(PS9-A2) Examining Behavioral Inhibition in Association with Quality of Life and Comorbidity in Social Anxiety Disorder

Background:  Behavioral inhibition, the tendency to react to novel situations with wariness or avoidance, is an established risk factor for developing social anxiety disorder (SAD) and other anxiety disorders. Those with SAD often display impairments in social life and leisure activities which may be contributed to adverse reactions to novelty. Few studies have assessed the association between behavioral inhibition and aspects of SAD such as quality of life and comorbidity in a clinical sample. The purpose of this study was to examine the impact of behavioral inhibition on quality of life and comorbidity in those with SAD.

Methods:  A total of 104 adults with SAD were included in this study. Participants were recruited as part of a larger study on OC spectrum and anxiety disorders. The Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) was used to diagnosis participants. Participants completed the following measures: Behavioral Inhibition Scale (BIS), Beck Depression Inventory (BDI), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Correlational and regression analyses was conducted to determine the relationship between behavioral inhibition, quality of life, and presence of comorbidity.

Results:  Behavioral inhibition was significantly associated with quality of life (r(98)=-0.20, p < 0.05) and depressive symptoms (r(100=0.25, p < 0.05). In a model assessing behavioral inhibition and depressive symptoms on quality of life, only depressive symptoms were significant (F(2, 96)=55.21, p < 0.05); this model explained 52% of the variance in quality of life. 62% of subjects had a comorbid OC spectrum and/or anxiety disorder (agoraphobia, panic disorder, PTSD, and/or OCD). Logistic regression was conducted to investigate the association between behavioral inhibition and the likelihood of a comorbid anxiety disorder, OR=1.04 (95% CI: 0.93, 1.18). The model was not statistically significant (p > 0.05).

Conclusion:  Greater behavioral inhibition was significantly associated with lower quality of life. However, when depressive symptoms are accounted for, behavioral inhibition was no longer associated with quality of life. These findings suggest that although behavioral inhibition may have some impact on quality of life, depressive symptoms should be a primary target for interventions to improve quality of life in those with SAD. Although behavioral inhibition has been identified as a risk factor for anxiety disorders broadly, we found no association between behavioral inhibition and the likelihood of a comorbid anxiety disorder. Similarly, Rotge et al (2011) found that retrospective report of behavioral inhibition in those with social phobia were not associated with other anxiety disorders. Previous research has indicated variability in the trajectories of behavioral inhibition (Degnan et al., 2007) which highlight the importance of assessing other factors that could increase or decrease the risk of anxiety problems. Future research should examine the relationship between behavioral inhibition and specific types of anxiety problems to better understand the mechanism in which behavioral inhibition increases risk for certain anxiety disorders.