A taxometric investigation of the latent structure of social anxiety disorder in outpatients with anxiety and mood disorders

The latent structure of social phobia was examined in a sample of 2,035 outpatients with anxiety and mood disorders to determine whether the disorder operates in a categorical or dimensional fashion. We performed three mathematically distinct taxometric procedures-MAMBAC, MAXEIG, and L-Mode-using five indicators constructed from clinical interview ratings and questionnaire measures of social anxiety symptoms. Results from screening analyses and simulated comparison data consistently indicated that the data were suitable for taxometric analysis. The collective results across procedures, consistency tests, and analysis of simulated comparison data produced converging evidence in support of the conclusion that the latent structure of social phobia is dimensional.     

The latent structure of generalized anxiety disorder in midlife adults

Generalized anxiety disorder (GAD) is identified as a discrete disorder in the DSM-5, but evidence suggests that GAD and the related construct of pathological worry possesses a dimensional latent structure. The objective of this study was to ascertain the latent structure of GAD using taxometric methods. A subsample of adults (N=2061) from the Midlife in the United States Study, a national sample of Americans, provided the data. Additional data from individuals who were re-interviewed 10 year later (n=1228) were also analyzed. Items corresponding to the DSM-IV-TR diagnostic criteria for GAD were used to generate indicators for the taxometric analyses. Multiple taxometric procedures provided no evidence that GAD has a categorical or taxonic latent structure. Instead, the results were more consistent with the proposition that GAD exists on a continuum. Evidence that GAD is dimensional suggests that dichotomizing individuals into GAD versus non-GAD groups will typically result in decreased statistical power. They also suggest that any diagnostic thresholds for identifying GAD are likely to be arbitrary. The findings are consistent with models that locate GAD within the framework of extant dimensional models of personality and with research that emphasizes a multifactorial etiology for GAD.     

The structure of emotional and cognitive anxiety symptoms

A sample of 327 patients with primary panic disorder or social phobia completed a questionnaire comprising 77 emotional and cognitive anxiety symptoms from which 12 index scales were constructed. Explorative factor analysis yielded two factors, but confirmatory factor analysis indicated that the factor solution was not invariant across diagnoses. Nevertheless, the two-factor structures fitting data from patients with panic disorder and social phobia, respectively, had similarities in content. The first factor, emotions and cognitive-social concerns, comprised emotional expressions (sadness, fear, and anger), cognitions about cognitive dysfunction (difficulty concentrating, confusion, and loss of control) and social phobic cognitions. It was positively correlated with severity of bodily anxiety symptoms and with the neuroticism personality trait. The second factor, fear of physical sensations, was positively correlated with a cardio-respiratory dimension of bodily anxiety symptoms in panic disorder, lending support to the hypothesis of specific threat-relevant links between bodily symptoms and catastrophic cognitions.     

焦虑障碍的核心特征与治疗

焦虑障碍的代表疾病主要包括广泛性焦虑障碍、惊恐障碍、场所恐怖症、社交焦虑障碍(社交恐怖症)等,该组障碍的共同特征是过度害怕和焦虑的心境,以及相关的行为紊乱。广泛性焦虑障碍表现为对多种主题、事件或任务感到严重的焦虑与担心。惊恐障碍是指在没有预警的情况下反复出现惊恐发作并担心再次发作。场所恐怖症是指个体对某些场合的强烈恐惧、焦虑与回避,患者常担心无法逃离、得不到帮助或健康受到威胁。社交焦虑障碍表现为回避社交环境,过分担心他人的负性评价。焦虑障碍的治疗方法包括药物治疗、心理咨询等。     

