title: New evidence of heterogeneity in social anxiety disorder: defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors.
abstract: OBJECTIVE
  To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions.
  
  
  METHODS
  One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR).
  
  
  RESULTS
  Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with "high-HA/low-NS", and a smaller (39%) atypical impulsive subgroup with high-moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005).
  
  
  CONCLUSIONS
  Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Binelli
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Muñiz
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Sanches
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Human Pharmacology and Clinical Neurosciences Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Navines
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Egmond
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Udina
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Batalla
authors.affiliation: Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain.
authors.forename: C
authors.initials: C
authors.lastname: López-Sola
authors.affiliation: Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: J A
authors.initials: JA
authors.lastname: Crippa
authors.affiliation: Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Subirà
authors.affiliation: Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain. Electronic address: rmsantos@clinic.ub.es.
authors.forename: R
authors.initials: R
authors.lastname: Martín-Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D005106:Exploratory Behavior; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D010551:Personality; D010554:Personality Disorders / Q000235:genetics / Q000523:psychology; D010698:Phobic Disorders / Q000235:genetics* / Q000523:psychology*; D011110:Polymorphism, Genetic; D050486:Serotonin Plasma Membrane Transport Proteins / Q000235:genetics*; D012931:Social Environment
chemical_list: C493230:SLC6A4 protein, human; D050486:Serotonin Plasma Membrane Transport Proteins
keywords: Harm avoidance; Impulsive subtype; Novelty seeking; Social anxiety disorder; Temperament and character inventory, STin2.VNTR