Social Anxiety Disorder Is Associated With PTSD Symptom Presentation: An Exploratory Study Within A Nationally Representative Sample

Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) demonstrate a high degree of comorbidity (ranging from 14.8% to 46.0%); however, little is known about the nature of this association. Contemporary research has largely focused on treatment‐seeking or veteran samples, and may not generalize to the population as a whole. Large‐scale epidemiological studies are needed to fill existing gaps in the literature and to clarify this association for the general population. The current study examined whether the presence of comorbid SAD influenced PTSD symptom presentation. The rate of individual PTSD symptoms was investigated among individuals with PTSD and SAD in comparison to those with PTSD alone. Data were obtained from Wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions, a large, nationally representative survey of American adults (n = 34,653). Analyses revealed elevated rates of PTSD symptoms among those with comorbid PTSD and SAD across all symptom clusters, with significant odds ratios ranging from 1.5 to 4.87. Adjusting for depression and other Axis I disorders did not substantially alter study findings. Results suggest that the presence of SAD is associated with differences in the expression of PTSD symptoms.     

Etiology of obsessive–compulsive symptoms and obsessive–compulsive personality traits: common genes,mostly different environments

Background: Little is known about the etiologic relationship between obsessive–compulsive (OC) symptoms and traits of OC personality disorder. The traits include perfectionism and rigidity. Some theorists have proposed that OC personality disorder is one of several disorders falling within an OC spectrum. This implies that OC personality traits and symptoms should have etiologic factors in common, and this should not be simply because symptoms and traits are both shaped by nonspecific etiological influences, such as those shaping negative emotionality (neuroticism). Methods: To investigate these issues, a community sample of 307 pairs of monozygotic and dizygotic adult twins provided scores on six types of OC‐related symptoms, two markers of negative emotionality, and a measure of OC personality traits. Results: Analyses indicated that symptoms and traits arose from a combination of genetic and nonshared environmental factors. A matrix of genetic correlations was computed among the variables, which represented the correlations between the genetic components of pairs of variables. A matrix of environmental correlations was similarly computed. Each matrix was factor analyzed. One genetic factor was obtained, indicating that all variables were influenced by a common genetic factor. Three environmental factors were obtained, with salient loadings on either (a) all six OC symptoms, (b) negative emotionality and obsessing, or (c) OC personality traits and ordering. Conclusions: OC symptoms and traits were etiologically related primarily because they are shaped by the same nonspecific genetic factor that influenced negative emotionality. Implications for the concept of the OC spectrum are discussed. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

The Attentional Resource Allocation Scale (ARAS): psychometric properties of a composite measure for dissociation and absorption

Background: Differences in attentional processes have been linked to the development and maintenance of psychopathology. Shifts in such processes have been described by the constructs Dissociation and Absorption. Dissociation occurs when external and/or internal stimuli are excluded from consciousness due to discrepant, rather than unitary, manifestations of cognitive awareness [Erdelyi MH. 1994: Int J Clin Exp Hypnosis 42:379–390]. In contrast, absorption can be conceptualized by a focus on limited stimuli, to the exclusion of other stimuli, because of unifying, rather than discrepant, manifestations of cognitive awareness. The Dissociative Experiences Scale [DES; Bernstein EM, Putnam FW. 1986: J Nerv Ment Dis 174:727–735] and Tellegen Absorption Scale [TAS; Tellegen A, Atkinson G. 1974: J Abnorm Psychol 83:268–277] are common measures of each construct; however, no factor analyses are available for the TAS and despite accepted overlap, no one has assessed the DES and TAS items simultaneously. Previous research suggests the constructs and factor structures need clarification, possibly including more parsimonious item inclusion [Lyons LC, Crawford HJ. 1997: Person Individ Diff 23:1071–1084]. The purpose of this study was to evaluate the factor structure of the DES and TAS and create a psychometrically stable measure of Dissociation and Absorption. Methods: This study included data from an undergraduate ( n =841; 76% women) and a community sample (n=233; 86% women) who each completed the DES and TAS. Results: Exploratory factor analyses [Osborne JW (ed). 2008: Best Practices in Quantitative Methods. Los Angeles: Sage Publications Inc.] with all DES and TAS items suggested a 15‐item 3‐factor solution (i.e., imaginative involvement, dissociative amnesia, attentional dissociation). Confirmatory factor analyses resulted in excellent fit indices for the same solution. Conclusions: The items and factors were conceptualized in line with precedent research as the Attentional Resource Allocation Scale (ARAS). Comprehensive results, implications, and future research directions are discussed. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample

