Transdiagnostic assessment of anxiety symptoms using the Anxiety Disorder Diagnostic Questionnaire – weekly version

Background: Norton and Robinson [2010. Development and evaluation of the anxiety disorder diagnostic questionnaire. Cognitive Behaviour Therapy, 39(2), 137–149. doi:10.1080/16506070903140430] developed the Anxiety Disorder Diagnostic Questionnaire (ADDQ) as a transdiagnostic assessment of fear and anxiety to address problems in using diagnosis-specific measures as well as limitations with the extant transdiagnostic measures of anxiety. The present study validated a weekly version of the ADDQ, the Anxiety Disorder Diagnostic Questionnaire – Weekly (ADDQ-W) allowing session-by-session transdiagnostic assessment of anxiety.

Method: Data were a secondary analysis of 49 treatment-seeking outpatient adults from a previous clinical trial. The ADDQ-W was administered weekly over the course of 12-group therapy sessions.

Results: The ADDQ-W was a valid weekly measure and neither scores, F(2, 37)?=?2.70, p?=?.08, nor trajectories of change, F(2, 37)?=?0.31, p?=?.73, differed by primary diagnosis, though power was limited. Rate of ADDQ-W change was predictive of change in both primary diagnosis severity, t?=?2.40, p?=?.02, β?=?0.32, and overall severity, t?=?3.01, p?<?.01, β?=?0.36, at post-treatment.

Conclusions: This study has established initial support for the use of the brief, easily scored, ADDQ-W for repeated assessment over treatment using a diagnostically heterogeneous clinical sample of treatment-seeking individuals.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

Early evidence of the Italian validation of Separation Anxiety Assessment Scale for Children

The current study examined the validity of the Separation Anxiety Assessment Scale for Children (SAAS-C) in a sample of 1397 Italian children (aged 8–11 years). Scalar invariance across gender was established. Results reported higher levels of separation anxiety in girls and younger children. Moreover, the measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Overall, findings support the validity of the SAAS-C as a brief diagnostic tool to assess separation anxiety disorder in Italian children in line with DSM-5 criteria.     

Panic disorder in the families of patients with normal coronary arteries and non-fear panic disorder.

Patients with non-fear panic disorder (NFPD) meet DSM-III-R criteria for panic disorder, but do not report subjective fear or anxiety. Although apparently common in medical settings, this controversial group is in need of further diagnostic validation. This study assessed family history of panic disorder in patients with chest pain and normal coronary arteries (CP/NCA) and either NFPD, panic disorder with fear, or no panic. It was hypothesized that the two panic disorder groups would have similar, elevated rates of panic disorder in their first-degree relatives, compared to patients without panic. The results support the hypothesis; about 17% of the first-degree relatives of both NFPD and panic disorder patients were diagnosable with panic disorder according to proband interviews, whereas only 4.6% of the first-degree relatives of patients without panic were so diagnosable. These results support the diagnostic validity of NFPD in CP/NCA patients, because such patients had a family history of panic disorder similar to patients with a more classical panic disorder presentation. The lack of fear symptoms and behavior in NFPD may cause panic disorder to be overlooked as a potential cause of somatic symptoms in patients with no medical explanation for their condition.     

The reliability and validity of the panic disorder self-report: a new diagnostic screening measure of panic disorder

This study examined the Panic Disorder Self-Report (PDSR), a new self-report diagnostic measure of panic disorder based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). PDSR diagnoses were compared with structured interview diagnoses of individuals with generalized anxiety disorder, social phobia, and panic disorder and nonanxious controls. Receiver operating characteristic analyses revealed that the PDSR showed 100% specificity and 89% sensitivity. The PDSR also demonstrated retest reliability, convergent and discriminant validity, and kappa agreement of .93 with a structured interview. Finally, the PDSR demonstrated clinical validity. Students who were identified as having panic disorder using the PDSR did not have significantly different scores on the Panic Disorder Severity Scale--Self-Report form (P. R. Houck, D. A. Speigel, M. K. Shear, & P. Rucci, 2002) than a panic disordered community sample. However, both groups had significantly higher scores than students identified as not meeting criteria for panic disorder.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

An examination of the construct validity of posttraumatic stress disorder with veterans using a revised criterion set

Ongoing concerns exist in the literature regarding the construct of posttraumatic stress disorder (PTSD) and how to best conceptualize and measure this disorder. We compared the traditional DSM-IV PTSD symptom criteria (i.e., symptoms from clusters B, C, and D) to a revised criterion set that omits overlapping mood and other anxiety symptoms on PTSD prevalence, PTSD diagnostic caseness, associated psychiatric comorbidity, functional status, and structural validity using a cross-sectional, multi-site primary care sample of 747 veterans. After removing items theorized to overlap with mood and other anxiety disorders, PTSD prevalence was identical using both criterion sets (i.e., 12%). Overall, there were few statistically significant differences in PTSD caseness, associated psychiatric comorbidity, functional status, and structural validity across the two diagnostic criterion sets. These data provide further support that removing items that overlap with other psychiatric disorders does not significantly impact the prevalence of PTSD, its associated comorbidity and functional impairment, or its structural validity. Although the revised criterion set represents a more parsimonious model, the current study findings generally support the strong construct validity of PTSD. The implications of these study findings for research and clinical practice are discussed.     

