Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD

Although worry is central to the diagnosis of generalized anxiety disorder (GAD), it is also commonly observed in other anxiety disorders. In this meta-analytic review, we empirically evaluated the extent to which worry is specific to GAD relative to patients with other anxiety disorders, those with other psychiatric disorders, and nonpsychiatric controls. A total of 47 published studies (N = 8,410) were included in the analysis. The results yielded a large effect size indicating greater severity/frequency of worry, meta-worry, and domains of worry among anxiety disorder patients v. nonpsychiatric controls (d = 1.64). In contrast to the many differences emerging from comparisons between anxiety disordered patients and nonpsychiatric controls, when anxiety disordered patients were compared to people with other psychiatric disorders they differed only on severity/frequency and not on meta-worry or domains of worry. A large effect size indicating greater severity/frequency of worry, meta-worry, and domains of worry among patients with GAD v. nonpsychiatric controls was also found (d = 2.05). However, differences between GAD and those with other psychiatric disorders also emerged for severity/frequency of worry. GAD was associated with greater worry difficulties than other anxiety disorders, which generally did not differ from those with other psychiatric disorders and each other. The implications of these findings for conceptualizing worry in GAD and other anxiety disorders, and the potentially moderating effects of age and gender are discussed.     

The latent structure of anxiety sensitivity--revisited

Anxiety sensitivity has been implicated as a risk factor for the development and maintenance of panic and other anxiety disorders. Although researchers have generally assumed that anxiety sensitivity is a dimensional, rather than categorical, variable, recent taxometric research has raised questions concerning the accuracy of this assumption. The present study examined the latent structure of anxiety sensitivity by applying four taxometric procedures (MAXEIG, MAXCOV, MAMBAC, and L-Mode) to data collected from two large nonclinical samples (n = 1,025 and n = 744) using two distinct measures of anxiety sensitivity (Anxiety Sensitivity Profile and Anxiety Sensitivity Index-Revised). In contrast to previous taxometric analyses of anxiety sensitivity, results of the present research provided convergent evidence for a latent anxiety sensitivity dimension. Several potential explanations for the discrepancy between these findings and those of previous research are discussed, as well as the implications of these findings for the conceptualization and measurement of anxiety sensitivity.     

Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder

The present study utilizes multiple methods to examine the relationship between disgust and contamination-related obsessive-compulsive disorder (OCD) symptoms in an analogue sample. Questionnaire findings revealed that participants with high OCD contamination concerns showed stronger disgust sensitivity than did participants with low OCD contamination symptoms after controlling for negative affect. High OCD participants (N=30) also reported significantly more disgust than did low OCD participants (N=30) when exposed to a disgust-inducing video, whereas no significant between-group differences were detected on other negative emotional dimensions. Results from a series of disgust-specific behavioral avoidance tasks (BATs) revealed that high OCD participants demonstrated both less compliance and less approach behavior. Subsequent analysis also revealed that disgust sensitivity generally mediated avoidance on the BATs among high OCD subjects. High OCD participants also rated the BATs as more fearful and disgusting than did low OCD participants, with disgust generally emerging as the dominant emotional response. The results are consistent with a disgust-based, disease-avoidance approach in understanding contamination-related OCD themes.     

Body vigilance in nonclinical and anxiety disorder samples: structure, correlates, and prediction of health concerns

The Body Vigilance Scale (BVS) is a measure developed to assess one’s conscious attendance to internal cues. The present report investigated the structure, correlates, and predictive utility of the BVS in nonclinical (N = 442) and anxiety (N = 135) disorder samples. The findings of Study 1 suggest that the BVS is 1-dimensional in a nonclinical sample, and Study 2 replicated the factor structure of the BVS in an anxiety disorder sample. Correlations between the BVS and related (i.e., anxiety sensitivity) and unrelated (i.e., social anxiety) variables were consistent with predictions in both studies. Study 2 also showed that body vigilance is primarily elevated in patients with panic disorder relative to other anxiety disorders. Relative elevations in body vigilance were also observed for patients with hypochondriasis and generalized anxiety disorder. The BVS also demonstrated a specific association with medical utilization and health-related safety-seeking behaviors after controlling for related variables in nonclinical and anxiety disorder samples. The implications of our findings for the nature and measurement of body vigilance as a predictor of health concerns in anxiety disorders are considered.     

Specificity of disgust sensitivity in the prediction of behavioral avoidance in contamination fear

This study examined the specificity of disgust sensitivity in predicting contamination-related anxiety and behavioral avoidance. Participants high (n=26) and low (n=30) in contamination fear completed self-report measures of disgust sensitivity, contamination cognitions (overestimation of the likelihood and severity of contamination from everyday objects), anxiety, and depression. They then completed three randomly presented contamination-based behavioral avoidance tasks (BATs) that consisted of exposure to a used comb, a cookie on the floor, and a bedpan filled with toilet water. Results indicated that disgust sensitivity was significantly associated with anxious and avoidant responding to the contamination-related BATs. This association remained largely intact after controlling for gender, contamination fear group membership, anxiety, and depression. Contamination cognitions were also significantly related to BAT responses. However, this relationship was fully mediated by disgust sensitivity. These findings indicate that disgust sensitivity has a specific and robust association with contamination concerns commonly observed in obsessive compulsive disorder. The findings are discussed in the context of a disease-avoidance model.     

