Prediction of treatment outcome in social phobia: a cross-validation.

This study was a replication of a study on the prediction of treatment outcome in social phobic patients [Chambless, D. L., Tran, G. Q. Glass, C.R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11 221-240]. Results at the posttest and the 18-months follow-up were analyzed for DSM-III-R social phobic patients, with either a generalized social phobia (n = 50) or a nongeneralized fear, i.e. fear of blushing, trembling or sweating in social situations (n = 26). Predictors were pretreatment depression, personality disorder traits, clinician rated severity of impairment and frequency of negative self-statements during social interactions. The criterium variable was (the residual gain score of) self-reported avoidance of social situations. In line with Chambless et al., pretreatment depression showed some predictive value, but smaller and only at the posttest. Change in the frequency of negative self-statements paralleled, but did not predict, change in social phobia symptoms. In contrast with Chambless et al., clinician rated severity was (slightly) predictive for treatment outcome, whereas avoidant personality traits had reverse correlations with outcome in both subgroups. The results are discussed and directions for further research are given.     

Anxious-Irritable Children: A Distinct Subtype of Childhood Anxiety?

Children with anxiety disorders often present with other co-occurring symptom clusters, of which irritability is among the most highly co-occurring. Despite compelling clinical and pathophysiological evidence linking anxiety and irritability, little is known regarding the clinical presentation and associated impairment of children with both anxiety and irritability. In this study, our aims were to confirm the preponderance of irritability in clinically anxious children and compare clinically anxious children with irritability to those without irritability across sociodemographic, clinical, psychosocial, and family domains. Participants were 230 children with anxiety disorders (ages 6–14 years) and their mothers, and 91 healthy controls (ages 6–17 years) and their mothers. Of the clinically anxious children, 121 were anxious and irritable; 109 were anxious but not irritable. Irritability levels were significantly higher in the clinically anxious children compared with the healthy controls. Children with anxiety disorders and irritability presented with greater severity and impairment across clinical phenomenology, psychosocial, and family domains relative to anxious children without irritability. Regression analysis findings were convergent in that greater severity and impairment across these same domains predicted higher irritability levels in the children with anxiety disorders. Results support the meaningful distinction between anxious children with and without irritability. Implications of the findings are discussed particularly in regard to assessment and treatment and future research directions are delineated.     

The relationship between five-factor personality measurements and ICD-10 personality disorder dimensions: results from a sample of 229 subjects

This article examines the relationship between the five-factor model (FFM) and dimensional ICD-10 personality disorders. In a follow-up study of a child and adolescent psychiatric cohort, former patients and controls were assessed with NEO-FFI and the IPDE interview (CD-10 personality disorder). Full data were available for 229 subjects (149 former patients, 80 controls). Multiple regression analysis showed that the five factors of the FFM as independent variables explained between 5% (schizoid personality disorder) and 32% (anxious personality disorder) of the variance of ICD-10 dimensional personality disorder scores. For the two types of emotionally unstable personality disorder dimension (impulsive and borderline), for anxious (avoidant) personality disorder dimension and for the total score of any personality disorder dimension, FFM explained between 17% and 32% of the variance with almost identical results for the former patient group and the control group. High neuroticism was a feature of paranoid, emotionally unstable, histrionic, anankastic, anxious (avoidant), and dependent personality disorder dimensions, whereas low agreeableness was found in dissocial, emotionally unstable and histrionic personality disorder dimensions. Low extraversion was found in schizoid, anxious (avoidant) and dependent personality disorder dimensions, whereas histrionic PD dimension correlated with high extraversion. We find that the FFM is valuable for the further understanding not only of DSM-IV but also of ICD-10 personality disorder dimensions. The differences between ICD-10 and DSM-IV in this respect seem to be small.     

Attributional mediators of social inhibition and avoidance

People differ in the degree to which they become inhibited and avoidant when they feel socially anxious This study explored the hypothesis that characterological attributions for one's feelings of nervousness in social settings are related to social inhibition and avoidance In a preliminary study, the dimensions people use to explain their feelings of nervousness and relaxation were determined One hundred and twenty-five subjects then completed measures of social anxiousness, inhibition, and avoidance, and made attributions for feeling nervous and relaxed in 10 interpersonal scenarios As predicted, attributions of nervousness to characterological factors, such as ability and personality traits, correlated positively with social inhibition and avoidance Unexpectedly, behavioral attributions for nervousness also predicted inhibition and avoidance     

Avoidant personality disorder and implicit schema-congruent information processing bias: a pilot study with a pragmatic inference task.

