|Year : 2022 | Volume
| Issue : 1 | Page : 24-30
Social Anxiety Disorder among Undergraduate Students: Exploring Association with Self-esteem and Personality Traits
Adetunji Obadeji1, Banji Ferdinand Kumolalo2
1 Department of Psychiatry, Ekiti State University Teaching Hospital; Department of Psychiatry, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
2 Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
|Date of Submission||23-Jan-2022|
|Date of Decision||18-Mar-2022|
|Date of Acceptance||22-Mar-2022|
|Date of Web Publication||27-Apr-2022|
Dr. Adetunji Obadeji
Department of Psychiatry, Ekiti State University Ekiti State University Teaching Hospital, PMB 5535, Ado-Ekiti, Ekiti State
Source of Support: None, Conflict of Interest: None
Background: Social phobia impacts negatively on the social and academic life of students and exerts a detrimental effect on the quality of life of the bearer. The study examined the burden of social anxiety disorder (SAD), the relationship of SAD with sociodemographic variables and self-esteem, and the big five personality traits correlates of both SAD and self-esteem among undergraduate students. Methods: Participants completed the Social Phobia Inventory (SPIN), the Big Five Personality Trait Inventory (BFPI), Rosenberg Self-Esteem Scale, and a sociodemographic questionnaire. The relationships between variables were explored using bivariate and multivariate statistics. Results: Two hundred and eighty (62.5%) participants reported significant SAD, mostly in the mild form (50.9%). There was a significant negative correlation between the SPIN scores and the total score on BFPI, extraversion, agreeableness, conscientiousness, openness, and self-esteem and a positive correlation with the neuroticism subscale. Similarly, a significant positive correlation with self-esteem and agreeableness, extraversion and conscientiousness, and a negative correlation between neuroticism subscale of BFPI were noted. Younger age also significantly increased the risk of social anxiety among the participants. Conclusions: The burden of social phobia among the undergraduate students was high, and highly correlated with personality traits and self-esteem. The study underscores the need to consider several factors in reducing social performance anxiety among undergraduate students with central effort geared toward reducing neuroticism and promotion of positive self-imagery and appraisal.
Keywords: Personality traits, self-esteem, social anxiety disorders, social phobia, young adult
|How to cite this article:|
Obadeji A, Kumolalo BF. Social Anxiety Disorder among Undergraduate Students: Exploring Association with Self-esteem and Personality Traits. World Soc Psychiatry 2022;4:24-30
|How to cite this URL:|
Obadeji A, Kumolalo BF. Social Anxiety Disorder among Undergraduate Students: Exploring Association with Self-esteem and Personality Traits. World Soc Psychiatry [serial online] 2022 [cited 2022 Jul 1];4:24-30. Available from: https://www.worldsocpsychiatry.org/text.asp?2022/4/1/24/344117
| Introduction|| |
Anxiety is a common human experience, and some degree of anxiety is needed for day-to-day activities. This becomes a disorder when such experience interferes with activities of daily living. In social phobia or social anxiety disorder (SAD), an individual experiences a marked fear or intense anxiety in one or more social situations where such an individual is exposed to possible scrutiny by others., This may occur in different social interactions, from meeting unfamiliar people, having a conversation, to being observed or in public performance.,, Although social phobia develops mostly in late childhood or adolescence, the onset of critical or severe social impairments usually manifests between the ages of 15 and 25 years in both males and females.
Among undergraduate students, the prevalence of social phobia ranges from 7.8% to 80% depending on the instrument and methodological approach adopted.,,,, Students with SAD experience lower quality of life with significant impairment in their overall well-being.,,, They were more like to report poor academic performance (including a poor performance at clinical examinations), avoidance of oral presentation, and higher usage of alcoholic beverages and anxiolytics.,, They tend to have poor social support,,,, be at higher risk of developing depressive symptoms, and more likely to come from a rural residence and be in the early part of their academic career.
Self-esteem plays a key role in SAD.,,, There is continuous evidence that negative self-images play a role in causation, as well as maintenance of SAD., Promoting positive self-imagery, on the other hand, had been reported to have multiple benefits, such as improving self-esteem and positive affect and enhancing social performance.,, People holding positive self-images are likely to report higher levels of explicit self-esteem than those holding negative self-images. In feared social situations, individuals with SAD often develop negative images of themselves leading to uncertainties about self and fear of negative evaluation by others.
