Brief report--associations of personality disorder with early separation anxiety in patients with adult separation anxiety disorder

A recent study has suggested a link between early separation anxiety and personality disorder. It is possible that this relationship is mediated or confounded by the presence of adult separation anxiety disorder (ASAD). In a clinic study of 397 anxiety patients, we found that ASAD patients with heightened early separation anxiety had higher rates of any Cluster C personality disorder compared to ASAD patients without elevated early separation anxiety, and higher rates of any Cluster B or C personality disorder compared to anxiety patients with low early separation anxiety and no ASAD. Although cross-sectional in design, the study supports a direct link between early separation anxiety and some adult personality disorders, irrespective of the type of adult anxiety disorder present, including ASAD.     

Panic symptoms in asthma and panic disorder: a preliminary test of the dyspnea-fear theory.

Ley's (Behaviour Research and Therapy, 27, 549-554, 1989) dyspnea-fear theory was tested on three groups of subjects: 10 with panic disorder, 24 with asthma, and 12 who were nonanxious and nonasthmatic, using measures of pulmonary function, muscle tension; and self-report measures of generalized anxiety, dyspnea, and psychopathology. Results are supportive of dyspnea-fear theory for asthmatics but not for individuals with panic disorder. Differences between groups on panic/fear measures were explained by a combination of general anxiety and dyspnea. Within-group regression analyses showed that only generalized anxiety symptoms contributed significantly to scores on the Asthma Symptom Checklist scale of panic/fear within the panic disorder group; while only dyspnea contributed to panic/fear among asthmatics. Additional results show that panic disorder subjects performed normally on pulmonary function tests but reported respiratory symptoms as severe as did asthmatics. Compared with normal subjects, both patient groups displayed lower correlations between self-rated symptoms of bronchoconstriction and objective pulmonary measures. Panic disorder subjects showed a negative relationship between pulmonary function and hyperventilation symptoms, suggesting a heightened sensitivity to, and discomfort with, sensations associated with normal pulmonary function. Asthmatics displayed a significant relationship between degree of airway obstruction and both trapezius surface EMG and ratings of hyperventilation symptoms.     

Panic disorder: cognitive-behavioral treatment

The effectiveness of an integrated treatment program utilizing cognitive-behavioral therapies for Panic Disorder was examined. Treatment was comprised of Cognitive Model of Panic-derived procedures, Cognitive Therapy and Applied Relaxation Training. Subjects meeting DSM-III-R criteria for Panic Disorder received thirteen 2.5-hr sessions of outpatient therapy in small groups, over a 12-week period. Subjects were given an extensive rationale of the etiology, development and maintenance of Panic Disorder, within the framework of the Cognitive Model of Panic, and controlled behavioral experiments in panic evocation to internal panicogenic cues, cognitive reappraisal of somatic and ideational cues, breathing retraining, Applied Relaxation Training and Cognitive Therapy to identify and remediate maladaptive beliefs and dysfunctional cognitive schemas. A comprehensive assessment battery was given at pre-mid-post-treatment which included measures of tripartite functioning, global severity, panic, fear, anxiety, depression and psychiatric symptomatology. Analyses indicated statistically significant improvements across all outcome domains. All subjects were free of spontaneous (uncued) panic attacks at post-treatment, and all met operationalized criteria for high endstate functioning. These findings are discussed, with recommendations for future research.     

Effects of test anxiety on motor learning: The processing efficiency hypothesis

Abstract

The hypothesis that, under test (stress) conditions, high trait-anxious individuals invest extra processing resources to reach motor learning levels similar to those of low-anxious individuals was investigated. A transfer procedure (practice trial, rest interval, and transfer trial) was employed to analyse motor learning effects. In Experiment 1, a secondary task (click detection) was used to measure the extra processing resources expenditure on motor learning during the practice trial. Neither motor performance in the transfer trial nor secondary task performance differed as a function of test condition or anxiety trait. A critical analysis of the secondary task paradigm suggested that it was not sensitive enough to reflect the amount of processing capacity expended on the primary motor tasks. In Experiment 2, subjects performed a loading task (verbal shadowing of sentences) concurrently with the motor tasks during the practice trial to prevent extra resources from being allocated to motor learning. Results showed that anxiety trait was associated to performance time increments on the high-demanding motor tasks in the transfer trial. A plausible explanation is that anxiety impairs learning because it reduces the efficiency of processing. An alternative interpretation, concerning an ability deficit of high trait-anxious individuals, is discussed.     

Boyhood separation anxiety disorder: thought disorder and object relations psychopathology as manifested in Rorschach imagery

Rorschach scales were used to examine the quality of thought disturbance and object relations in boys meeting the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III; American Psychiatric Association, 1980) criteria for separation anxiety disorder (SAD). Nineteen urban, middle and low socioeconomic status (SES), SAD boys were compared to a group of 14 male control subjects. The hypotheses of the study were that SAD boys as compared to controls would: (a) have significantly more thought disordered responses as measured by a Rorschach Thought Disorder Scale (Blatt & Ritzler, 1974), and (b) evidence significantly less adaptive object relations scale scores as measured by the Mutuality of Autonomy Scale (Urist, 1977). Results confirmed both hypotheses. The SAD group had more thought disordered responses and more disrupted object relations scores than the controls. Ideas and images of these boys were found to generally be more unstable, boundary compromised, fluid, idiosyncratic, tangential, and psychotic-like than the controls. It was concluded that these boys possess a significant potential to have thinking abnormalities that will interfere with their independent functioning. Concerning their object relations scores, the SAD subjects were found to have significantly fewer benign, adaptive object interactional percepts, and a greater number of dependent and/or clinging interactional object representations (imagery) than the controls. This study supports the viewpoint that SAD boys are deeply psychologically troubled.     

