Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal.

Using outpatients with anxiety and mood disorders (N?=?350), the authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression). Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to tube understanding of the pathogenesis, course, and co-occurrence of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic and phobic anxiety: defining phenotypes for genetic studies

OBJECTIVE: With recent advances in molecular genetics, the rate-limiting step in identifying susceptibility genes for psychiatric disorders has become phenotype definition. The success of psychiatric genetics may require the development of a "genetic nosology" that can classify individuals in terms of the heritable aspects of psychopathology. The authors' aim is to begin to apply this analysis to the anxiety disorders, focusing on panic and phobic disorders. METHOD: Two parallel traditions of defining anxiety phenotypes are reviewed: the first, more closely identified with clinical psychiatry, has identified categorical diagnoses (e.g., panic disorder and social phobia). The other, more closely identified with psychological studies of personality development, has examined dimensional traits (e.g., neuroticism) and anxious temperament (e.g., behavioral inhibition). RESULTS: The authors suggest that a genetic nosology of panic and phobic disorders may incorporate features of both traditions and discuss strategies for optimizing genetic approaches to anxiety including 1) studying phenotypic extremes, 2) identifying biological trait markers, and 3) using animal models to identify candidate loci. CONCLUSIONS: An important dividend from the effort to define the boundaries of heritable phenotypes for genetic studies of anxiety may be a refinement of the nosology of anxiety disorders.     

Explicit and implicit memory bias in panic disorder with agoraphobia

Thirty patients with a diagnosis of panic disorder with agoraphobia and 30 normal controls were compared on explicit memory (cued recall) and implicit memory (word stem completion) for positive, neutral, social threat, and physical threat words. The panic patients showed an explicit memory bias, but no implicit memory bias, for physical threat words. The index of explicit memory bias for physical threat words was found to correlate with anxiety sensitivity and degree of agoraphobic fear and avoidance. The index of baseline bias for threat words on the word completion task, on the other hand, correlated with trait anxiety. Although there were no correlations between explicit and implicit memory bias for physical threat words, explicit memory bias for physical threat words correlated with explicit memory bias indexes for positive words and social threat words. The results are discussed in terms of the functional role of an explicit memory bias for physically threatening events in panic disorder. The negative results on implicit memory bias are discussed in relation to earlier studies, the use of different implicit memory tasks, and the role of baseline bias on implicit memory tasks. Finally, the hypothesis is suggested that explicit and implicit memory bias for emotional information may represent two different styles of information processing, which serve as vulnerability factors for different emotional disorders.     

Assessment instrument for panic disorder that includes fear of sensation-producing activities: the Albany Panic and Phobia Questionnaire

A set of items was developed to assess fear of activities which produce physical sensations (e.g., exercise) based on clinical observations that individuals with panic disorder fear such activities in addition to agoraphobic situations. Factor analysis of a 32-item pool based on responses from 438 subjects confirmed three distinct factors which were labelled: agoraphobia, social phobia, and interoceptive fears. Evidence was obtained to support the internal consistency, test-retest reliability, and construct validity of all three factors. Importantly, the interoceptive factor demonstrated a slightly different pattern of relationships with other constructs to the agoraphobic factor, even though the two were highly related. The present questionnaire will help to expand current assessments of panic disorder for both clinical work and research.     

Comorbid anxiety disorders and treatment of depression in people with multiple sclerosis.

Objective: Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders. Design: Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment. Results: Participants with comorbid anxiety disorders improved to a similar degree during treatment as those without anxiety disorders. Outcomes during follow-up were mixed, and thus we divided the anxiety diagnoses into distress and fear disorders. The distress disorder (GAD) was associated with elevated anxiety symptoms during and after treatment. In contrast, fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia) were linked to depression, specifically during follow-up, across 3 different measures. Conclusions: People with GAD receiving treatment for depression may benefit from additional services targeting anxiety more specifically, while those with comorbid fear disorders may benefit from services targeting maintenance of gains after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implicit and explicit measures of alcohol and smoking cognitions.

The present study tested convergent, discriminant, and incremental validity of implicit and explicit measures of alcohol and smoking cognitions. College-aged participants (n = 264) completed questionnaire measures of alcohol and smoking expectancies and behavior. Participants also completed the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) for alcohol and smoking on two occasions, approximately 1 month apart. Psychometric qualities of these IATs were evaluated. Modest associations were found between implicit and explicit measures for the same substance. Both implicit and explicit measures had unique associations with use. Discriminant validity was stronger for alcohol measures than for smoking measures. These results support the utility of the IAT as a technique for assessing implicit associations about alcohol and smoking. They also provide some evidence that smoking motivations may make unique contributions to alcohol use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A metacognitive approach to "implicit" and "explicit" evaluations: Comment on Gawronski and Bodenhausen (2006).

