Detachment and Generalized Social Phobia

To the Editor: We read with great interest the finding of Aki Laakso, M.D., Ph.D., and colleagues (1) that the personality trait of “detachment” is associated with low dopamine transporter binding in healthy subjects, complementing prior findings of its association with low dopamine D₂ receptor density (2, 3). These results parallel findings in generalized social phobia of low dopamine transporter binding (4) and low D₂ receptor binding (5). The authors suggested that “detachment,” as measured by the detachment scale of the Karolinska Scales of Personality (6), relates to a behavioral pattern of withdrawal and aloofness and that the findings may be relevant for schizoid personality disorder. We would caution, however, that “detachment” is also associated with generalized social phobia and may represent social avoidance due to anxiety.

Most of the 10 items of the detachment scale could easily apply to persons who avoid social situations because of fear of embarrassment, rather than aloofness (e.g., “It is [not] easy for me to get close to people”). In an ongoing study in our clinic, 20 patients with generalized social phobia had a mean detachment score of 25.5 (SD=3.8, range=19–35). Nineteen (95%) of the 20 patients had scores exceeding the median score of 19 found among healthy subjects by Dr. Laakso and colleagues (1). The detachment scale therefore may be sensitive to social avoidance related to anxiety in social phobia. Alternatively, the detachment scale may have detected aloofness as an unexpected element (or consequence) of social phobia.

Because social phobia is highly prevalent in the community yet is frequently missed by clinicians, studies recruiting healthy subjects may inadvertently include persons with social phobia unless they are systematically screened out. Because two articles regarding detachment and dopamine (1, 2) did not include the methods used to exclude subjects with psychiatric disorders, some of their subjects with elevated detachment scores may have had social phobia. Future studies of detachment should systematically assess the presence of social phobia among subjects.