 |
 |
|
|
|
There has been a recent increase in interest regarding social phobia because of higher-than-expected incidences of social phobia, and because social phobia leads to disrupted relationships, severe anxiety, depression, substance abuse, and loss of natural faculties at an important level in patients (1). Until recently, the concept of self-esteem in psychiatry literature, in broadest terms, has been a judgement that shows “how a person values him/herself” (2). Rosenberg examined adolescents to determine whether the orientation of a person was of positive or negative value to their self-esteem. Individuals with a positive internal orientation were found to have high self-esteem while those with a negative internal orientation were found to have low self-esteem (3). Body image is most simply defined as the mental image that we have formed concerning how we see our physical self. Sensations from both outside and within our bodies teach us the totality of our bodies (4). A specific meaning is given to the perception of one’s own physical body and the body’s individual parts, which is closely related to self-confidence, self-respect, self-image, and identity. Moreover, individuals with a positive and realistically defined body image are more secure in their interpersonal relationships and are more successful in their jobs. These individuals’ attitudes and behaviours are also healthier and more realistic (4). According to the cognitive and emotive models of social phobia, negative expectations that patients with social phobia develop about social situations form the foundation for social phobia. Typically, patients’ fear negative social performance, negative evaluation by others, and uncontrollable anxiety (5). It has been reported that body image affects self-perception and negative thinking among persons with social phobia and that a negative and distorted self-image plays an important role in fostering social phobia (6). Material and MethodsSubjects were selected from among students enrolled in university programs on the Cumhuriyet University campus. Our population target was 10% of the total number of students. The students were identified and placed into sample groups. We aimed to represent a wide range of subjects by including students from the first-, second-, third-, and fourth-year classes of every program. The total number of students on the Cumhuriyet University campus was 11 276. Of these students, 4125 were female and 7151 were male; 691 students in the county professional schools and 289 students in the fifth and sixth years of medical school were not included in the study. Our study population comprised 10 296 students, compared with our intended goal of 1127 students. Instruments 1. A sociodemographic information form. The form is divided into sections and asks questions about such features as age, sex, school, and class. 2. The Rosenberg Self-Esteem Scale (RSES). We used this scale to measure self-esteem (3). Validity and reliability studies on the RSES were conducted in Turkey in 1986 (7). 3. The Multidimensional Body–Self Relations Questionnaire (MBSRQ). The MBSRQ is an instrument for evaluating self-attitude aspects of body image and is determined from the 69-item self-evaluation tool. Dogan and Dogan performed the tool’s validity and reliability studies in Turkey (4). 4.The Diagnostic Interview Schedule-III-Revised (DIS-III-R) Social Phobia Scale and the DSM-III-R. The DIS-III-R was developed using references to emotional health. Social phobia was diagnosed according to DIS and DSM-III-R criteria and by interview format. Procedure Statistical Analysis ResultsSubjects’ Sociodemographic Characteristics
Prevalence of Social Phobia Lifetime prevalence of social phobia was 9.8% among female students and 9.4% among male students; past-year prevalence of social phobia was found to be 8.9% among female students and 7.1% among male students. There was no statistically significant difference between male and female groups with social phobia (P > 0.05). The highest lifetime prevalence of social phobia was found in the group aged 21 to 24 years (11%), and lowest lifetime prevalence was found in the group aged 25 years and over (5.5%). The highest prevalence of past-year social phobia was found in the group aged 21 to 24 years (8.9%), and lowest prevalence of past-year social phobia was found among the group aged 25 years and over (3.7%). There was no statistically significant difference found between the age groups (P > 0.05). Self-Esteem and Social Phobia
The highest prevalence of social phobia was found in the group with low self-esteem (14.9%), and lowest prevalence was found in the group with high self-esteem (6.6%). We found a statistically significant difference between the groups with low self-esteem and high self-esteem (P < 0.02) and in RSES mean scores between those with social phobia and those without (Table 3).
Body Image and Social Phobia DiscussionIn this study, we investigated the prevalence of social phobia among university students and its relation to self-esteem and body image. Recent research on social phobia shows that the prevalence of social phobia has increased significantly. Several studies have reported that the prevalence of social phobia within society is approximately 10% (9–11). Reports of lifetime prevalence of social phobia vary between 0.5% and 22.6% (12). In this study, we found the lifetime prevalence of social phobia to be 9.6% and past-year prevalence of social phobia to be 7.9%. Kessler and others found lifetime prevalence of social phobia to be 13.3% and past-year prevalence to be 7.9% (13). In Basel’s study, lifetime prevalence of social phobia was found to be between 9.6% (according to the ICD-10) and 16% (according to the DSM-III-R). Epidemiologic studies have mutually signalled that this disorder is observed more frequently among female subjects than among male subjects; however, the same ratios of male and female patients are seen in clinical examples (14). The results obtained in our study are consistent with the literature: the prevalence of social phobia among female subjects was found to be higher than that among male subjects. Our study supports the findings that social phobia frequently begins in the second decade of life (that is, between age 15 and 20 years) (1,15,16). When examined, we found that the prevalence of social phobia was statistically significantly different among high, average, and low self-esteem groups. The RSES mean score of the 79 subjects with social phobia was statistically significantly higher than the RSES mean score of the 924 subjects without social phobia (the high score shows low self-esteem). There could be many reasons for this finding. Persons with high self-esteem may enter into social relationships more easily and may act