Cognitive theory of personality disorders hypothesizes that each personality disorder is characterized by typical maladaptive schemes and that these schemas direct the processing of information resulting in schema-congruent biases. With regard to the avoidant personality disorder, these hypotheses were put to an initial test in a pilot study, using a self-report questionnaire to asses DSM-III-R personality pathology, a belief questionnaire to assess avoidant schemas and a pragmatic inference task to assess schema-congruent implicit attributional bias. Participants were students (n = 57) who scored high or low on DSM-III-R avoidant personality pathology. As predicted from cognitive theory, DSM-III-R avoidant personality pathology was associated with avoidant beliefs (t(45.1) = 4.68, p < 0.001) and avoidant beliefs were associated with schema-congruent information processing bias (t(55) = 2.17, p = 0.02, one-tailed test). However, DSM-III-R avoidant personality pathology was not associated with schema-congruent information processing bias (t(55) = 0.17, p = 0.43, one-tailed test). In addition to avoidant beliefs, low self-esteem was also related to the information processing bias. Social phobia and general personality pathology, two other control variables, were not. The findings warrant further study using the pragmatic inference task in a clinical group.     

Insecure attachment and personality disorder: a twin study of adults

This study used 239 twin pairs from a volunteer community sample to investigate how anxious and avoidant attachment are related to personality disorder (PD). Factor analysis showed that self‐reported anxious attachment and 11 PD scales from the Dimensional Assessment of Personality Problems loaded onto one factor (emotional dysregulation), and avoidant attachment and four PD scales loaded onto a second factor (inhibitedness). Biometric models indicated that 40% of the variance in anxious attachment was heritable, and 63% of its association with corresponding PD dimensions was attributable to common genetic effects. Avoidant attachment was influenced by the shared environment instead of genes. Correlations between avoidance and corresponding PD dimensions were attributable to experiences in the nonshared environment that influenced both variables. Copyright © 2006 John Wiley & Sons, Ltd.     

What's in a (neutral) face? Personality disorders, attachment styles, and the appraisal of ambiguous social cues

Attachment theory suggests that borderline, avoidant, and schizoid personality disorders are differentially associated with anxious and avoidant attachment styles. The variations of insecure attachment in these disorders, in turn, might influence how others are perceived or appraised. To test these ideas, 176 college students completed questionnaires measuring attachment styles and personality disorder features, and each rated 10 emotionally neutral faces on 18 bipolar appraisal dimensions. As expected, borderline personality was associated with anxious attachment, avoidant personality was associated with anxious and avoidant attachment, and schizoid personality was weakly associated only with avoidant attachment. Furthermore, path analyses showed that borderline and avoidant personality features were associated with anxious attachment, which in turn related to negative face appraisals (e.g., tendencies to rate faces as less friendly and more rejecting). Discussion highlights the potential of simultaneously studying biases in social information processing and attachment disturbances among individuals with personality disorders.     

Anxiety-related biases in children's avoidant responses to a masked angry face

While anxious children often show escape and withdrawal behaviours towards threats, few studies have experimentally assessed avoidance. The present study examined whether children with high levels of anxiety showed more avoidant responses to a neutral conditioned cue (CS+) that was paired with an unconditioned threat stimulus (UCS), a masked angry facial expression. Thirty-six 10 and 11 year-olds participated in a task, which involved choosing between two CS card stimuli of different colours to win points. Whilst both cards awarded the same number of points, one colour was systematically paired with a masked angry face (CS+), whilst the other colour was paired with a masked neutral face (CS-). Children with higher anxiety scores had an overall tendency to choose the card associated with the neutral face, with some evidence suggesting that this tendency emerged gradually across trials. These results suggest a relationship between anxiety and stimulus-response learning for CS+-UCS associations that support behavioural avoidance.     

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.     