Comments on the article by B. Gawronski and G. V. Bodenhausen (see record 2006-10465-003). A metacognitive model (MCM) is presented to describe how automatic (implicit) and deliberative (explicit) measures of attitudes respond to change attempts. The model assumes that contemporary implicit measures tap quick evaluative associations, whereas explicit measures also consider the perceived validity of these associations (and other factors). Change in explicit measures is greater than implicit measures when new evaluative associations are formed and old associations are rejected. Implicit measure change is greater than explicit when newly formed evaluative associations are rejected. When implicit and explicit evaluations conflict, implicit ambivalence can occur. The authors relate the MCM to the associative-propositional evaluation model and explain how the MCM builds on the attitude strength assumptions of the elaboration likelihood model of persuasion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment.

A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM–IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM–IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked phenotypal overlap of the DSM–IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specificity of panic attacks in panic disorder and specific phobia). Although extant dimensional proposals may address some drawbacks associated with the DSM nosology (e.g., inadequate assessment of individual differences in disorder severity), these proposals do not reconcile key problems in current classification, such as modest reliability and high comorbidity. This article considers an alternative approach that emphasizes empirically supported common dimensions of emotional disorders over disorder-specific criteria sets. Selection and assessment of these dimensions are discussed along with how these methods could be implemented to promote more reliable and valid diagnosis, prognosis, and treatment planning. For instance, the advantages of this system are discussed in context of transdiagnostic treatment protocols that are efficaciously applied to a variety of disorders by targeting their shared features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war

OBJECTIVE: The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined. METHOD: A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R. RESULTS: The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD. CONCLUSIONS: The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma.     

Discrepancies between explicit and implicit self-concepts: Consequences for information processing.

Individuals with discrepancies among their explicit beliefs often engage in greater elaboration of discrepancy-related information in a presumed attempt to reduce the discrepancy. The authors predicted that individuals with discrepancies between explicit and implicit self-conceptions might similarly be motivated to engage in processing of discrepancy-related information, even though they might not be aware of the discrepancy. Four studies were conducted in which various self-dimensions were assessed with explicit and implicit measures. Across several different self-dimensions (e.g., need to evaluate, self-esteem), the authors found that as the discrepancy between the explicit and implicit measure increased (regardless of direction), people engaged in more thinking about information framed as related to the self-dimension on which the discrepancy existed. This research suggests that individuals might be motivated to examine relevant information as a strategy to minimize the implicit doubt that accompanies an inconsistency between explicit and implicit self-conceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of a system of classifying female substance abusers on the basis of personality and motivational risk factors for substance abuse.

This study explored the validity of classifying a community-recruited sample of substance-abusing women (N?=?293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion-hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted-hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Further validation of the IDAS: Evidence of convergent, discriminant, criterion, and incremental validity.

The authors explicated the validity of the Inventory of Depression and Anxiety Symptoms (IDAS; D. Watson et al., 2007) in 2 samples (306 college students and 605 psychiatric patients). The IDAS scales showed strong convergent validity in relation to parallel interview-based scores on the Clinician Rating version of the IDAS; the mean convergent correlations were .51 and .62 in the student and patient samples, respectively. With the exception of the Well-Being Scale, the scales also consistently demonstrated significant discriminant validity. Furthermore, the scales displayed substantial criterion validity in relation to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) mood and anxiety disorder diagnoses in the patient sample. The authors identified particularly clear and strong associations between (a) major depression and the IDAS General Depression, Dysphoria and Well-Being scales, (b) panic disorder and IDAS Panic, (c) posttraumatic stress disorder and IDAS Traumatic Intrusions, and (d) social phobia and IDAS Social Anxiety. Finally, in logistic regression analyses, the IDAS scales showed significant incremental validity in predicting several DSM-IV diagnoses when compared against the Beck Depression Inventory-II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996) and the Beck Anxiety Inventory (A. T. Beck & R. A. Steer, 1990). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.     

Implicit and explicit preferences for physical attractiveness in a romantic partner: A double dissociation in predictive validity.

