Looking back at the Lorentz Workshop
“Endophenotypes of Social Anxiety Disorder: Can we detect them and are they useful in clinical practice”
From December 14 th to 18 th, 24 national and international experts in genetics, brain imaging, psychiatry and clinical and developmental psychology came together in Leiden to discuss possible endophenotypes of social anxiety disorder. Participants highly appreciated the multidisciplinary and interactive nature of the workshop. Compared with large-scale conferences, there was more time to hear about the details of each other’s work and to receive feedback from experts. The time reserved for discussion offered ample opportunity to exchange ideas, set-up new collaborations and start working on a joint paper.
Putting Social Anxiety on the Agenda
Participants also considered the workshop an opportunity to build an international network of social anxiety researchers that may be more successful at raising awareness of the disorder and obtaining funding for further research. Social anxiety disorder is highly prevalent, difficult to treat and often precedes mood and substance abuse disorders. It is detrimental to the quality of life of individuals and costly to society. Yet, the results presented during the workshop stem hopeful: they suggest several possible targets for intervention. It would be a missed opportunity not to invest in research exploring these possibilities.
Social Anxiety Disorder
Social Anxiety Disorder is characterized by a strong fear of being evaluated by others in a social situation. Socially anxious individuals may fear public speaking, meeting new people, eating in front of others, etc. Many may recognize such fears to some extent: they occur at low levels in some people and at higher levels in others. Social anxiety disorder is diagnosed when fear and avoidance of social situations impair one’s occupational and/or social functioning.
Previous research has shown that social anxiety runs in families. Patients’ relatives often show high levels of social anxiety and have an increased risk of developing the disorder themselves. Although this suggests that genes are involved, there is no single social anxiety gene. The disorder seems to result from the interplay of many different genes, together with life experiences.
Because genes are difficult to relate to symptoms, scientists are currently focusing at an intermediate step on their way to unravel the causes of the disorder: the endophenotype. An endophenotype is a heritable characteristic related to the disease, that is more strongly present in patients’ relatives than in non-relatives and stronger in relatives that are more affected by the disorder. The definition of an endophenotype is rather broad and to some extent still open to discussion. During the workshop, for example, the participants debated whether a characteristic may be responsive to treatment or has to be present throughout a person’s life to qualify as an endophenotype.
After discussing endophenotypes and the reasons for suspecting their presence in social anxiety disorder on Monday, the workshop continued by examining candidate endophenotypes proposed in different fields for the next three days. These fields included the functioning of various brain regions and circuits, as measured by MRI, patterns of electrical activity of the brain (EEG, registered by placing electrodes on the head), hormones involved in the regulation of social behaviour, and biases in information processing. On Thursday, the workshop addressed development. Social anxiety disorder often has its onset in adolescence, an important period of biological and social change. In the biological domain, changes in hormone levels during puberty affect brain maturation and genes may be expressed in new ways. In the social domain, adolescents face the novel tasks of forming close relations with peers and romantic partners. Family factors that contribute to social anxiety were also discussed. The final day of the workshop focused on treatment of social anxiety disorder. The programme ended with a public keynote lecture by prof. Marcus Munafò, who discussed the utility of endophenotypes and offered recommendations to further improve the reproducibility of endophenotype research.
The workshop was organized by the Leiden Family Study-team, including researchers from Leiden University (LU) and the Leiden University Medical Center (LUMC). This team is currently conducting a multigenerational family study to detect endophenotypes of social anxiety (see: www.leidenfamilylab.nl and www.facebook.com/FamilieOnderzoekExtremeVerlegenheid). The scientific organizers were Janna Marie Bas-Hoogendam (LU), Jennifer Lau (King’s College London, UK), Nic van der Wee (LUMC) and Michiel Westenberg (LU). The workshop has been sponsored by the Leiden University Fund/Den Dulk-Moermans, the Institute of Psychology (LU), the department of Psychiatry (LUMC), and the Leiden University Research Profile Health, Prevention and the Human Life Cycle.