Development and Initial Validation of an Abbreviated Spider Phobia Questionnaire Using Item Response Theory

An abbreviated Spider Phobia Questionnaire (SPQ) was developed using methods based in item response theory. Fifteen of the 31 SPQ items that demonstrated good to excellent discrimination along the spider fear continuum were retained in Study 1 that consisted of 1,555 nonclinical and clinical participants. The SPQ-15 demonstrated good internal consistency and correlated highly with the full SPQ. Structural equation modeling revealed that the SPQ-15 demonstrated excellent convergent validity, with strong associations with small animal disgust and other phobic symptoms. Supportive evidence was also found for divergent validity in relation to panic-related symptoms. The SPQ-15 was uniquely predictive of avoidance behavior and fear and disgust responding towards spiders in nonclinical, analogue, and treatment-seeking samples in Studies 2, 3, and 4. Lastly, in Study 5, the SPQ-15 was sensitive to the effects of exposure-based treatment. These findings suggest that the SPQ-15 has considerable strengths, including decreased assessment and scoring time while retaining high reliability, validity, and sensitivity.     

Langage,Mathematiques Et Observables

Sans résumé     

Fear and Disgust Responding to Heterogeneous Blood-Injection-Injury Stimuli: Distinctions from Anxiety Symptoms

Discrepancies exist in the literature regarding the unique role of disgust in Blood-Injection-Injury (BII) phobia. The present study attempts to clarify the discrepancy using a sample of analogue BII phobics (n = 40) and nonphobics (n = 40) who completed a series of questionnaires and were exposed to blood, mutilation, and injection pictures. The findings revealed that BII phobics reported greater disgust and contamination fears than nonphobics after controlling for anxious symptoms. When rating phobia-relevant pictures, BII phobics responded with greater fear and disgust than nonphobics after controlling for baseline anxiety scores. Furthermore, disgust was the dominant emotional response for BII phobics for the blood and mutilation stimuli. However, no differences were found between fear and disgust within the BII group when rating injection stimuli. The implications of these findings for better understanding the potential unique role of disgust in the etiology, maintenance, and treatment of BII phobia are discussed.

Disgust Sensitivity and Anxiety Disorder Symptoms: Psychometric Properties of the Disgust Emotion Scale

Recent research has implicated disgust sensitivity in the etiology of specific anxiety disorders. The Disgust Emotion Scale (DES) is a newly developed measure that was designed to improve the assessment of disgust sensitivity. The present study examines the psychometric properties of the DES. Exploratory factor analysis in Study 1 revealed five factors of disgust towards: (1) rotting foods, (2) blood and injection, (3) smells, (4) mutilation and death, and (5) small animals. The DES demonstrated adequate internal consistency and convergent validity. Significant positive correlations were found between the five factors of the DES and blood-injection-injury fears and obsessive-compulsive disorder symptoms. Confirmatory factor analysis in Study 2 provided support for the five-factor model. However, there was indication of item overlap within the factors. These findings suggest that the DES is a reliable measure of disgust as it relates to specific anxiety disorder symptoms.     

A taxometric study of the latent structure of disgust sensitivity: converging evidence for dimensionality

Disgust sensitivity has recently been implicated as a specific vulnerability factor for several anxiety-related disorders. However, it is not clear whether disgust sensitivity is a dimensional or categorical phenomenon. The present study examined the latent structure of disgust by applying three taxometric procedures (maximum eigenvalue, mean above minus below a cut, and latent-mode factor analysis) to data collected from 2 large nonclinical samples on 2 different measures of disgust sensitivity. Disgust sensitivity in the first sample (n=1,153) was operationalized by disgust reactions to food, animals, body products, sex, body envelope violations, death, hygiene, and sympathetic magic, as assessed by the Disgust Sensitivity Scale (J. Haidt, C. McCauley, & P. Rozin, 1994). Disgust Sensitivity Scale indicators of core, animal reminder, and contamination disgust were also examined in the 1st sample. Disgust sensitivity in the 2nd independent sample (n=1,318) was operationalized by disgust reactions to animals, injections and blood draws, mutilation and death, rotting foods, and odors, as assessed by the Disgust Emotion Scale (R. A. Kleinknecht, E. E. Kleinknecht, & R. M. Thorndike, 1997). Results across both samples provide converging evidence that disgust sensitivity is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. These findings are discussed in relation to the conceptualization and assessment of disgust sensitivity as a specific dimensional vulnerability for certain anxiety and related disorders.