Social Anxiety Disorder as a Densely Interconnected Network of Fear and Avoidance for Social Situations

The hallmark symptoms of social anxiety disorder (SAD) are fear and avoidance of social evaluative situations. Yet, even people without SAD sometimes fear and avoid certain social situations without ever developing the disorder. Apart from differences in number and severity, uncertainty abounds about how fear and avoidance of distinct interpersonal and social evaluative situations organize differently in people with and without SAD. Inspired by novel network approaches to psychopathology, we sought to characterize the network structure of fear and avoidance of distinct social evaluative situations among individuals with (n = 238) and without SAD (n = 232). Although the network structure and node centrality metrics did not differ between the groups, the network for those with SAD was more strongly interconnected than that of people free of the diagnosis. This study is the first to provide evidence that SAD can be conceptualized as a densely interconnected network of fear and avoidance of social situations. Our results are consistent with the network theory of mental disorders that regards networks with strong between-symptom connections as more pathogenic than similar networks with weaker connections. As prior studies indicated that overall network connectivity can predict the course of mental disorders, our findings set the scene for novel indicators of SAD prognosis.