Panic disorder: A product of classical conditioning

Contrary to the common view that all panic attacks have a single etiology, it is shown that a distinction must be made between initial attacks, for which there are many causes, and recurrent attacks (panic disorder) which have a common basis. Most initial panic attacks are attributable to the physiological effects of hyperventilation resulting from severe and prolonged anxiety. It has been claimed that the attacks are due to such symptoms as dyspnea, tachycardia and dizziness being misattributed to deadly illness or incipient insanity. We reject this view on several grounds, and in particular because of a pilot study that showed that such attributions follow the onset of panic. Apart from some biological cases, the common initial panic is an unconditioned response to a bizarre stimulus complex produced by excessive hyperventilation, and panic disorder is the result of contiguous stimuli, especially endogenous stimuli, being conditioned to the elicited anxiety. Treatment accords with principles of conditioning.     

Panic disorder: A cognitive-behavioural approach to treatment

The present study investigated the relationship between panic disorder and cognitive-behavioural therapy in a sample of 27 panic disorder patients who were randomly assigned to either a Treatment (six weeks of cognitive-behavioural therapy) or a Control group. Panic disorder was operationalized using three subjective and three physiologic indices. Results indicated that six weeks of cognitive-behavioural therapy were effective in decreasing panic disorder, as measured by three report measures: the Anxiety Sensitivity Index (catastrophic thoughts), State-Trait Anxiety Inventory (trait anxiety), and number of panic attacks, for the Treatment group relative to the Control group. In contrast, cognitive—behavioural therapy was ineffective in decreasing physiologic arousal as defined by blood pressure, pulse rate, and finger temperature. Implications of these results are discussed.     

Trait anxiety,stress, and learning a test of Saltz's hypothesis

Behavioral predictions from Saltz's, Spence's, and Spielberger's interpretations of trait anxiety were tested in a complex verbal learning task. Fifty-three high-anxious and 52 low-anxious male college students were randomly distributed to test conditions of failure-stress, pain-stress, or neutral instructions. The learning data revealed that high-anxious-failure and low-anxious-pain Ss were disrupted and supported Saltz's hypothesis; self-reported anxiety (A-State scale, STAI) was observed only in high-anxious-failure Ss and supported Spielberger's theory of the arousal of state anxiety as a function of trait anxiety. However, the contradiction between self-reported anxiety and learning behavior in low-anxious-pain Ss indicated that the verbal report of these Ss was an inaccurate or insensitive index of arousal.     

Panic disorder: the psychobiology of external treat and introceptive distress

Panic disorder seems to be mediated by the neuronal circuitry and neurochemical systems that have evolved to respond to external threatening stimuli. Distant threats activate prefrontal cortex (involved in complex planning of avoidance strategies), while immediate threats activate midbrain structures (involved in fast reflexive behaviors). Panic disorder may, however, also involve more specific interoceptive mechanisms. For example, the association between respiratory dysfunction and panic disorder has bolstered a false suffocation alarm hypothesis. Genetic and environmental contributors to panic disorder are beginning to be delineated. Effective pharmacotherapy and psychotherapy are able to normalize the relevant psychobiology.     

Developmental coordination disorder: exploration of a cerebellar hypothesis

This study explored the hypothesis of a specific cerebellar dysfunction in children with developmental coordination disorder (DCD): motor adaptation. The performance of a group of children with DCD (3 girls and 6 boys) was compared to that of a control group (5 girls and 6 boys) on a measure of motor adaptation, the prism adaptation test (PAT). Children were between 6 years 11 months and 11 years 10 months of age. Between-group differences were only found for PAT variables related to throwing accuracy, the DCD group being more variable and less accurate than the control group. While no between-group differences were found for the adaptation variables, individual data analysis revealed that only three children in the DCD group obtained normal adaptation variables. While these findings do not confirm the hypothesis of a cerebellar dysfunction, they also do not refute it. It is possible that the poor throwing accuracy of the DCD group masked the findings for some of the PAT variables. Further exploration of the function of the cerebellum among children with DCD is needed.     

Lightness constancy: a direct test of the illumination-estimation hypothesis

Many models of color constancy assume that the visual system estimates the scene illuminant and uses this estimate to determine an object's color appearance. A version of this illumination-estimation hypothesis, in which the illuminant estimate is associated with the explicitly perceived illuminant, was tested. Observers made appearance matches between two experimental chambers. Observers adjusted the illumination in one chamber to match that in the other and then adjusted a test patch in one chamber to match the surface lightness of a patch in the other. The illumination-estimation hypothesis, as formulated here, predicted that after both matches the luminances of the light reflected from the test patches would be identical. The data contradict this prediction. A second experiment showed that manipulating the immediate surround of a test patch can affect perceived lightness without affecting perceived illumination. This finding also falsifies the illumination-estimation hypothesis.     

The unique impact of parent training for separation anxiety disorder in children

This investigation examined the preliminary efficacy of an integrated cognitive-behavioral parent-training protocol for six families of separation-anxious children (7 to 10 years of age) using a multiple baseline design across participants. Although families were assessed on child, parent, and clinician ratings at pre- and posttreatment as well as 6-month follow-up, only parents received education and training. Although the parent-training protocol was largely effective and treatment gains were maintained at 6-month follow-up, only those child participants whose parents experienced clinically significant improvement on parental process measures (i.e., enhanced efficacy or satisfaction, reduced stress) achieved high end-state functioning. Implications regarding the importance of individualized family-based interventions for treating anxious youth are discussed.