34 Chapter 2 2000, n = 40 ; Maner et al., 2008, n = 64), recent findings from a large cohort study show reduced testosterone levels in women with SAD compared to women without a lifetime history of anxiety or depressive disorders. (Giltay et al., 2012, n = 2102, small-medium effect size). Interestingly, testosterone administration to women with SAD promotes social threat approach on the AAT (Enter, Spinhoven, & Roelofs, 2016, n = 17) and socially dominant gaze behavior. For example, patients with SAD have been shown to display reduced fixations on the eye-regions of angry (versus neutral) faces (Enter, Terburg, Harrewijn, Spinhoven, & Roelofs, 2016, SAD n = 18, HC n = 19; Horley, Williams, Gonsalvez, & Gordon, 2004, SAD n = 22, HC n = 22). Administration of 0.5 mg testosterone in 18 patients with SAD resulted in normalization of the gaze pattern, increasing the number of first fixations to the eye-region of angry faces (see Figure 2.1 ). These results suggest that testosterone is able to promote social dominant behavior by its anxiolytic and reward-promoting properties, presumably by influencing early automatic mechanisms (van Peer, Enter, van Steenbergen, Spinhoven, & Roelofs, 2017, SAD n = 19, HC n = 19). Quite a few studies have focused on the role of oxytocin in SAD, but the results should be interpreted with caution, as statistical power tends to be low (Walum, Waldman, & Young, 2016). There is no evidence of altered baseline levels in SAD compared to healthy controls, although higher levels of oxytocin were associated with more severe social anxiety symptomatology and less satisfaction in social relationships in one study ( n = 46) (Hoge, Pollack, Kaufman, Zak, & Simon, 2008). Oxytocin administration studies in SAD (18 SAD patients versus 18 healthy controls) have shown that this neuropeptide is able to dampen heightened amygdala and prefrontal responses (Labuschagne et al., 2010; Labuschagne et al., 2012) and to normalize amygdala–frontal connectivity during resting state (Dodhia et al., 2014, n = 36). Interestingly, oxytocin administration promotes other-oriented reward motivation, but only in patients with generalized SAD who have less severe social interaction anxiety (Fang, Treadway, & Hofmann, 2017, n = 52). In sum, individuals with SAD show alterations in the regulation of social motivational behavior characterized by persistent social avoidance, reduced testosterone levels, increased cortisol responses, enhanced threat sensitivity, and probably reduced reward processing, a pattern that is associated with socially submissive behavior. Results on the role of oxytocin in SAD are inconclusive and need to be elucidated in future research. Psychopathy Psychopathy is a multidimensional personality condition which overlaps partly with anti-social personality disorder, sharing an anti-social lifestyle, but distinguished by affective–interpersonal impairments (Brazil, van Dongen, Maes, Mars, & Baskin-Sommers, 2016). The full clinical manifestation affects less than 1% of the general population, and ap-
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