more confidently. Elevated self-esteem ensures that the individual acts comfortably, which also lessens social timidity. In addition, elevated self-esteem and feelings of self-confidence increase feelings of confidence in others. Persons with social phobia may suffer from lowered self-esteem as they examine themselves; they tend to focus their attention on negative thoughts, which thereby increases self-dissatisfaction. Geist has reported a correlation between interpersonal relationships and self-esteem, stating that those with low self-esteem have more problems in their interpersonal relationships (17). Rosenberg reported that people with low self-esteem face problems in social relationships; they perceive more threat and display greater sensitivity to criticism, and they behave in a reward-seeking manner (3). Self-esteem was examined in 3 studies with university students. Social timidity was found to be less among students who had high self-esteem, and their self-confidence scores were also higher (18–20). In our study, the MBSRQ scores were significantly lower in the group with social phobia than in the group without social phobia. The body-image score for those with social phobia was lower than that for those without social phobia, and the group with the low body-image score showed increased prevalence of social phobia. There may be several reasons why people with social phobia had lower body-image scores and people with low body-image scores had higher prevalence of social phobia. Those with low body-image scores may reflect their dissatisfaction with their bodies in their relationships and may thereby form fewer social relationships. When persons with social phobia have a negative self-assessment, this attitude is internalized, and they become dissatisfied with themselves and their bodies. They may lean toward low self-worth in their self-assessments. Attractive adolescents are more popular, both with classmates and with teachers. The “beauty bias” operates in almost all social situations—all experiments show we react more favourably to physically attractive people. Most societies also believe in the “what is beautiful is good” stereotype—an irrational but deep-seated belief that physically attractive people possess other desirable characteristics, such as intelligence, competence, social skills, and confidence. Few studies were found in the literature on this subject. Stein stated that obese people have a distorted body image, have weak social relationships, and lack self-confidence (21). Stein’s results are similar to those of Bowen and others (22) and of Wineman (23). Social phobia patients’ negative thoughts about their physical appearance affect their mental image—which is especially important in cognitive therapy. A positive change in the self-imagination is important for successful psychological therapy for patients with social phobia (24). This study included only university students and did not represent the general population. From an epidemiologic perspective, it is necessary to study a representative sample from the entire population to achieve more sound results. In addition, further studies are needed to examine changes in the body image and self-esteem of outpatients before and after therapy. References1. Kaplan H, Sadock B. Comprehensive textbook of psychiatry. Baltimore (MD): Williams and Wilkins; 1995. 2. Pope AW, McHale SM, Craighead WWE. Self-esteem enhancement with children and adolescents. New York: Pergamon Press; 1988. 3. Rosenberg M. Society and adolescent self-image. Princeton (NJ): Princeton University Press; 1965. 4. Dogan O, Dogan S. Çok yönlü beden-self ilÕikileri ölçe—i el kitabi (Multidimensional Body–Self Relations Questionnaire manual in Turkish). Sivas: Cumhuriyet University Press. nr 53; 1992. 5. Wells A, Clark DM. Social phobia: a cognitive approach on phobias. In: Paved GCL, editor. A handbook of theory, research on treatment. Chichester (UK): Wiley; 1997. p 3–26. 6. Wells A, Papageorgiou C. The observer perspective biased in social phobia, agoraphobia and blood/injury phobia. Behav Res Ther 1999;37:653–8. 7. Cuhadaroglu F. Adolesanlarda benlik sayg1s1 (Self-esteem in adolescents in Turkish). [Doctoral Thesis]. Ankara: Hacettepe University; 1986. 8. Sumbuloglu K. Research techniques and statistics in health science. Ankara: Cag Press; 1978. 9. Davidson JRT, Hughes PL, George K. The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med 1993;23:709–18. 10. Hollander E, Aronowitz Br. Comorbid social anxiety and body dysmorphic disorder: managing the complicated patient. J Clin Psychiatry 1999;60(Suppl 9):27–31. 11. Davidson JR, Hughes PL, George K. The boundary of social phobia. Arch Gen Psychiatry 1994;51:975–83. 12. Montgomery S. Social phobia: a clinical review. Basel: World Psychiatric Association Social Phobia Task Force; 1999. 13. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, and others. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8–19. 14. Stein MB, McQuard Jr, Laffge C. Social phobia in the primary care medical setting. J Fam Pract 1999;48:514–9. 15. Schneier FR, Johnson J, Hornig CD. Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 1992;49:282–8. 16. Judd LL. Social phobia: a clinical overview. J Clin Psychiatry 1994;55:5–9. 17. Geist CR. Social avoidance and distress as a predictor of perceived levels of control and level of self-esteem. J Clin Psychol 1982;38:611–3. 18. Morrison TL, Thomas MB. Self-esteem and classroom participation. J Educ Res 1975;68:374–7. 19. Coopersmith S. The antecedents of self-esteem. San Francisco (CA): Freeman; 1967. 20. Yelsma P, Yelsma J. Self esteem and social respect within the high school. J Soc Psychol 1998;138:431–41. 21. Stein RF. Comparison of self-concept of non-obese and obese university junior female nursing students. Adolescence 1987;22:77–99. 22. Bowen DJ, Tomoyasu N, Cauce AM. The triple threat: a discussion of gender, class, and race differences in weight. Women Health 1991;17:123–43. 23. Wineman NM. Obesity: locus of control, body image, weight loss, and age-at-onset. Nurs Res 1980;29:231–7. 24. Hofmann SG. Self-focused attention before and after treatment of social phobia. Behav Res Ther 2000;38:717–25. Author(s)Manuscript received February 2003, revised, and accepted July 2003. 1. Adult Psychiatrist, Fellow, Department of Psychiatry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. 2. Adult Psychiatrist, Assistant Professor, Department of Psychiatry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. 3. Adult Psychiatrist, Professor, Head, Department of Psychiatry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. Address for correspondence: Dr O Doğan, CUTF Psikiyatri ABD, 58140 Sivas, Turkey. e-mail: odogan@cumhuriyet.edu.tr
1 | 2
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||