The moderating role of avoidance behavior on anxiety over time: Is there a difference between social anxiety disorder and specific phobia?

Contains fulltext : 174254.pdf (publisher's version ) (Open Access)Theories of anxiety disorders and phobias have ascribed a critical role to avoidance behavior in explaining the persistence of fear and anxiety, but knowledge about the role of avoidance behavior in the maintenance of anxiety in social anxiety disorder relative to specific phobia is lacking. This study examined the extent to which avoidance behavior moderates the relationship between general anxiety at baseline and 18 months later in women with a diagnosed social anxiety disorder (n = 91) and women with a diagnosed specific phobia (n = 130) at baseline. Circumscribed avoidance of social and specific situations were clinician-rated using the Anxiety Disorders Interview Schedule-Lifetime (ADIS-IV-L), and general anxiety was measured using the Beck Anxiety Inventory (BAI). Moderated regression analyses revealed that (a) general anxiety at baseline predicted general anxiety at follow-up in both women with a specific phobia and women with a social anxiety disorder and (b) avoidance behavior moderated this relationship in women with a specific phobia but not in women with a social anxiety disorder. Specifically, high avoidance behavior was found to amplify the effect between general anxiety at baseline and follow-up in specific phobia. Reasons for the absence of a similar moderating effect of avoidance behavior within social anxiety disorder are discussed.14 p

Dysfunctional attitudes and anxiety sensitivity in the manifestation and first onset of social anxiety disorder versus specific phobia and healthy: A prospective longitudinal study

Contains fulltext : 161920.pdf (publisher's version ) (Open Access)This study evaluated the role of two cognitive vulnerability factors, anxiety sensitivity and dysfunctional attitudes, in the prediction of the manifestation and onset of social anxiety disorder relative to specific phobia and relative to healthy controls. Women, aged between 18 and 24 years, were studied at baseline and 18 months later using the Anxiety Disorders Interview Schedule-Lifetime-ADIS-IV-L and the Anxiety Sensitivity Index-ASI and the Dysfunctional Attitude Scale-DAS. First, 52 women with current social anxiety disorder were compared to 97 women with current specific phobia and 1124 healthy controls (cross-sectional analysis). Second, 24 women with a first incidence of social anxiety disorder were compared to 55 women with a first incidence of specific phobia and 684 healthy controls (longitudinal analysis). Multiple logistic regression analyses, adjusted for baseline anxiety and depressive severity, revealed that a) dysfunctional attitudes were elevated in women with current social anxiety disorder versus healthy controls as well as women with current specific phobia in the cross-sectional analysis and b) dysfunctional attitudes were elevated in women who subsequently developed social anxiety disorder versus healthy controls in the longitudinal analysis. However, dysfunctional attitudes were not predictive for women who developed social anxiety disorder during the study relative to women who developed specific phobia. The results suggest that dysfunctional attitudes are a marker of severity for social anxiety disorder relative to other phobias and a risk factor for phobias more generally. Anxiety sensitivity seems not to contribute to the manifestation and onset of social anxiety disorders.14 p

Dimensional assessment of anxiety disorders in parents and children for DSM-5

The current shift in the DSM towards the inclusion of a dimensional component allows clinicians and researchers to demonstrate not only the presence or absence of psychopathology in an individual, but also the degree to which the disorder and its symptoms are manifested. This study evaluated the psychometric properties and utility of a set of brief dimensional scales that assess DSM-based core features of anxiety disorders, for children and their parents. The dimensional scales and the Screen for Child Anxiety Related Emotional Disorders (SCARED-71), a questionnaire to assess symptoms of all anxiety disorders, were administered to a community sample of children (n = 382), aged 8-13 years, and their mothers (n = 285) and fathers (n = 255). The dimensional scales assess six anxiety disorders: specific phobia, agoraphobia, panic disorder, social anxiety disorder, generalized anxiety disorder, and separation anxiety disorder. Children rated their own anxiety and parents their child's anxiety. The dimensional scales demonstrated high internal consistency (α > 0.78, except for father reported child panic disorder, for reason of lack of variation), and moderate to high levels of convergent validity (rs = 0.29-0.73). Children who exceeded the SCARED cutoffs scored higher on the dimensional scales than those who did not, providing preliminary support for the clinical sensitivity of the scales. Given their strong psychometric properties and utility for both child and parent report, addition of the dimensional scales to the DSM-5 might be an effective way to incorporate dimensional measurement into the categorical DSM-5 assessment of anxiety disorders in children

Health anxiety and fear of fear in panic disorder and agoraphobia vs. social phobia: A prospective longitudinal study

Contains fulltext : 90464.pdf (publisher's version ) (Closed access)Background: This study is aimed to evaluate the role of two vulnerability factors, health anxiety and fear of :Par in the prediction of the onset of panic disorder/agoraphobia (PDA) relative to a comparison anxiety disorder Methods: Young women, aged between 18 and 24 years, were investigated at baseline and, 17 months later using the Anxiety Disorders Interview Schedule-Lifetime and measures of health anxiety and fear of bodily sensations (subscale disease phobia of the Whiteley Index, and total score of the Body Sensations Questionnaire). First, 22 women with current PDA were compared to 81 women with current social phobia and 1,283 controls. Second, 24 women with an incidence of PDA were compared to 60 women with an incidence of social phobia and 1,036 controls. Results: Multiple logistic regression analyses adjusted for history of physical diseases, somatic symptoms, and other psychological disorders revealed that (a) fear of bodily sensations was elevated for women with PDA vs. controls as well as women with social phobia, and (b) health anxiety (and history of physical diseases) was elevated in women who developed PDA vs. controls and vs. women who developed social phobia. Conclusions: These results suggest that health anxiety, as well as history of physical diseases, may be specific vulnerability factors for the onset of PDA relative to social phobia. Whereas fear of bodily sensations was not found to be a risk factor for the onset of panic disorder/agoraphobia, it was a specific marker of existing PDA relative to social phobia.8 p

Annual research review: conceptualising functional impairment in children and adolescents

Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for defining and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the influence of impairment on diagnostic decisions and prevalence rates. Several factors influencing impairment in childhood such as culture, development and gender are considered. This article concludes with a discussion of the utility of separating judgements of impairment from specific diagnoses, which is proposed for consideration in the forthcoming DSM-5

The DSM-5 Dimensional Anxiety Scales in a Dutch non-clinical sample: Psychometric properties including the adult separation anxiety disorder scale

With DSM-5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM-5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM-5-based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM-5 Dimensional Anxiety Scales for social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder that were included in previous studies on the scales, and also for separation anxiety disorder, which is included in the DSM-5 chapter on anxiety disorders. Moreover, they completed the Screen for Child Anxiety Related Emotional Disorders Adult version (SCARED-A). The DSM-5 Dimensional Anxiety Scales demonstrated high internal consistency, and the scales correlated significantly and substantially with corresponding SCARED-A subscales, supporting convergent validity. Separation anxiety appeared present among adults, supporting the DSM-5 recognition of separation anxiety as an anxiety disorder across the life span. To conclude, the DSM-5 Dimensional Anxiety Scales are a valuable tool to screen for specific adult anxiety disorders, including separation anxiety. Research in more diverse and clinical samples with anxiety disorders is needed