September 19, 2025
Dear Colleagues,
The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Annika Okamoto, PhD, A-CBT of NSAC Santa Barbara. The article, Recalled Parental Behavior of Women and Men with Social Anxiety Disorder – The Importance of the Father-Child Relationship by Elling-Lueder et al (2025), investigates the correlation of parenting behavior styles in childhood and the severity of social anxiety in adulthood.
The researchers examined how sociodemographic factors, comorbidities, clinical impairment, and recalled parenting behaviors differ between men and women with social anxiety. The sample included 425 women and 283 men, all diagnosed with social anxiety disorder (SAD), through structured clinical interviews. Women reported higher SAD symptom severity than men and were more likely to present with comorbid depressive disorders, while men more frequently reported alcohol or substance-related disorders. No significant sex differences were found in partnership status or educational attainment.
The study also examined the role of paternal parenting style in predicting SAD severity. Women with SAD reported that paternal affectionless control (low care, high overprotection) predicted more severe symptoms. In men, both paternal affectionless control and affectionate constraint (high care, high overprotection) predicted greater SAD severity, highlighting nuanced differences in how paternal influence shapes symptom development across genders. These parenting categories come from the Parental Bonding Instrument (PBI) that measures two dimensions: care (warmth and affection versus rejection or neglect) and overprotection (control and intrusion versus autonomy granting). Thus, paternal affectionless control represents a cold, restrictive style, while paternal affectionate constraint represents a warm but smothering style that limits autonomy. Both were linked to more severe SAD symptoms, though with different gender patterns.
The researchers examined the recalled parental behavior for both mothers and fathers. However, only paternal variables were statistically significant predictors of severity of social anxiety in adulthood.
Take-away: These findings suggest that therapeutic work with SAD may benefit from addressing paternal influences and that broader cultural shifts away from rigid gendered parenting roles could reduce vulnerability to SAD.
Clinical Question: How might you use Socratic questions about paternal parenting—especially patterns of control—to inquire about internalized self-attitudes in social anxiety?
Reference:
Elling-Lueder, C; Forstner, A J; Ramm, M; Stahl, J; Schumacher, J; & Conrad, R. (2025). Recalled Parental Behavior of Women and Men with Social Anxiety Disorder – The Importance of the Father-Child Relationship. Journal of Psychiatric Research,190, 540–546.
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Annika Okamoto, PhD, A-CBT
Representing NSAC Santa Barbara
(Oceanside Clinics)