The association between posttraumatic stress disorder (PTSD) and positive psychotic symptoms was examined in the National Comorbidity Survey (N = 5,877). The Composite International Diagnostic Interview (CIDI) was used to make DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; American Psychiatric Association, 1987) diagnoses. Posttraumatic stress disorder was found to be associated with an increased likelihood of endorsing one or more psychotic symptoms after adjusting for sociodemographics, psychiatric and medical comorbidity (odds ratios (OR) = 1.83; 95% confidence interval (CI): 1.43-2.45; p < .001). The co-occurrence of PTSD with psychotic symptoms was marked by greater levels of severity (higher total number of PTSD symptoms, greater levels of comorbidity, and high distress) compared with PTSD alone. This is the first population-based study to investigate PTSD in relation to endorsement of positive psychotic symptoms, and a strong association was obtained.     

Automatic and strategic processing of threat cues in patients with chronic pain: a modified stroop evaluation

OBJECTIVE: The goal of this study was to clarify whether patients with chronic pain selectively attend to syndrome-specific (i.e., pain-related) information and, if so, to determine whether this occurs at the conscious (i.e., strategic) or unconscious (i.e., automatic) level. SETTING: This study was conducted at a tertiary care rehabilitation center. PATIENTS: Thirty-three patients with chronic back and/or neck pain and 33 healthy volunteers matched for age, sex, and education participated in this study. OUTCOME MEASURES: A computerized version of a modified Stroop color-naming task, with unmasked and masked conditions, was used to assess strategic and automatic information processing of words related to sensory pain, affect pain, physical threat, social threat, and neutral themes. RESULTS: A repeated-measures ANOVA indicated that patients with chronic pain but not healthy volunteers had delayed color-naming latencies to both sensory and affect pain words in the unmasked condition. Color-naming latency differences were not evident for other word types in the unmasked condition or for any word types in the masked condition. Correlational and regression analyses indicated that the delayed color-naming latencies to pain words in the unmasked condition observed for the chronic pain patients were, in part, associated with high pain-specific cognitive anxiety and interference and lower levels of anxiety sensitivity. CONCLUSIONS: Individuals with chronic pain selectively process pain-related cues at the strategic level but not at the automatic level. Implications of the findings and future research directions are discussed.     

Waddell’s Symptoms as Indicators of Psychological Distress, Perceived Disability, and Treatment Outcome

Introduction Waddell’s signs and symptoms have been described as patient presentations not within usual anatomic patterns of injury pathology. Waddell’s signs were thought to indicate psychological distress and were termed “non-organic findings”; similarly, Waddell’s symptoms were described as inappropriate and attributable to psychological features. Endorsement of more than two of Waddell’s symptoms is thought to be associated with psychological distress, disability, and poor treatment outcomes; however, this has not been empirically assessed. Methods The current study used a sample of patients (n = 108; 30% women) involved in a multi-disciplinary work hardening program provided by a third-party insurer. Patients who endorsed more than two of Waddell’s symptoms were compared with those who did not on demographic variables as well as self-report measures of psychological distress, disability, and treatment outcome. Results Patients who endorsed more than two of Waddell’s symptoms reported higher levels of psychological distress, perceived disability, pain intensity, and pain durations. Moreover, consistent with previous research on Waddell’s symptoms, patients endorsing more than two symptoms were also less likely to return to work. Conclusions Waddell’s symptoms were associated with increased perceived disability and pervasive pain interference. Patients who endorsed more than two symptoms were significantly less likely to return to work than those who endorsed zero, one, or two symptoms. Patients who endorsed more than two symptoms may indeed be affected by factors beyond tissue pathology that nonetheless warrant clinical attention. Waddell’s symptoms appear to have promise as a quick indicator of treatment complexity and outcome.     

Chronic musculoskeletal pain and cigarette smoking among a representative sample of Canadian adolescents and adults

The present investigation sought to examine the relation between specific types of chronic musculoskeletal pain and cigarette smoking among a large representative sample of adolescents and adults residing in Canada. Specifically, we examined the relations between chronic back pain, arthritis, and daily smoking status. As predicted, individuals with chronic back pain were more likely to smoke than those without chronic back pain or arthritis; this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder. An opposite, albeit less robust, association was evident for the prescence of lifetime arthritis and smoking. Future work is needed to better understand the mechanisms underlying the association between chronic pain and smoking.     