The latent structure of obsessive-compulsive symptoms: a taxometric study

There is increasing consensus that obsessive-compulsive (OC) symptoms are heterogeneous clinical phenomena that should be assessed, diagnosed, and treated from a multidimensional perspective. However, it remains unclear whether the heterogeneous OC symptoms represent discrete taxonomic entities. In this study, the categorical versus dimensional nature of OC symptoms and associated cognitions was examined in a large undiagnosed sample using taxometric methods. Six potential OC symptoms (washing, checking, obsessing, neutralizing, ordering, and hoarding) and three potential OC-related cognitions (responsibility/threat estimation, perfectionism/certainty, and importance of thoughts/control of thoughts) were examined using the MAXimum EIGenvalue and mean above minus below a cut procedures. Findings were largely consistent with dimensional models of the latent structure of all OC symptoms and cognitions with the exception of hoarding. The implications of these findings for the clinical assessment and diagnosis of OC symptoms and obsessive-compulsive disorder are discussed.     

Threat-confirming belief bias and symptoms of anxiety disorders

This study tested the hypothesis that a generally enhanced threat-confirming reasoning style would set people at risk for the development of anxiety disorders. Therefore, a non-clinical student sample (N = 146) was presented with a series of linear syllogisms referring to threatening and safety themes and with the anxiety subscale of the SCL-90 and trait anxiety in order to correlate reasoning with anxiety. Half of the syllogisms' conclusions were in line and half were in conflict with generally believable threat and safety related convictions (e.g., potassium cyanide is more toxic than tylenol; The Netherlands are safer than Afghanistan). For each type of syllogism, half was logically valid and half invalid. Overall, participants showed a clear interference of believability on logical reasoning, which is known as the belief bias effect. Furthermore, in line with the idea that people are generally characterized by a better safe than sorry strategy, the pattern indicated that the participants took more time to solve invalid threat related syllogisms as well as valid safety related syllogisms. This threat-confirming belief bias was however not especially pronounced in participants reporting relatively intense anxiety symptoms. Thus, the present findings do not lend support to the idea that a generally enhanced threat-confirming belief bias is a diathesis for the development of anxious psychopathology.     

焦虑障碍儿童的性别、年龄与焦虑症状的关系

目的:研究焦虑障碍儿童的性别和年龄与焦虑症状的关系,了解儿童焦虑症状的性别、年龄特征. 方法:对4 500名6～15岁儿童使用长处和困难问卷、儿童和青少年发育和正常状况评定量表进行筛查和诊断,查出焦虑障碍儿童158例,对焦虑障碍儿童按年龄分组,并进行儿童焦虑障碍自评量表的测量,运用多因素方差分析对性别和年龄与自评量表得分之间的关系进行分析. 结果:方差分析结果显示,性别主效应显著,不同性别间广泛性焦虑(F=4.449,P=0.037)和社交焦虑维度(F =-3.880,P =0.050)差异有统计学意义,女童得分高于男童；不同年龄间在分离焦虑维度上(F=3.911,P=0.010)差异有统计学意义,得分随年龄增加而降低.交互作用分析结果显示,性别和年龄对焦虑症状的影响没有交互作用. 结论:焦虑障碍儿童的焦虑症状存在性别与年龄差异.     

Somatic symptoms in children and adolescents with anxiety disorders

ObjectiveTo evaluate the prevalence of somatic symptoms (SSs) in children and adolescents with anxiety disorders; the relationship between SSs and anxiety severity, impairment, and child global functioning; and the impact of fluvoxamine (FLV) versus pill placebo (PBO) on reducing SSs.MethodAs part of a double-blind, placebo-controlled trial, 128 children (mean age, 10.8 years; range, 6-17) with DSM-IV anxiety disorders (i.e., social, separation, and generalized anxiety) were assessed by expert clinicians on 16 SSs using the Pediatric Anxiety Rating Scale.ResultsThe most common SSs at baseline were restlessness (74%), stomachaches (70%), blushing (51%), palpitations (48%), muscle tension (45%), sweating (45%), and trembling/shaking (43%). Older children (age 12 and older) reported more SSs than younger children, boys and girls reported similar numbers of SSs, and SSs were higher among children with than without generalized anxiety disorder. SSs were significantly and positively correlated with anxiety severity, impairment, and global functioning. Pre-/postreductions in SSs were statistically significant in both PBO and FLV conditions; however, FLV was superior to PBO in reducing SSs.ConclusionsSSs are highly prevalent among children and adolescents with anxiety disorders and are associated with greater anxiety severity and impairment. Treatment with FLV was effective in reducing rather than increasing SSs. The high rates of SSs in youths with each of the three anxiety disorders suggest a re-evaluation of SSs in the DSM-IV diagnostic criteria for the most common anxiety disorders among children and adolescents.     

