Social performance deficits in social anxiety disorder: reality during conversation and biased perception during speech.

Cognitive models emphasize that patients with social anxiety disorder (SAD) are mainly characterized by biased perception of their social performance. In addition, there is a growing body of evidence showing that SAD patients suffer from actual deficits in social interaction. To unravel what characterizes SAD patients the most, underestimation of social performance (defined as the discrepancy between self-perceived and observer-perceived social performance), or actual (observer-perceived) social performance, 48 patients with SAD and 27 normal control participants were observed during a speech and conversation. Consistent with the cognitive model of SAD, patients with SAD underestimated their social performance relative to control participants during the two interactions, but primarily during the speech. Actual social performance deficits were clearly apparent in the conversation but not in the speech. In conclusion, interactions that pull for more interpersonal skills, like a conversation, elicit more actual social performance deficits whereas, situations with a performance character, like a speech, bring about more cognitive distortions in patients with SAD.