Shorter communication Gaze avoidance in social phobia: Objective measure and correlates Albert Moukheiber a, * , Gilles Rautureau a , Fernando Perez-Diaz a , Robert Soussignan a , Ste ´ phanie Dubal a , Roland Jouvent a, b , Antoine Pelissolo a, b a CNRS USR 3246, UPMC, Ho ˆpital Pitie ´-Salpe ´trie `re, Paris, France b Department of Psychiatry, Ho ˆpitalPitie´-Salpe´trie`re,AP-HP,Paris,France article info Article history: Received 24 February 2009 Received in revised form 31 August 2009 Accepted 30 September 2009 Keywords: Social phobia Anxiety Emotion Gaze aversion Visual scanpaths abstract Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder. Ó 2009 Elsevier Ltd. All rights reserved. Introduction Social phobia affects 3–5% of the general population, often with high degrees of impairment and psychiatric comorbidity such as depression or addiction (Fehm, Schneider, & Hoyer, 2007). It is an anxiety disorder defined by excessive fear reactions that are trig- gered by social or performance situations in which the person is exposed to possible scrutiny by others. The individual fears that he or she will act in a way that might be humiliating or embarrassing. One main observation in clinical studies of social phobia is the avoidance of eye contact in social interactions (Greist, 1995; Marks & Gelder, 1969; Ohman, 1986). Gaze avoidance is, furthermore, one of the causes that leads to sustain, even aggravate, the phobic pathology by a classical negative reinforcement scheme: avoidance reinforces fear. Perceiving faces accurately as well as integrating the emotional expressions of these faces is a crucial element in interpersonal communication. Face and facial emotion processing relies on the integrity of visuomotor and visuospatial information processing systems (Bruce & Young, 1986). Studies have shown that healthy subjects create a regular schema of eye movement and fixations while observing a face. Subjects focus in particular on the salient facial features of eyes, nose and mouth, producing scanpaths that represent an inverted triangle in shape (Mertens, Siegmund, & Gru ¨sser, 1993; Walker- Smith, Gale, & Findlay, 1977). However, the eyes remain the area that gathers the greatest attention and is considered to be the most important source of information about emotional expression in social interactions (Ohman, Lundqvist, & Esteves, 2001). The possibility of sustaining an eye to eye contact between two individuals in the same species is an exclusively human behavior. Exchanging looks and stares is a fundamental part of social cogni- tion, especially as a mean of non verbal and emotional communi- cation. This phenomenon starts at a very early stage in life, where it might be considered as one of the building blocks of attachment. Some conditions based on social cognition dysfunction such as autism or social anxiety spectrum may be associated with an alteration of this communication (Gilbert, 2001). Information processing also plays a crucial role in social inter- actions. Creswell et al. (2008), has shown that offspring of mothers with social phobia show processing biases to emotional expression in infancy. Brain functioning data also show the need to further our research in gaze aversion and social phobia. Gentili et al. (2008) illustrate enhanced activity in the brain (amygdala and insula notably) areas related to processing of information about emotional * Corresponding author. Centre EMOTION, CNRS USR 3246, Pavillon Cle ´ rambault, CHU Pitie ´ -Salpe ´ trie `re, 47, Bd de l’Hopital, 75651 Paris Cedex 13, France. Tel.: þ33 1 42 16 12 59; fax: þ33 6 76 04 99 35. E-mail address: amoukheiber@gmail.com (A. Moukheiber). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2009.09.012 Behaviour Research and Therapy 48 (2010) 147–151