Despite mixed reports about the relationship between self-esteem and academic achievement among undergraduate students,,,, most studies among undergraduates have reported a positive association between self-esteem and academic achievement,, and between self-esteem and resilience, and self-efficacy and body satisfaction. Nonetheless, other factors such as a family history of psychological distress, perceived social support, parental education, gender, and place of residence may also influence students' self-esteem.
High level of neuroticism and extraversion had been reported as significant independent predictors of SAD, even after controlling for the effects of the other big five personality dimensions. Personality colors every aspect of our lives, from thinking, feeling, and behavior to the way we appraise life generally. This may explain why personality traits such as extraversion, agreeableness, conscientiousness, and openness are associated with high scores on self-esteem scales suggesting the role of personality in the development of self-esteem.
Social phobia exerts a detrimental effect on the quality of life of the bearer and impacts negatively on the social and academic life of students.,,, It increases the risk of harmful use of alcohol and other substances., Although personality appeared to be a common factor in the development of self-esteem and SAD, limited studies have looked at the burden of social phobia among emerging adults, more importantly among undergraduates, and the personality trait correlates of both SAD and self-esteem in this part of the globe.
We hypothesized that a high score on the Social Phobia Inventory (SPIN) will be associated with low self-esteem and this relationship may be explained by common personality traits correlates.
In this study, we examined the burden of a SAD, the relationship of SAD with sociodemographic variables and self-esteem, and the big five personality traits correlate of both SAD and self-esteem among undergraduate students.
Design and setting
This cross-sectional study was carried out among undergraduate students at the Faculty of Science and Humanities of the Ekiti State University (EKSU), Ado Ekiti. The EKSU is located in Ado Ekiti, the capital town of Ekiti State, Southwestern Nigeria. Although the majority of the students are indigenes of the State, the institution attracts students from all works of life with diverse social, economic, as well as religious backgrounds.
Sample size and sampling
A total of 448 participants took part in the study. The minimum sample size was determined using an online sample size calculator for a cross-sectional survey with the following assumptions: the proportion of the population with a social phobia as 50%, standard normal distribution with 95% confidence interval (CI), the tolerable margin of error or precision (d = 0.05), and a z-score of 1.96. Considering a 10% nonresponse rate, a total of 440 participants were estimated for the study. In each faculty of the study, some departments were randomly selected and 448 students were finally recruited through systemic sampling from the selected departments.
Social anxiety was measured using the SPIN. It measures three domains of social phobia avoidance, fear, and physiological symptoms. Each of the 17 items was scored on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The instrument has high internal consistency with Cronbach's alpha of 0.94 for the full scale and 0.89, 0.91, and 0.80 for fear, avoidance, and physiological symptoms subscales, respectively. Those who scored 20 and below on SPIN were grouped as having no social anxiety, while those who scored above 20 were grouped as having significant SAD. A score of 21–30, 31–40, 41, and above represents mild, moderate, and severe social phobia, respectively. The SPIN has been revalidated and used in Nigeria.
Personality traits were measured using the 10-item Big Five Personality Traits Inventory (BFPI). The BFPI measures five personality traits: extraversion, agreeableness, conscientiousness, neuroticism, and openness. Each trait was measured by two items that were scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Studies have demonstrated high test–re-test reliability for the five subscales.,
The Rosenberg Self-Esteem Scale (RSES) was used to evaluate self-esteem among the population studied. It is a 10-item Likert scale with items answered on a 4-point scale from strongly disagree (1) to strongly agree (4). Its total scores range from 10 to 40, with higher scores representing higher self-esteem.
In this study, current substance use was evaluated by asking “In the last 4 weeks have you used any of the following substances?” similarly for lifetime use: “In your lifetime, have you used any of the following substances?” Current substance use was defined as the use of any psychoactive substances (excluding coffee) in the last 4 weeks, while lifetime use denotes the use of substances anytime in one's lifetime.
The Research and Ethical Committee of the EKSU Teaching Hospital, Ado Ekiti, approved the research protocol. Written informed consent was sought and obtained from each participant, and confidentiality of all information obtained was maintained.
