Social anxiety in schizophrenia: The specificity of the unspecific

Comorbidity between schizophrenia and social anxiety disorder (SAD) is found to be considerable. However, contra current conventional psychiatric belief, one might also view social anxiety as appertaining to the schizophrenia spectrum, and not merely as a co-occurring disorder. In this paper, I argue that by comprehensively investigating an unspecific phenomenon, such as social anxiety, we can acquire a grasp of the specific ways-of-being-in-the-world for the person with schizophrenia. In this respect, social anxiety proves revelatory of the Gestalt of schizophrenia, yet, simultaneously, the Gestalt reciprocally illuminates the quality of the social anxiety. I begin by outlining the structure of social anxiety in schizophrenia, which has a qualitatively different structure from social anxiety in itself or in other conditions, since the anxiety primarily is directed toward the social domain as such, i.e., sociality may constitute an ontological threat. Next, I discuss three modalities of social anxiety in schizophrenia: anxiousness about losing uniqueness, fusion anxiety, and engulfment. I end by stressing the importance of the Gestalt-oriented approach in the elucidation of social anxiety in schizophrenia. Additionally, I also introduce some reflections on the relationship between social anxiety and psychosis, and some considerations on psychotherapy for social anxiety in schizophrenia.