The natural history of anxiety disorders.

The article reviews research and presents our results on the natural history of 2 forms of anxiety disorder, panic disorder and generalized anxiety disorder. Data from our epidemiological cohort study give evidence of premorbid anxiousness and overadaptation already in childhood. Distressing conditions in the family are more prevalent among subjects with anxiety disorders or major depression than among controls. Anxiety disorders frequently begin between age 20-30 and can be triggered by life events. The course is often characterized by a certain chronicity that manifests itself in residual symptoms and mild impairment in social roles even after many years and is frequently complicated with depression. The best predictors are severity and duration of symptoms, as well as comorbidity with depression. Future studies of the natural history should take into account these factors in multivariate approaches.     

The relation between anger management style, mood and somatic symptoms in anxiety disorders and somatoform disorders

The objective of this study was to examine the relationship between anger management style, depression, anxiety and somatic symptoms in anxiety disorder and somatoform disorder patients. The subjects comprised 71 patients with anxiety disorders and 47 with somatoform disorders. The level of anger expression or anger suppression was assessed by the Anger Expression Scale, the severity of anxiety and depression by the Symptom Checklist-90-Revised (SCL-90-R) anxiety and depression subscales, and the severity of somatic symptoms by the Somatization Rating Scale and the SCL-90-R somatization subscale. The results of path analyses showed that anger suppression had only an indirect effect on somatic symptoms through depression and anxiety in each of the disorders. In addition, only anxiety had a direct effect on somatic symptoms in anxiety disorder patients, whereas both anxiety and depression had direct effects on somatic symptoms in somatoform disorder patients. However, the anxiety disorder group showed a significant negative correlation between anger expression and anger suppression in the path from anger-out to anger-in to depression to anxiety to somatic symptoms, unlike the somatoform disorder group. The results suggest that anger suppression, but not anger expression, is associated with mood, i.e. depression and anxiety, and somatic symptoms characterize anxiety disorder and somatoform disorder patients. Anxiety is likely to be an important source of somatic symptoms in anxiety disorders, whereas both anxiety and depression are likely to be important sources of somatic symptoms in somatoform disorders. In addition, anger suppression preceded by inhibited anger expression is associated with anxiety and somatic symptoms in anxiety disorders.     

Parent-child agreement of anxiety symptoms in youth with autism spectrum disorders

Best practice for assessment of anxiety symptoms in children suggests that child self-report is an important element to consider. Yet, it is not known if it is a reliable assessment method for children with high-functioning autism spectrum disorders (ASDs). The present study examines the extent to which verbally fluent children with ASD and their parents agree on the child's symptoms of anxiety. Sixty-three children with ASD and their parents independently completed the Screen for Child Anxiety Related Emotional Disorders (SCARED). Intraclass correlations indicated moderate-to-strong agreement on several domains. Associations among child factors (e.g., verbal IQ, metacognitive ability) and parent-child agreement were explored. More advanced verbal ability was associated with better agreement on Separation, School Avoidance, and Total Anxiety; higher metacognitive skills were associated with better agreement on Social Anxiety. Implications for the use of child self-report are discussed.     