Data were analyzed using statistical software SPSS version 24 (IBM Inc., Armonk, NY, USA). Descriptive statistics including frequency distribution, mean with standard deviation (SD), bivariate analyses as well as multivariate analyses using multiple logistic regression were performed. The relationships between personality traits as measured by the BFPTI, self-esteem as measured by RSES, and SAD as measured SPIN were explored using Spearman's correlation. P = 0.05 or less was adjudged significant.
| Results|| |
Of the 448 students that participated in the study, 280 (62.5%) were experiencing some degrees of social phobia. Majority of these presented with mild form (50.9%), while the rest presented with moderate (34.6%) and severe form (14.5%). The mean age of the participants was 21.0 years (SD = ±2.9 years). The mean score on the BFPI was 31.94 (SD = ±3.66), extraversion subscale – 5.55 (SD = ±1.74), agreeableness – 7.28 (SD = ±1.84), contentiousness – 6.91 (SD = ±1.89), neuroticism – 5.66 (SD = ±1.80), and openness – 6.62 (SD = 1.46). As shown in [Table 1], the majority of the participants (225, 50.2%) were 21 years and above, had their secondary education in public schools (236, 52.7), live in small towns/villages (56.6%), and were satisfied with their financial status (82.4%).
Correlation between the Big Five Personality Trait Inventory and its subscales, Rosenberg Self-Esteem Scale, and Social Phobia Inventory scores
[Table 2] presents the relationship between BFPI scores and its subscales, the RSES, and the SPIN scores. There was a negative correlation between the SPIN scores and the total score on BFPI (r = −0.159, P = 0.001), extraversion (r = −0.139; P = 0.003), agreeableness (r = −0.175; P = 0.001), conscientiousness (r = −0.153, P = 0.001), openness (r = −0.053, P = 0.260), and self-esteem (−0.236, P = 0.001), and likewise, there is a positive correlation between SPIN scores and neuroticism (r = 0.214, P = 0.001). Likewise, there was a significant correlation between self-esteem and agreeableness (r = 0.198, P = 0.001), conscientiousness (r = 0.215, P = 0.001), openness (r = 0.378, P = 0.001), and neuroticism (r = −0.139, P = 0.003) subscales of BFPI.
|Table 2: Correlation between Rosenberg Self-Esteem Scale, the Big Five Personality Trait Inventory and its subscales, and Social Phobia Inventory scores|
Click here to view
Relationship between sociodemographic variables and social anxiety disorder
[Table 3] shows the relationships between SAD and sociodemographic variables. Participants who were <21 years were twice more likely to experience social phobia (adjusted odds ratio [AOR] = 2.06, 95% CI = 1.31–3.25). Those who attended public secondary schools (AOR = 1.45, 95% CI = 0.96–2.15, P = 0.075), live in semi-urban and rural areas (AOR = 1.35, 95% CI = 0.89–2.04, P = 0.152), and had a lifetime history of substance use (AOR = 1.73, 95% CI = 0.96–2.15, P = 0.069) were at greater risk of developing SAD compared with their counterparts.
|Table 3: Relationship between sociodemographic variables and social phobia|
Click here to view
| Discussion|| |
Several factors increase the risk of SAD among this population. These range from age, public secondary education, living in villages or small towns, and a lifetime history of substance use. Earlier studies had reported association between increased risk of social phobia or SAD with younger age, female gender, rural dwelling, low income, and being unmarried.,,, Social anxiety develops mostly in late childhood or adolescence, with the onset of critical social impairments manifesting between the ages of 15 and 25 years. This may further explain the higher risk of SAD in the younger age group. Academic level, gender, course of study, and current substance use did not substantially increase the risk of SAD. However, findings from other studies suggest that the female gender significantly increases the risk of SAD., Although the risk of SAD was not significantly increased by the course of study, a higher rate of social phobia has been reported among science-based students compared with students in the social sciences similar to our finding.
Current substance use did not significantly increase the risk of SAD; however, a history of lifetime substance use did. There are conflicting reports on the relationship between SAD and substance use, with some reporting association between substance use and social SAD,,, while others did not.,, The association between lifetime substance use and social phobia may be due to peer pressure on adolescents thus, culminating in lifetime history, with many adolescents experimenting with such substances rather than this being precipitated by social phobia. However, this may also be a reflection of ones 'personality. A finding from another study suggests that adolescents with social phobia avoid substance use.
One interesting finding from our study was the association between SPIN scores and the BFPI and its subscales. Except for the neuroticism subscale, there was a negative correlation between BFPI, its subscales and SPIN scores. This shows that as the level of extraversion, contentiousness, and agreeableness increases, the level of social anxiety decreases and vice versa. Nevertheless, a positive correlation was observed between neuroticism and SAD. The fact that people with this personality trait are naturally self-conscious with some degree of nervousness may explain this association. Nonetheless, our observation confirmed previous findings.,,, There was no significant association between openness and social phobia, similar to an earlier report. People who are low in trust are likely to be less open-minded, and therefore, they are more likely to exhibit some degrees of anxiety in a social situation, while high-level open-mindedness may offer some protection against negative consequences of low trust. Besides the positive association between personality traits and social phobia, a positive association had also been reported between personality disorders, particularly avoidance personality disorders and SAD, thus corroborating the role of personality in the evolution of SAD.
