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28-09-2011 | Mental health | Article

Remitted BD patients have high levels of social anxiety


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MedWire News: Patients with bipolar disorder (BD) who are in remission have high levels of social anxiety, which is associated with self-stigmatization and low self-esteem, say Turkish researchers.

Writing in the journal Acta Neuropsychiatrica, Omer Aydemir (Celal Bayar University, Manisa) and Cengiz Akkaya (Uludag University, Bursa) explain that "social anxiety disorder is the most common comorbid disorder in the Systematic Treatment Enhancement Programme for Bipolar Disorder data, and the third most common comorbid disorder in the Turkish comorbidity study in BD."

To investigate social anxiety levels in remitted BD patients, and associations with stigmatization and self-esteem, the researchers studied 150 such patients (52.7% women) who had been in remission for at least 6 months. At enrolment, all of the participants had a score of less than 7 on the 17-item Hamilton Depression Rating Scale and a score of less than 4 on Young Mania Rating Scale.

The mean age of the patients was 39.5 years, the mean duration of the illness was 13.4 years, and the mean number of mood episodes was 7.8. Most (90.0%) of the patients had bipolar I disorder.

Social anxiety was assessed using the Liebowitz Social Anxiety Scale (LSAS), which measures anxiety and avoidance/withdrawal to produce two subscale scores ranging from 0 to 72, with higher scores indicating greater severity of social anxiety and avoidance/withdrawal.

Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), which consists of 63 items and 12 subscales. The sum of the scores on these items is measured on a 4-point Likert-type scale, with higher scores indicating greater levels of self-esteem.

The team used the four-item sense of stigmatization subscale of the Bipolar Disorder Functioning Questionnaire (BDFQ-Stigma) to assess self-stigmatization.

Overall, the mean LSAS anxiety subscale score was 39.7 and the mean LSAS avoidance/withdrawal subscale score was 38.3. The mean LSAS total score was 78.1. The mean RSES score was 1.2 and the mean BDFQ-Stigma score was 8.6.

The researchers found that higher levels of social anxiety were associated with higher levels of stigmatization and lower levels of self-esteem. Self-esteem was negatively associated with stigmatization.

Stigmatization and self-esteem were not influenced by demographic variables such as age, gender and education, or by clinical features such as duration of illness and number of mood episodes, the researchers note.

Aydemir and Akkaya conclude: "In remitted bipolar patients, social anxiety is very high and… seems to be caused by self-stigmatization and low self-esteem."

They add: "To reduce social anxiety in remitted bipolar patients, all therapeutic and social interventions to improve self-esteem of the patients and to reduce concerns about stigma should be implemented."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Mark Cowen

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