Self- and other-reports of traits from the five-factor model: relations to personality disorder

The current study used a psychiatric sample (N = 69) to examine: (1) the correspondence between self- and other-reports of general personality, as measured by the Five-Factor Model (FFM; Costa & McCrae, 1990), and personality disorder (PD) traits, as measured by a structured interview, (2) the relations between these two sets of ratings (FFM and PD traits) and consensus ratings of PD and impairment, and (3) the incremental validity of other-rated personality scores. Agreement between raters for the five domains of the FFM ranged from .23 (agreeableness) to .71 (openness); for the PD traits agreement ranged from .37 (avoidant) to .69 (antisocial). At both the domain and facet level, the personality profiles reflected in the correlations between the FFM scores and PD criteria were consistent across raters with the exception of narcissistic PD. Substantial evidence was found for the incremental validity of other-rated personality scores, with these ratings accounting for an additional 8 to 20% of the overall variance in PD features. The other-rated FFM scores also accounted for more variance in consensus ratings of impairment in the domains of romance, work, and social relations.     

Personality Dimensions in Two Types of Learning-Disabled Children: A Rorschach Study

Children referred for psychoeducational assessment of learning disabilities (LDs) commonly receive the Rorschach test. Yet little is known about the impact of LD on Rorschach response patterns. This study investigated Rorschach response patterns in two groups of 9- to 12-year-old children (n = 41) classified by their respective intellectual abilities. Another group of 9- to 12-year-olds (n = 143) served as a nonclinical comparison group. Rorschach variables indicative of personality dimensions failed to discriminate between the two LD groups. Compared to the nonclinical group, the LD group exhibited several Rorschach characteristics—including problems in perceptual accuracy, inefficient visual scanning and problem-soving strategies, and avoidance of affect-laden stimuli—having implications for successful socioemotional adaptation.     

Motor proficiency and emotional/behavioural disturbance in autism and Asperger's disorder: another piece of the neurological puzzle?

The relationship of motor proficiency with emotional/behavioural disturbance, autistic symptoms and communication disturbance was investigated in children diagnosed with autism and Asperger's disorder (AD). The Movement Assessment Battery for Children was used as a measure of motor impairment, and the Developmental Behavioural Checklist was used as a measure of emotional/behavioural disturbance in the following groups: AD (n?=?22), high functioning autism (HFA) (n?=?23), LFA (n?=?8) and typically developing children (n?=?20). The HFA group had more difficulty with motor items, such as ball skills and balance, than did the AD group. There were significant positive correlations between impairments in motor proficiency (in particular ball skills and balance) and emotional/behavioural disturbance, autistic symptoms and communication disturbance. These findings are consistent with the hypothesis that there are qualitative and quantitative differences in the motor profile between autism and AD. In addition, the association between motor proficiency impairment and emotional/behavioural disturbance in autism and AD emphasizes the importance for screening of co-occurring emotional/behavioural symptoms in individuals with motor difficulties. These findings have implications for the potential use of adjunct motor measures in the diagnosis and definition of autism spectrum disorders.     

Personality dimensions in two types of learning-disabled children: a Rorschach study

Children referred for psychoeducational assessment of learning disabilities (LDs) commonly receive the Rorschach test. yet little is known about the impact of LD on Rorschach response patterns. This study investigated Rorschach response patterns in two groups of 9- to 12-year-old children (n = 41) classified by their respective intellectual abilities. Another group of 9- to 12-year-olds (n = 143) served as a nonclinical comparison group. Rorschach variables indicative of personality dimensions failed to discriminate between the two LD groups. Compared to the nonclinical group, the LD group exhibited several Rorschach characteristics--including problems in perceptual accuracy, inefficient visual scanning and problem-solving strategies, and avoidance of affect-laden stimuli--having implications for successful socioemotional adaptation. Suggestions for further research are discussed.     

Two Dimensions of Attachment to God and Their Relation to Affect, Religiosity, and Personality Constructs

In this study we sought to address several limitations of previous research on attachment theory and religion by (1) developing a dimensional attachment to God scale, and (2) demonstrating that dimensions of attachment to God are predictive of measures of affect and personality after controlling for social desirability and other related dimensions of religiosity. Questionnaire measures of these constructs were completed by a sample of university students and community adults (total n = 374). Consistent with prior research on adult romantic attachment, two dimensions of attachment to God were identified: avoidance and anxiety . After statistically controlling for social desirability, intrinsic religiousness, doctrinal orthodoxy, and loving God image, anxious attachment to God remained a significant predictor of neuroticism , negative affect , and (inversely) positive affect ; avoidant attachment to God remained a significant inverse predictor of religious symbolic immortality and agreeableness . These findings are evidence that correlations between attachment to God and measures of personality and affect are not merely byproducts of confounding effects of socially desirable responding or other dimensions of religiosity.     