We found a significant negative correlation between social phobia and self-esteem, suggesting that low self-esteem (particularly explicit or conscious self-esteem) may predispose to social phobia. Evidence suggests that negative self-image may play a role in causation, as well as maintenance of social phobia,, and effort at promoting positive self-imagery may improve self-esteem and enhanced social performance.,, Similarly, a significant positive correlation was observed between agreeableness and conscientiousness subscales of BFPI and self-esteem, as well as a negative correlation between neuroticism subscale and self esteem, similar to earlier finding. The degree of association between low self-esteem, social phobia, and the big five personality traits suggests that similar personality traits may be the foundation for both SAD and poor self-esteem. Again, neuroticism characterized by self-consciousness is a prominent feature of both social phobia and low self-esteem, suggesting that self-consciousness or poor self-image may be a foundation of both poor self-esteem and social phobia. Understanding the relation between self-esteem and personality traits is an important factor in understanding the link between other psychological constructs and outcomes. This may help in developing appropriate psychological therapy for people with significant SAD.
Findings from our study showed that nearly two-third of the participants were experiencing one form of social phobia or the other, with the majority presenting with mild form. This is quite high compared with previous studies.,,,, However, the difference in the rates may be due to sociodemographic and methodological differences. For example, the study by Bella and Omigbodun was conducted 12 years ago in a university located in one of Nigeria's major cities using the Composite International Diagnostic Interview. Again, some do not include those with mild form in their analyses. The fact that this was conducted in a relatively small state with most of the students from middle-to-low socioeconomic backgrounds could also explain this finding. Moreover, previous findings had reported an association between socioeconomic background, rural-dwelling, and SAD. Although the rate of SAD was relatively high, the majority of those with SAD presented with a mild form similar to other findings.,
Although our study is one of the few studies providing insight into the relationship between SAD, self-esteem, and the big five personality traits in sub-Saharan African, the study possesses some limitations. First, the cross-sectional study design precludes drawing causality or temporal association between variables. Participants' experience around the time of the interview and the environment in which the study was conducted may have influenced the participants' responses. Again, the participants were taken from a single university which may not represent the generality of the population of a young adult in the general population. However, the fact that the participants in this study were drawn from the relatively heterogeneous socioeconomic background and town/cities may provide a fair representation of the young adult in the general population of undergraduate students. Finally, study constructs were examined using self-administered questionnaires which may influence associations among variables. Nonetheless, our study possesses several strengths. One, quite a substantial number of students participated in the study. Besides, it is one of the few studies examining the burden of social anxiety using a more reliable instrument, and at the same time exploring the association between social anxiety, self-esteem, and their relationship with the big five personality traits in this part of the globe.
| Conclusions|| |
There was a high rate of SAD among the undergraduate students studied; however, most presented with a mild form. Several factors increase the risk of SAD, from sociodemographic, low self-esteem to participants' personality traits. Helping students with social phobia needs a multidimensional approach incorporating the understanding of their personality profiles, their appraisal of self-image as well as their socioeconomic background. An effort at reducing neuroticism and improving self-imagery may go a long way in reducing the burden of social phobia among undergraduate students, more importantly among younger ones, and those from rural settings. Social phobia impacts negatively on the social and academic life of students,, and exerts a detrimental effect on the quality of life of the bearer., With this understanding, and more importantly for those with moderate-to-severe forms, provision of psychological support may be beneficial for such a group of students with SAD to ensure their optimal academic success.
The authors would like to appreciate psychology students who assisted during data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington, VA: American Psychiatric Association; 2013.
Harrison PJ, Cowen P, Burns T, Fazel M. Shorter Oxford Textbook of Psychiatry. Oxford, OX2 6DP: Oxford University Press; 2017.
Sadock BJ, Sadock VA, Ruiz P. Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. Philadelphia: Wolters Kluwer; 2015.
Piet J, Hougaard E, Hecksher MS, Rosenberg NK. A randomized pilot study of mindfulness-based cognitive therapy and group cognitive-behavioral therapy for young adults with social phobia. Scand J Psychol 2010;51:403-10.
Ahmad RJ, Bayan H, Faque T, Seidi PM. Prevalence of social anxiety in students of college of education – University of Garmian. Int J Arts Technol 2017;8:79-83.