Five studies develop and examine the predictive validity of an implicit measure of the preference for physical attractiveness in a romantic partner. Three hypotheses were generally supported. First, 2 variants of the go/no-go association task revealed that participants, on average, demonstrate an implicit preference (i.e., a positive spontaneous affective reaction) for physical attractiveness in a romantic partner. Second, these implicit measures were not redundant with a traditional explicit measure: The correlation between these constructs was .00 on average, and the implicit measures revealed no reliable sex differences, unlike the explicit measure. Third, explicit and implicit measures exhibited a double dissociation in predictive validity. Specifically, explicit preferences predicted the extent to which attractiveness was associated with participants' romantic interest in opposite-sex photographs but not their romantic interest in real-life opposite-sex speed-daters or confederates. Implicit preferences showed the opposite pattern. This research extends prior work on implicit processes in romantic relationships and offers the first demonstration that any measure of a preference for a particular characteristic in a romantic partner (an implicit measure of physical attractiveness, in this case) predicts individuals' evaluation of live potential romantic partners. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor and macrophage colony-stimulating factor in the treatment of acute myeloid leukemia and acute lymphoblastic leukemia

To explore the role of perfectionism across anxiety disorders, 175 patients with either panic disorder (PD), obsessive compulsive disorder (OCD), social phobia, or specific phobia, as well as 49 nonclinical volunteers, completed two measures [Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R., (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P. L., & Flett, G. L., (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470.] that assess a total of nine different dimensions of perfectionism. Relative to the other groups, social phobia was associated with greater concern about mistakes (CM), doubts about actions (DA), and parental criticism (PC) on one measure and more socially prescribed perfectionism (SP) on the other measure. OCD was associated with elevated DA scores relative to the other groups. PD was associated with moderate elevations on the CM and DA subscales. The remaining dimensions of perfectionism failed to differentiate among groups. The clinical implications of these findings are discussed.     

Understanding general and specific connections between psychopathology and marital distress: A model based approach.

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive Processing of Emotional Information in Depression, Panic, and Somatoform Disorder.

Emotional Stroop tasks (subliminal/supraliminal exposures), implicit memory tasks (tachistoscopic word identification), and explicit memory tasks (free recall after incidental learning) with 4 word types (physical threat, positive, negative, and neutral words) were administered to patients with major depressive disorder (n = 30), panic disorder (n = 33), somatoform disorder (n = 25), and healthy control participants (n = 33). On the Stroop task, panic patients showed subliminal interferences for physical threat and negative words, depressive patients showed supraliminal interferences for negative words, and somatoform patients showed supraliminal interferences for physical threat words. No patient groups demonstrated implicit memory biases. On the explicit memory task, depressive and panic patients showed memory biases for negative words; somatoform patients showed biases for physical threat words. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia: an update

The literature on social phobia is reviewed in this article. Social phobia has undergone considerable diagnostic evolution to reach its present form in DSM-IV. Its differential diagnosis includes panic disorder with agoraphobia, avoidant personality disorder, depression, and "shyness." Cross-cultural issues are important to consider because the disorder may manifest differently in different cultures and social settings. It is common, with a lifetime prevalence of 13.3% in the United States according to recent epidemiological studies. Underrecognition of social phobia remains an issue of concern. Comorbidity with other psychiatric disorders, including other anxiety disorders, depression, alcohol abuse, and personality disorders, frequently occurs. Current conceptualizations of the etiology of social phobia reflect psychodynamic theories and evidence from family and genetic studies, neurobiological research, and neuroimaging. Drugs such as monoamine oxidase inhibitors, selective serotonin-reuptake inhibitors, benzodiazepines, and beta3-adrenergic blockers have proven to be efficacious, as has cognitive-behavioral treatment, including group approaches.     

Co-morbidity and familial aggregation of alcoholism and anxiety disorders

BACKGROUND: This study examined the patterns of familial aggregation and co-morbidity of alcoholism and anxiety disorders in the relatives of 165 probands selected for alcoholism and/or anxiety disorders compared to those of 61 unaffected controls. METHODS: Probands were either selected from treatment settings or at random from the community. DSM-III-R diagnoses were obtained for all probands and their 1053 first-degree relatives, based on direct interview or family history information. RESULTS: The findings indicate that: (1) alcoholism was associated with anxiety disorders in the relatives, particularly among females; (2) both alcoholism and anxiety disorders were highly familial; (3) the familial aggregation of alcoholism was attributable to alcohol dependence rather than to alcohol abuse, particularly among male relatives; and (4) the the pattern of co-aggregation of alcohol dependence and anxiety disorders in families differed according to the subtype of anxiety disorder; there was evidence of a partly shared diathesis underlying panic and alcoholism, whereas social phobia and alcoholism tended to aggregate independently. CONCLUSIONS: The finding that the onset of social phobia tended to precede that of alcoholism, when taken together with the independence of familial aggregation of social phobia and alcoholism support a self-medication hypothesis as the explanation for the co-occurrence of social phobia and alcoholism. In contrast, the lack of a systematic pattern in the order of onset of panic and alcoholism among subjects with both disorders as well as evidence for shared underlying familial risk factors suggests that co-morbidity between panic disorder and alcoholism is not a consequence of self-medication of panic symptoms. The results of this study emphasize the importance of examining co-morbid disorders and subtypes thereof in identifying sources of heterogeneity in the pathogenesis of alcoholism.