 2.44 3.8 (3.55) 3.09 (3.19) (3.43) 3.46 (3.19) 4.58 (3.46) 3.46 (3.19)
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GSAD = Generalized Social Anxiety Disorder; NOSAD = No Social Anxiety Disorder;

Highlights.

  • Examined reports of social impairment in people with social anxiety disorder

  • Utilized self- and informant report of interpersonal problems

  • Found self-report indicated interpersonal problems in multiple domains

  • Informants, however, reported restricted problem areas.

  • Demonstrates the importance of obtaining informant sources of social impairment

Acknowledgements

We would like to thank the research assistants who helped conduct this research. All of the authors, and especially Thomas Rodebaugh, would also like to thank Dianne Chambless for her direct and indirect mentorship. We would also like to thank the National Institutes of Health (UL1 RR024992 to Thomas Rodebaugh) and the National Institute of Mental Health (R21-MH090308 to Thomas Rodebaugh and F31 MH 115641-01 to Marilyn L. Piccirillo) for funding this research.

Footnotes

1

When referring to the participant sample, we use the term generalized social anxiety disorder or GSAD because the study took place prior to the release of Diagnostic and Statistical Manual (5th ed., American Psychiatric Association, 2013), and so diagnostic criteria was based on the revised 4th edition of the DSM. Generalized social anxiety disorder refers to fear or anxiety in a number of social situations and is largely consistent with the DSM-5 diagnosis of social anxiety disorder excluding the performance only subtype.

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