Bella TT, Omigbodun OO. Social phobia in Nigerian university students: Prevalence, correlates and co-morbidity. Soc Psychiatry Psychiatr Epidemiol 2009;44:458-63.
Desalegn GT, Getinet W, Tadie G. The prevalence and correlates of social phobia among undergraduate health science students in Gondar, Gondar Ethiopia. BMC Res Notes 2019;12:438.
Hakami RM, Mahfouz MS, Adawi AM, Mahha AJ, Athathi AJ, Daghreeri HH, et al
. Social anxiety disorder and its impact in undergraduate students at Jazan University, Saudi Arabia. Ment Illn 2017;9:7274.
Reta Y, Ayalew M, Yeneabat T, Bedaso A. Social Anxiety Disorder among Undergraduate Students of Hawassa University, College of Medicine and Health Sciences, Ethiopia. Neuropsychiatr Dis Treat 2020;16:571-7.
Dell'Osso L, Abelli M, Pini S, Carlini M, Carpita B, Macchi E, et al
. Dimensional assessment of DSM-5 social anxiety symptoms among university students and its relationship with functional impairment. Neuropsychiatr Dis Treat 2014;10:1325-32.
Russell G, Topham P. The impact of social anxiety on student learning and well-being in higher education. J Ment Health 2012;21:375-85.
Alqarni AA, Zalaa MA, El-Hadad AA, Al-Ghamdi RS, Asiri SA, Al-Thabet MM. Prevalence of social phobia among Saudi Medical Students. Med J Cairo Univ 2017;85:657-61.
Djidonou A, Tchégnonsi FT, Adoukonou T, Ataïgba IN, Assa-Issa CN, Gandaho P. Associated factors and impacts of social phobia on academic performance among students from the University of Parakou (UP). Open J Psychiatry 2016;6:151-7.
Rabie MA, Shorab E, ElGabry D, Sabry WM, Elghamry OA, Hassan G, et al
. Screening of social phobia symptoms in a sample of Egyptian university students. Arch Clin Psychiatry São Paulo 2019;46:27-32.
Pictet A. Looking on the bright side in social anxiety: The potential benefit of promoting positive mental imagery. Front Hum Neurosci 2014;8:43.
Murad O. Social anxiety in relation to self-esteem among university students in Jordan. Int Educ Stud 2020;13:96.
Väänänen JM, Isomaa R, Kaltiala-Heino R, Fröjd S, Helminen M, Marttunen M. Decrease in self-esteem mediates the association between symptoms of social phobia and depression in middle adolescence in a sex-specific manner: A 2-year follow-up of a prospective population cohort study. BMC Psychiatry 2014;14:79.
Izgiç F, Akyüz G, Doğan O, Kuğu N. Social phobia among university students and its relation to self-esteem and body image. Can J Psychiatry 2004;49:630-4.
De Jong PJ. Implicit self-esteem and social anxiety: Differential self-favouring effects in high and low anxious individuals. Behav Res Ther 2002;40:501-8.
Hulme N, Hirsch C, Stopa L. Images of the self and self-esteem: Do positive self-images improve self-esteem in social anxiety? Cogn Behav Ther 2012;41:163-73.
Kwek A, Bui HT, Rynne J, So KK. The impacts of self-esteem and resilience on academic performance: An investigation of domestic and international hospitality and tourism undergraduate students. J Hosp Tour Educ 2013;25:110-22.
Ndunguru N. The Relationship between Self-Esteem, Self-Confidence and Academic Achievement among Undergraduate Students in Selected Public and Private Universities in Iringa Region, Tanzania; 2011. Available from: http://188.8.131.52:8080/xmlui/handle/123456789/4033
. [Last accessed on 2021 Nov 01].
Paudel S. Factors associated with self-esteem among undergraduate students of pokhara metropolitan, Nepal: A cross-sectional study. Eur J Med Sci 2020;2:43-50.
Rosli Y, Othman H, Ishak I, Lubis SH, Mohd Saat NZ, Omar B. Self-esteem and academic performance relationship amongst the second year undergraduate students of Universiti Kebangsaan Malaysia, Kuala Lumpur Campus. Proc Soc Behav Sci 2012;60:582-9.
Gezu G, Kumera L, Lema Z. Determinants of self-esteem among undergraduate students of public higher education institutions in Ethiopia. Int J Educ Res Rev 2020;5:424-31. [doi: 10.24331/ijere. 779853].