Cognitive deficits in relation to personality type and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in women with stress-related exhaustion

Exhaustion caused by long-term work-related stress may cause cognitive dysfunction. We explored factors that may link chronic stress and cognitive impairment. Personality, psychiatric screening, and behavior were assessed by self-reporting measures in 20 female patients (mean age 39.3 years; range 26-53) with a preliminary diagnosis of stress-related exhaustion and in 16 healthy matched controls. Cognitive performance was investigated with a detailed neuropsychological test battery. Cortisol axis function was assessed by urinary and saliva collections of cortisol, dexamethasone suppression, Synacthen response, and corticotropin-releasing hormone (CRH) tests. Proinflammatory cytokines were measured. Hippocampal volumes were estimated by magnetic resonance imaging. Multivariate and univariate statistical methods were used to explore putative differences between groups and factors linked to cognitive impairment. Cognitive function clearly differed between groups, with decreased attention and visuospatial memory in the patient group, suggesting frontal cortex/medial temporal cortex-network dysfunction. Increased harm avoidance and persistence was present among patients, with lowered self-directedness linked to lower quality of life, increased anxious and depressive tendencies, and experiences of psychosocial stress. Attention was decreased with concomitantly impaired visuospatial memory. The pituitary (adrenocorticotropic hormone, ACTH) response to CRH was decreased in patients, with an increased cortisol/ACTH response to CRH. However, cortisol production rates, diurnal or dexamethasone-suppressed saliva cortisol levels, and the cortisol response to Synacthen were unaltered. Hippocampal volumes did not differ between groups. These findings suggest that cognitive dysfunction in stress-related exhaustion is linked to distinct personality traits, low quality of life, and a decreased ACTH response to CRH.     

Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults

Anxious and avoidant attachment were assessed in the Children in the Community (CIC) Study during adolescence and adulthood using self-report scales developed for this prospective study. The convergent and discriminant validity of the new CIC attachment scales were evaluated and their stability was assessed across a 17-year interval. Attachment scales predicted DSM-IV personality disorders in theoretically coherent and clinically meaningful ways, especially when supplemented with a separate measure of interpersonal aggression. Cluster B and C personality disorder symptoms were associated with elevated anxious attachment. Avoidant attachment was positively associated with Cluster A symptoms and inversely associated with Cluster B and C symptoms. Interpersonal aggression was higher in Cluster B symptoms and lower in Cluster C symptoms, thus differentiating between these symptom clusters.     

Adult attachment style and partner choice: Correlational and experimental findings

Three studies were conducted to assess the role of attachment style in partner selection using both correlational and experimental methods. Study 1 (n = 83 couples) assessed correlations between partner ratings on attachment-style dimensions and the relations between own and partner attachment style and relationship satisfaction. In Study 2 (n = 226) and Study 3 (n = 146), participants who varied in terms of attachment style rated the desirability of potential partners who also differed in terms of attachment style. Results of all three studies generally suggested that individuals were most attracted to partners with similar attachment styles. For example, anxious individuals tended to be dating anxious partners in Study 1, and they preferred anxious partners over secure and avoidant partners in Studies 2 and 3 (combined data). Thus, not all individuals preferred secure partners. Second, unlike previous studies that looked primarily at partner correlations, there was no evidence of anxious/avoidant matching. In fact, anxious individuals seemed particularly averse to avoidant partners. Finally, ratings of parental caregiving styles (especially ratings of mothers) were associated with adult attachment dimensions and partner choices. For example, individuals who rated their mothers as more cold and ambivalent were less attracted to secure partners. Clinical and research implications are discussed.     

Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes

This study compared the personality characteristics of 104 adults diagnosed with attention deficit hyperactivity disorder (ADHD). Personality features were assessed with the MCMI-II (Millon, 1987). Participants were divided into 4 groups based on the presence of persisting oppositional defiant disorder (ODD) or other comorbid diagnoses (ADHD only, ADHD-comorbid, ADHD-ODD, ADHD-ODD-comorbid). Significant differences between these groups were present for 9 of the 13 MCMI-II personality scales, resulting in 4 modal personality styles. ADHD-only adults evidenced mild histrionic traits, whereas the ADHD-comorbid group was more often avoidant and dependent in personality style. ADHD-ODD adults showed histrionic, narcissistic, aggressive-sadistic, and negativistic traits whereas the ADHD-ODD-comorbid group had a combination of avoidant, narcissistic, antisocial, aggressive-sadistic, negativistic, and self-defeating personality features. Implications for treatment are discussed.