Psychometric evaluation of the Fear of Positive Evaluation Scale in patients with social anxiety disorder

The Fear of Positive Evaluation Scale (FPES; J. W. Weeks, R. G. Heimberg, & T. L. Rodebaugh, 2008) was designed to assess fear of positive evaluation, a proposed cognitive component of social anxiety. Although previous findings on the psychometric properties of the FPES have been highly encouraging, only 1 previous study has examined the psychometric profile of the FPES in a sample of patients with social anxiety disorder (T. A. Fergus et al., 2009). The primary purpose of the present study was to conduct a large multisite examination of the psychometric profile of the FPES among patients with a principal diagnosis of social anxiety disorder (n = 226; generalized subtype = 97.8%). Responses of nonanxious control participants (n = 42) were also examined. The factorial validity, internal consistency, test-retest reliability, construct validity, and treatment sensitivity of the FPES were strongly supported by our findings. Furthermore, an FPES cutoff score was identified for distinguishing levels of fear of positive evaluation characteristic of patients with social anxiety disorder from those characteristic of the control group. Results provide additional support for the psychometric properties of the FPES in clinical samples.     

Diagnosing Oppositional Defiant Disorder Using the Anxiety Disorders Interview Schedule for DSM-IV: Parent Version and the Diagnostic Interview Schedule for Children

The purpose of this study was to determine whether the Anxiety Disorders Interview Schedule for DSM–IV: Parent Version (ADIS–P) is a valid diagnostic tool for the assessment of Oppositional Defiant Disorder (ODD) in youth. Although there is considerable evidence that the ADIS–P is effective in diagnosing anxiety disorders in youth, no studies have yet examined its validity in assessing ODD. In contrast, a number of studies support the Diagnostic Interview Schedule for Children–Version IV (DISC–IV) as a reliable and valid tool in the assessment of ODD. In the present study, the ADIS–P and DISC–IV ODD modules were administered in a counterbalanced order to the parents of a clinical sample of 106 children between 7 and 14?years of age referred for the treatment of ODD. It was hypothesized that the ODD module of the ADIS–P would be valid as determined by its concurrent and convergent validity with the DISC–IV, the Behavior Assessment System for Children (BASC) Aggression and Conduct Problems scales, and the Disruptive Behavior Disorders rating scale (DBD). Results demonstrated that ADIS–P ODD diagnoses had moderate agreement with DISC–IV ODD diagnoses (κ?=?.46, p?<?.001) and that Pearson correlations of ADIS symptom counts with questionnaire scales were similar in magnitude with correlations of DISC–IV symptom counts with the same questionnaires. Overall, findings suggest that clinicians and researchers can use the ADIS–P as an empirically-supported diagnostic interview for assessing children’s oppositional problems.     

The utility of screen for child anxiety related emotional disorders (scared) as a tool for identifying children at high risk for prevalent anxiety disorders

Abstract

The current study examined the utility of the Screen for Child Anxiety Related Emotional Disorders (SCARED) as a screening tool for the identification of children at high risk for prevalent childhood anxiety disorders. The child version of the Structured Clinical Interview for DSM (KSCID) was used as the diagnostic standard. It was investigated whether SCARED scores are indicative for the presence of generalized anxiety disorder, separation anxiety disorder, and social phobia. Five-hundred-and-thirty-seven children aged 7–14 years completed the SCARED. From this sample, 82 children were selected on the basis of their SCARED scores. A subgroup of these children scored relatively high on the generalized anxiety disorder, separation anxiety disorder, and/or social phobia scale(s) of the SCARED. A comparison group of children scored relatively low on these SCARED scales. Both groups of children then received the semi-structured interview to assess to what extent they fulfilled the DSM-IV criteria for the relevant anxiety disorders. Results provided some support for the predictive validity of the SCARED generalized anxiety disorder and separation anxiety disorder subscales. The implications of these findings for the detection of anxiety disorders in normal children are briefly discussed.     

The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder

The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS determined by the so-called hyperventilation provocation test (a brief period of voluntary hyperventilation with recognition of symptoms). The overlap rates with HVS were: 48% for panic disorder, 83% for panic disorder with agoraphobia and 82% for generalized anxiety disorder. However, a pilot study on transcutaneous monitoring of carbon dioxide tension leads us to question the validity of the voluntary hyperventilation method that we used to determine HVS-status. It is unclear whether hyperventilation plays an important role in panic and general anxiety, as our overlap findings suggest. For patients who recognize the symptoms induced by voluntary hyperventilation, the hyperventilation provocation procedure provides a therapeutic means of exposure to feared bodily sensations.     

MMPI and Rorschach indices of schizophrenic and depressive diagnoses among adolescent inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

MMPI and Rorschach Indices of Schizophrenic and Depressive Diagnoses Among Adolescent Inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

Health anxiety, hypochondriasis, and the anxiety disorders

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI's latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.     

