Symptom Accommodation Related to Social Anxiety Symptoms in Adults: Phenomenology, Correlates, and Impairment.

Background and Objectives: Socially anxious individuals often engage in various safety and avoidant behaviors to temporarily decrease distress. Similarly, friends or family members may engage in accommodating behaviors, commonly manifesting through the facilitation of avoidance, completion of tasks, or schedule modifications. Studies examining symptom accommodation in adult social anxiety are lacking, so this study seeks to better understand symptom accommodation and its consequent impairment in socially anxious adults. Design and Methods: There were 380 undergraduate students who completed a battery of self-report questionnaires through an online system. Constructs assessed include social anxiety, symptom accommodation, and impairment as well as related variables such as general anxiety, fear of negative evaluation, alcohol use, and anxiety sensitivity. Results: Symptom accommodation was positively correlated with social anxiety symptoms, functional impairment, general anxiety, anxiety sensitivity, fear of negative evaluation, and alcohol use. Individuals with considerable social anxiety reported significantly higher levels of symptom accommodation than individuals who reported lower levels of social anxiety. Anxiety sensitivity predicted symptom accommodation beyond the contribution of social anxiety. Symptom accommodation mediated the relationship between social anxiety and impairment. Conclusions: These data help elucidate the presentation and impact of symptom accommodation related to social anxiety. Implications for assessment, treatment, and future directions are presented.Keywords: symptom accommodation; social anxiety; anxiety sensitivity; impairment; adultSocial anxiety disorder (SAD) is a psychiatric condition characterized by an intense fear of social or performance situations because of fears of negative evaluation, embarrassment, or scrutiny (American Psychiatric Association, 2013). As such, individuals with SAD experience heightened distress within various social situations and commonly engage in maladaptive avoidance or safety behaviors. Socially anxious individuals are at risk for compounded difficulties, such as decreased quality of life and elevated functional impairment across various life domains (Fehm, Beesdo, Jacobi, & Fiedler, 2008; Katzelnick et al., 2001; Schneier et al., 1994; Wittchen & Fehm, 2003; Wittchen, Fuetsch, Sonntag, Muller, & Liebowitz, 2000). Specifically, individuals may experience functional impairment when their social anxiety interferes with their ability to operate optimally in day-to-day functioning, which can broadly affect school, work, social, or family life. With an estimated 6.8% of adults affected by social phobia (Kessler, Chiu, Demler, Merikangas, & Walters, 2005), further investigations into the phenomenology, impact, and maintaining mechanisms of social anxiety are pertinent.Extant literature contains various investigations into the phenomenology of social anxiety and its associations with other psychological constructs. For instance, socially anxious individuals present with an increased risk of experiencing comorbid psychopathology, such as other anxiety disorders and mood disorders (Fehm et al., 2008; Katzelnick et al., 2001). In addition, those with psychiatric comorbidities often present with compounded deleterious effects such as increased SAD-related functional impairment (Wittchen et al., 2000). Socially anxious individuals also demonstrate heightened anxiety sensitivity (Olatunji & Wolitzky-Taylor, 2009), which is characterized by the fear of anxiety-related sensations (Taylor & Cox, 1998). Indeed, when considering the different dimensions of anxiety sensitivity, social consequences and fear of negative evaluation because of somatic presentations of anxiety are emphasized (Deacon & Abramowitz, 2006; Reiss, 1991). For instance, a socially anxious individual may experience physical sensations such as sweating or blushing, intensifying cognitive distortions that others are hyperaware of their somatic symptoms and therefore negatively perceive them. …