Cytotoxic T-cell response to ectromelia virus-infected cells. Different H-2 requirements for triggering precursor T-cell induction or lysis by effector T cells defined by the BALB/c-H-2(db) mutation

The T(c)-cell response to ectromelia virus infection was studied in BALB/c-H-2(db) mice which carry a loss mutation in the H-2D region that results in the absence from cell surfaces of a molecule (D’) bearing certain public H-2 specificities. When infected, these mice showed a poor response of T(c) cells that recognize H-2D(d) plus virus-specific determinants on infected macrophage targets, but gave a normal response to H-2K d plus virus-specific antigens. However, their own infected macrophages do display wild-type antigenic patterns involving virus and H-2D(d) since they were killed as efficiently as wild-type (BALB/c,H- 2(d))-infected cells by T(c) cells specific only for H-2D(d) plus viral antigens. When tested in vitro, infected BALB/c-H-2(db) cells stimulated a poor T(c)-cell response to H-2D plus virus-specific antigens, but stimulated a normal response (in comparison with infected BALB/c macrophages) to H-2K(d) plus viral antigens. Uninfected BALB/c-H-2(db) cells stimulated a normal T(c)-cell response to minor H antigens or trinitrophenyl in association with H-2D(d), thus suggesting that the defective response to infection may reside in a failure of the relevant H-2D(d) antigens of mutant cells to physically associate with viral antigens. Close association of viral and H-2D-coded molecules was also suggested by ability of specific anti-H-2K or -H-2D to partially block T(c)-cell-mediated lysis of infected targets. These results were interpreted to mean that H-2Dd-dependent, virus- immune T(c) cells recognized an antigenic pattern consisting of virus- specific and H-2D(d) determinants with the latter borne on an H-2D molecule carrying serologically-defined H-2D(d) private specificities. A second H-2D(d)-coded molecule (D’) was not required for recognition and lysis by activated T(c) cells, but was apparently necessary for efficient stimulation of precursor T(c) cells, perhaps by promoting appropriate physical association of viral and H-2D(d) molecules.     

Factor Structure and Validity of a Revised Pain Anxiety Symptom Scale

The Pain Anxiety Symptoms Scale (PASS) (McCracken et al., 1992) is a frequently used 40-item measure designed to assess fearful appraisals of pain, pain-related cognitive and physiological anxiety, and escape/avoidance behavior. Research has shown the PASS to possess a reasonable validity; however, recent evidence has raised questions regarding the factorial validity of its subscales and indicates that revision and expansion appear warranted. Accordingly, we developed a revised and expanded Pain Anxiety Symptoms Scale (PASS-R). In Study 1, we expanded the item pool and administered the questions to a sample of 69 university students. On the basis of expert opinion and item analysis, we retained a total of 72 items. In Study 2, we subjected the responses of 256 university students to the 72-item PASS-R to a principal-components analysis with oblique rotation. This analysis revealed five lower-order factors (Interference, Approach Behaviours, Catastrophic Thoughts, Monitoring and Prevention, and Physiological Arousal) that loaded together on a single higher-order factor. We created new subscales on the basis of the lower-order factor structure and compared these subscales to a number of other self-report measures of pain, pain behavior, and related psychopathology. The PASS-R subscales demonstrated a good to excellent internal consistency as well as a good construct and criterion validity and contributed unique variance to the prediction of behavioral reactions to recent pain experiences (e.g., visiting a physician). Collectively, these results suggest that the PASS-R is a psychometrically sound self-report measure that allows detailed assessment of anxiety-related cognitions, physiological arousal, and behaviors in response to pain. The paper concludes with a discussion of implications of the studies and future research directions.     

“It's not just the judgements—It's that I don’t know”: Intolerance of uncertainty as a predictor of social anxiety

Interest in the role of intolerance of uncertainty (IU) – the tendency for a person to consider the possibility of a negative event occurring as unacceptable and threatening irrespective of the probability of its occurrence – in anxiety disorders has been increasing in recent research. IU has been implicated as an important construct associated with generalized anxiety disorder (GAD); however, a growing body of research suggests that levels of IU are also high among individuals with other anxiety disorders. Despite the increasing interest, few studies have examined the relationship between IU and social anxiety (SA). The purpose of the present investigation was to further investigate the relationship between IU and SA. Participants included 286 community members (71% women) from Canada who completed measures of IU, SA, anxiety sensitivity, and fear of negative evaluation (FNE). Regression analyses revealed that the inhibitory anxiety dimension of IU, the fear of socially observable anxiety symptoms dimension of anxiety sensitivity, and the FNE were consistently significant predictors of SA symptoms. Unexpectedly, IU and FNE were often comparable predictors of SA variance. Moreover, participants with SA symptoms consistent with SAD exhibited levels of IU comparable to those reported by participants with worry symptoms consistent with GAD. Comprehensive findings, implications, and directions for future research are discussed.