Social anxiety disorder women easily recognize fearfull, sad and happy faces: The influence of gender Kátia C. Arrais a , João Paulo Machado-de-Sousa a,b , Clarissa Trzesniak a,b , Alaor Santos Filho a,b , Maria Cecília F. Ferrari a,b , Flávia L. Osório a,b , Sonia R. Loureiro a,b , Antonio E. Nardi b,c , Luiz Alberto B. Hetem a , Antonio W. Zuardi a,b , Jaime Eduardo C. Hallak a,b , José Alexandre S. Crippa a,b, * a Department of Neuroscience and Behavior of the Ribeirão Preto Medical School, University of São Paulo, Brazil b INCT, Translational Medicine, CNPq, Brazil c Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil article info Article history: Received 28 August 2009 Received in revised form 27 October 2009 Accepted 3 November 2009 Keywords: Social phobia Social anxiety disorder Gender Recognition Emotion Face abstract Background: It has been suggested that individuals with social anxiety disorder (SAD) are exaggeratedly concerned about approval and disapproval by others. Therefore, we assessed the recognition of facial expressions by individuals with SAD, in an attempt to overcome the limitations of previous studies. Methods: The sample was formed by 231 individuals (78 SAD patients and 153 healthy controls). All indi- viduals were treatment naïve, aged 18–30 years and with similar socioeconomic level. Participants judged which emotion (happiness, sadness, disgust, anger, fear, and surprise) was presented in the facial expression of stimuli displayed on a computer screen. The stimuli were manipulated in order to depict different emotional intensities, with the initial image being a neutral face (0%) and, as the individual moved on across images, the expressions increased their emotional intensity until reaching the total emotion (100%). The time, accuracy, and intensity necessary to perform judgments were evaluated. Results: The groups did not show statistically significant differences in respect to the number of correct judgments or to the time necessary to respond. However, women with SAD required less emotional intensity to recognize faces displaying fear (p = 0.002), sadness (p = 0.033) and happiness (p = 0.002), with no significant differences for the other emotions or men with SAD. Conclusions: The findings suggest that women with SAD are hypersensitive to threat-related and approval-related social cues. Future studies investigating the neural basis of the impaired processing of facial emotion in SAD using functional neuroimaging would be desirable and opportune. Ó 2009 Elsevier Ltd. All rights reserved. 1. Introduction Social phobia, also known as social anxiety disorder (SAD), is characterized by the excessive fear of humiliation or embarrass- ment in social or performance situations. The generalized form of the disorder is frequently a chronic, disabling condition (Davidson, 1993) marked by the phobic avoidance of most interaction situa- tions, causing social, educational, professional and personal impairment (Schneier et al., 1994; Filho et al., 2009). The 12-month and lifetime DSM-IV prevalence rate of this disorder is high, of about 7.1% and 12.1%, respectively (Kessler et al., 2005; Ruscio et al., 2008). SAD is also associated with high rates of psychiatric comorbidities, the most common being depression and substance abuse, among other anxiety disorders (Filho et al., 2009). One of the major aspects of SAD is the excessive fear of negative evaluation and criticism. Cognitive theories of this anxiety disorder (Beck et al., 1985; Clark and Wells, 1995; Rapee and Heimberg, 1997; Ito et al., 2008) suggest that the patient in the feared social situation, feel negatively evaluated by others to an exaggerated unrealistic extent, expecting to be negatively evaluated and hence conjuring rejection. Thus, they tend to focus their attention toward themselves, which interferes with normal processing of external social cues. This could lead to attentional and interpretational biases in detecting social threat, resulting in hypervigilance toward negative emotions (Leber et al., 2009). The adequate social functioning is related to the capacity to ex- tract environmental information that is relevant to social outcome (Garner et al., 2006). In this process of evaluating and responding to environmental contingencies, the processing of facial expres- sions represent an important source of interpersonal information about positive or negative evaluations by others. 0022-3956/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2009.11.003 * Corresponding author. Address: Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Av. dos Bandeirantes, 3900, 3° andar, CEP 14025-048, Brazil. Tel./fax: +55 16 3602 2201. E-mail address: jcrippa@fmrp.usp.br (José Alexandre S. Crippa). Journal of Psychiatric Research 44 (2010) 535–540 Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/jpsychires