Costache ME, Frick A, Månsson K, Engman J, Faria V, Hjorth O, et al
. Higher- and lower-order personality traits and cluster subtypes in social anxiety disorder. PLoS One 2020;15:e0232187.
Amirazodi F, Amirazodi M. Personality traits and Self-esteem. Proc Soc Behav Sci 2011;29:713-6.
Liu X, Ping S, Gao W. Changes in undergraduate students' psychological well-being as they experience university life. Int J Environ Res Public Health 2019;16:2864.
Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry 2000;176:379-86.
Chukwujekwu DC, Olose EO. Validation of the social phobia inventory (Spin) in Nigeria. J Psychiatry Psychiatr Disord 2018;2:49-54.
Rammstedt B, John OP. Measuring personality in one minute or less: A 10-item short version of the Big Five Inventory in English and German. J Res Personal 2007;41:203-12.
Rammstedt B, Kemper CJ, Klein MC, Beierlein C, Kovaleva A. Big Five Inventory (BFI-10). In: Zusammenstellung Sozialwissenschaftlicher Items Und Skalen. 2013;7:233-49.
Sinclair SJ, Blais MA, Gansler DA, Sandberg E, Bistis K, LoCicero A. Psychometric properties of the Rosenberg Self-Esteem Scale: Overall and across demographic groups living within the United States. Eval Health Prof 2010;33:56-80.
Jogdande AJ, Gupta A. Social anxiety disorder in medical students: Socio-demographic correlates. Int J Community Med Public Health 2017;4:3293-6.
Stein DJ, Lim CC, Roest AM, de Jonge P, Aguilar-Gaxiola S, Al-Hamzawi A, et al
. The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Med 2017;15:143.
Talepasand S, Nokani M. Social phobia symptoms: Prevalence and sociodemographic correlates. Arch Iran Med 2010;13:522-7.
Gao W, Ping S, Liu X. Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China. J Affect Disord 2020;263:292-300.
Hajure M, Abdu Z. Social phobia and its impact on quality of life among regular undergraduate students of Mettu University, Mettu, Ethiopia. Adolesc Health Med Ther 2020;11:79-87.
Crum RM, Pratt LA. Risk of heavy drinking and alcohol use disorders in social phobia: A prospective analysis. Am J Psychiatry 2001;158:1693-700.
Merikangas KR, Avenevoli S, Acharyya S, Zhang H, Angst J. The spectrum of social phobia in the Zurich cohort study of young adults. Biol Psychiatry 2002;51:81-91.
Yoshimi NT, Campos LM, Simão MO, Torres AR, Torresan RC. Social anxiety symptoms in alcohol-dependent outpatients: Prevalence, severity and predictors. J Bras Psiquiatr 2016;65:117-26.
Blöte AW, Miers AC, Westenberg PM. Adolescent social anxiety and substance use: The role of susceptibility to peer pressure. Child Dev Res 2016. https://doi.org/10.1155/2016/9468972
Fröjd S, Ranta K, Kaltiala-Heino R, Marttunen M. Associations of social phobia and general anxiety with alcohol and drug use in a community sample of adolescents. Alcohol Alcohol 2011;46:192-9.
Ham LS, Hope DA. Incorporating social anxiety into a model of college student problematic drinking. Addict Behav 2005;30:127-50.
Bienven OJ, Costa PT, Howard WT, Samuels JF, Easton WW. Phobic, panic, and major depressive disorders and the five-factor model of personality. J Nerv Ment Dis 2001;189:154-61.
Kaplan SC, Levinson CA, Rodebaugh TL, Menatti A, Weeks JW. Social anxiety and the Big Five personality traits: The interactive relationship of trust and openness. Cogn Behav Ther 2015;44:212-22.
Karsten J, Penninx BW, Riese H, Ormel J, Nolen WA, Hartman CA. The state effect of depressive and anxiety disorders on big five personality traits. J Psychiatr Res 2012;46:644-50.
Marteinsdottir I, Furmark T, Tillfors M, Fredrikson M, Ekselius L. Personality traits in social phobia. Eur Psychiatry 2001;16:143-50.
Robins RW, Tracy JL, Trzesniewski K, Potter J, Gosling SD. Personality correlates of self-esteem. J Res Personal 2001;35:463-82.
Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Sedláčková Z, et al
. Quality of life in borderline patients comorbid with anxiety spectrum disorders – A cross-sectional study. Patient Prefer Adherence 2016;10:1421-33.
[Table 1], [Table 2], [Table 3]