Does cyberchondria overlap with health anxiety and obsessive–compulsive symptoms? An examination of latent structure and scale interrelations

Searching for medical information online is a widespread activity that increases distress for many individuals. Researchers have speculated that this phenomenon, referred to as cyberchondria, overlaps substantially with both health anxiety and obsessive–compulsive symptoms. This study sought to examine: (1) the distinguishability of cyberchondria from health anxiety and obsessive–compulsive symptoms and (2) the components of health anxiety and obsessive–compulsive symptoms that cluster most strongly with cyberchondria. The sample consisted of community adults in the United States with no current reported medical problems (N = 375). Results from confirmatory factor analyses (CFAs) support the idea that cyberchondria is distinct from, yet related to, health anxiety and obsessive–compulsive symptoms. Results from zero-order correlations and regression analyses suggest that cyberchondria clusters with the affective (health worry) component of health anxiety. Regression results diverged from prior findings, as obsessive–compulsive symptoms did not share associations with cyberchondria after accounting for negative affect and health anxiety. The present results indicate that cyberchondria is possibly discernible from both health anxiety and obsessive–compulsive symptoms, while also providing insight into areas of potential overlap.     

Threat perception abnormalities in children: the role of anxiety disorders symptoms,chronic anxiety,and state anxiety

This study investigated the relative contribution of general (trait) anxiety and state anxiety to threat perception abnormalities in nonreferred children aged 8-13 years (N=299). Children were first asked to complete self-report measures of anxiety disorders symptoms and chronic anxiety. Next, they were individually interviewed using an ambiguous story paradigm from which a number of threat perception indexes were derived. Just before the interview started, children were asked to fill out a measure of state anxiety. Results showed that high levels of general anxiety (as indexed by anxiety disorders symptoms and chronic anxiety) were significantly related to increased threat perception and lower threat thresholds. High levels of state anxiety were also associated with increased threat perception and lower threat thresholds. Regression analyses indicated that general anxiety and state anxiety both accounted for a unique proportion of the variance in threat perception abnormalities, although the contribution of general anxiety was in most cases substantially larger than that of state anxiety. Finally, no support was found for the notion that threat perception abnormalities are the result of the conjoint influence of general anxiety and state anxiety.     

A taxometric investigation of the latent structure of eating disorders

The present study examined the latent structure of eating disorder symptoms in a large sample of patients with a diagnosis of anorexia nervosa restricting type, anorexia nervosa binge eating/purging type, and bulimia nervosa (n=3747). Three taxometric procedures (MAXimum EIGenvalue (MAXEIG), Mean Above Minus Below A (MAMBAC), and Latent-Mode Factor Analysis (L-Mode)) were applied to self-reported symptoms of bulimia, drive for thinness, body dissatisfaction, as well as body mass index. Taxometric analysis among patients with the restricting and binge eating/purging subtype of anorexia and those with bulimia nervosa supported a dimensional latent structure of eating disorder symptoms. Taxometric analysis also revealed a dimensional latent structure of eating disorder symptoms among patients with the restricting and binge eating/purging subtype of anorexia suggesting that the two anorexia subtypes may not represent discrete categories. These findings suggest that the diagnosis and assessment of eating disorder symptoms should be conceptualized from a dimensional framework.     

Dimensional, non-taxonic latent structure of psychotic symptoms in a student sample

Introduction

We examined the construct of psychosis using the self-report instrument CAPE (Community Assessment of Psychic Experiences) in a sample of 1,323 students.

Materials and Methods

Taxometric analysis was carried out using Taxometric Programs for the R Computing Environment. The MAXCOV CCFI was 0.34, indicating a dimensional latent structure. All other taxometric analysis yielded very similar results indicative of dimensional structure.

Conclusion

In this study, using powerful analytic techniques designed expressly for the purpose, i.e. taxometric analysis, the latent construct of psychosis in a sample of young students appeared to be consistent with a dimensional, non-taxonic latent structure.     

The pharmacotherapy of anxiety disorders in children and adolescents.

Psychopharmacologic agents may offer potentially effective treatment of child and adolescent anxiety disorders. Much further research, however, remains to be done to determine medication specificity, dosages, duration of treatment, and the optimal relationship between pharmacologic and nonpharmacologic therapies.