Neurocognitive Heterogeneity in Social Anxiety Disorder: The Role of Self-Referential Processing and Childhood Maltreatment

Social anxiety disorder (SAD) is characterized by negative self-beliefs and altered brain activation in the default mode network (DMN). However, the extent to which there is neurocognitive heterogeneity in SAD remains unclear. We had two independent samples of patients perform a self-referential encoding task, and complete self-reports of childhood maltreatment, subjective well-being, and emotion regulation. In the replication sample, we also measured DMN activation using functional magnetic resonance imaging. K-means clustering revealed two distinct sub-groups of SAD patients in the discovery sample. Cluster 1 demonstrated higher levels of negative and lower levels of positive self-referential trait endorsement, and significantly higher levels of childhood emotional maltreatment, lower subjective well-being, and altered emotion regulation strategy use. A similar pattern was observed in the replication sample, which further demonstrated higher DMN activation during negative trait judgments in cluster 1. These findings reveal neurocognitive heterogeneity in SAD and its relationship to emotional maltreatment.