Assessment of fear of fear among Agoraphobic patients: The Agoraphobic Cognitions Scale

A self-report scale for the measurement of fear of fear, the Agoraphobic Cognitions Scale (ACS), was psychometrically evaluated. Two samples of inpatients satisfying DSM-III-R criteria for unipolar depressive and/or anxiety disorder were studied. Intercorrelational and factor analyses indicated that the ACS measured three dimensions of fear of fear: fear of bodily incapacitation, fear of losing control, and fear of acting embarrassingly. Three subscales were constructed to measure these dimensions. The subscales proved to have satisfactory internal consistency and criterion-related validity. However, fear of losing control was related not only to other anxiety symptoms, but also to depressive symptomatology. Agoraphobic patients reported more fear of bodily incapacitation and fear of losing control than social phobic, generally anxious, and nonanxious depressed patients. Fear of embarrassing action was higher among agoraphobic and social phobic patients than among generally anxious and nonanxious depressed patients. These results were obtained after controlling for general anxiety and depression level and, thus, support the validity of the fear of fear construct.     

Factor analysis and validation of a self-report measure of impaired fear inhibition

Difficulties with inhibiting fear have been associated with the emergence of anxiety problems and poor response to cognitive–behavioural treatment. Fear inhibition problems measured using experimental paradigms involving aversive stimuli may be inappropriate for vulnerable samples and may not capture fear inhibition problems evident in everyday life. We present the Fear Inhibition Questionnaire (FIQ), a self-report measure of fear inhibition abilities. We assess the FIQ’s factor structure across two cultures and how well it correlates with fear inhibition indices derived experimentally. Adolescent participants from Hong Kong and England completed the FIQ, with the English participants also completing a conditioning and extinction task to assess fear inhibition problems. Across both cultures, the FIQ showed a single factor structure and low FIQ scores, or worse fear inhibition problems, were associated with self-reports of heightened anxiety. Correlation of FIQ scores with experimental indices, whilst controlling for anxious symptoms, suggests that the FIQ represents a valid and unique measure of fear inhibition abilities. The FIQ might be used to assess more ecologically valid fear inhibition problems particularly amongst people who have or who are at risk of anxiety diagnoses.     

Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples

This study investigated the psychometric properties of a newly developed 20-item instrument that assesses one's anticipation of being able to change anxiety: the Anxiety Change Expectancy Scale (ACES). Study 1 evaluated the ACES in undergraduate university students, self-identified as experiencing difficulties with anxiety. Study 2 examined the ACES in a community sample of persons with anxiety difficulties. Study 3 tested the utility of the ACES in predicting treatment change in a group of individuals with generalized anxiety disorder participating in group cognitive behavioral therapy for anxiety. Across these samples, the ACES demonstrated excellent internal reliability (coefficient alphas=.89–.92) as well as good convergent, divergent, and factorial validity. The ACES was also significantly predictive of treatment-related changes in somatic anxiety symptoms and worry. The results of these studies provide strong support for the ACES as a reliable and valid measure of expectancies for changing anxiety.     

Early evidence of the Italian validation of the Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children

Anxiety is one of the most widespread disorders in childhood. Researchers claim the need for a tool useful to assess the core constructs common to multiple anxiety disorders, to catch the generalized propensity to be anxious and to assess anxiety stability across the lifespan. The Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children (STAIC-T) seems to fill these gaps. The present study examined STAIC-T validity in a sample of 1324 Italian children aged 8–13 years old. Scalar invariance across gender was established. Internal consistency was good. Results reported higher levels of anxiety in girls, whereas no gender differences were found. The measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Findings support the validity of the STAIC-T as a brief and concise diagnostic tool to assess the anxiety proneness in Italian children.     

Construct validity of the Anxiety Sensitivity Index-3 in clinical samples

Using two clinical samples of patients, the presented studies examined the construct validity of the recently revised Anxiety Sensitivity Index-3 (ASI-3). Confirmatory factor analyses established a clear three-factor structure that corresponds to the postulated subdivision of the construct into correlated somatic, social, and cognitive components. Participants with different primary clinical diagnoses differed from each other on the ASI-3 subscales in theoretically meaningful ways. Specifically, the ASI-3 successfully discriminated patients with anxiety disorders from patients with nonanxiety disorders. Moreover, patients with panic disorder or agoraphobia manifested more somatic concerns than patients with other anxiety disorders and patients with nonanxiety disorders. Finally, correlations of the ASI-3 scales with other measures of clinical symptoms and negative affect substantiated convergent and discriminant validity. Substantial positive correlations were found between the ASI-3 Somatic Concerns and body vigilance, between Social Concerns and fear of negative evaluation and socially inhibited behavior, and between Cognitive Concerns and depression symptoms, anxiety, fear of negative evaluation, and subjective complaints. Moreover, Social Concerns correlated negatively with dominant and intrusive behavior. Results are discussed with respect to the contribution of the ASI-3 to the assessment of anxiety-related disorders.     

A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings.