Association of delusions and lack of cognitive flexibility with social anxiety in schizophrenia spectrum disorders

Though often overlooked clinically, social anxiety appears to be unusually common in schizophrenia and may represent a barrier to quality of life and wellness. To explore the possible roots of social anxiety in schizophrenia, we concurrently assessed delusions using the Positive and Negative Syndrome Scale, flexibility of abstract thought using the Wisconsin Card Sorting Test, capacity for interpersonal relations using the Quality of Life Scale and social anxiety using the Liebowitz Social Anxiety Scale among 71 participants with schizophrenia or schizoaffective disorder. ANOVA revealed participants classified as having both significant delusions and impairments in flexibility of abstract thought (n = 11) had significantly higher levels of social anxiety and fewer psychological resources for interpersonal relationships than participants with only one or neither of these difficulties. Groups did not differ on demographic variables, awareness of illness or negative symptoms. Clinical and theoretical implications are discussed.