Harm avoidance and self-directedness as essential features of panic disorder patients

Anxiety Disorder Program, Hospital de Clínicas de Porto Alegre and Graduate Program in Medical Sciences, Psychiatry, Universidade Federal do Rio Grande do Sul, Brazil.
Comprehensive psychiatry (Impact Factor: 2.25). 09/2008; 49(5):476-81. DOI: 10.1016/j.comppsych.2008.03.003
Source: PubMed


The purpose of the study is to compare the personality traits assessed with the Temperament and Character Inventory (TCI) between patients with panic disorder (PD) and a control group in a Brazilian sample.
One hundred thirty-five patients with PD paired according to sex and age with 135 controls without any psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview (MINI), a structured interview. Temperament and character were assessed with the TCI.
Consistently, patients with PD presented higher scores on the harm avoidance (HA) temperament scale (23.20 +/- 5.41 vs 15.21 +/- 4.92; P < .001) and lower scores on the self-directedness (SD) (27.81 +/- 7.25 vs 35.16 +/- 5.47; P < .001) if compared to the control group and has been associated independently from other TCI scales and confounders with PD. The multivariate logistic model containing HA and SD explains 38.6% to 51.4% of the differences between PD and controls.
Harm avoidance could be a good candidate to be heritable because it appears to be a consistent finding across current literature in anxious and depressed patients independent of their cultural context. Also, SD seems to be a key character characteristic of PD patients. The dimensional assessment is an interesting alternative for understanding the relationship between the psychobiologic bases of temperament and character and is highly related to the development of psychiatric syndromes.

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Available from: Giovanni Abrahão Salum, Oct 09, 2015
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    • "In Cloninger's model, a low self-directedness score is an indicator of poor individual maturity and of an enhanced risk of personality disorder without specificity to the underlying types of personality (Svrakic et al., 1993). Other studies have already shown that this trait is lower for OCD patients when compared to healthy subjects (Bejerot et al., 1998; Kusunoki et al., 2000; Lyoo et al., 2001; Alonso et al., 2008; Kim et al., 2009; Cruz-Fuentes et al., 2004) as well as subjects with social phobia (Pelissolo et al., 2002), panic disorder (Wachleski et al., 2008) or post-traumatic stress disorder (Evren et al., 2010) although without direct comparisons between these groups. However, in our study, the SD difference between AD and OCD groups seems to be due to a state effect and it is no longer significant when depressive symptoms (and age) are taken into account. "
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    ABSTRACT: Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the existence of two partially distinct temperamental profiles. We used the Temperament and Character Inventory (TCI-R) and the Positive and Negative Emotionality (PNE) scale to compare two groups of patients with OCD (n=227) or AD (n=827). The latter group included patients with social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. Most temperament, character and emotionality measures showed no significant differences between both groups. In the personality measures results, only the self-directedness score (TCI-R) was significantly lower in OCD patients but this difference was not significant when the comparison was adjusted for the depressive scale score and age. Only lower PNE positive affects scores were obtained in OCD patients in the adjusted comparisons. These findings suggest that OCD and AD are not really distinguishable from the point of view of associated personality traits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    08/2015; 229(3):PSYD1400683. DOI:10.1016/j.psychres.2015.08.020
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    • "Moreover, higher HA may constitute a familial risk for emotional disorders [7] [18]. High scores in HA, along with lower values in the character dimension SD have been suggested to constitute a risk for depression [14] [16] [19] and anxiety [17]. Moreover, low scores in character dimensions SD and ST have been found to predict suicide ideations in patients with major depression [20]. "
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    ABSTRACT: Background: Previous studies suggest that temperament and character may impact depression and anxiety through dysfunctional cognition. This study targets the mediating role of meta-cognitive beliefs in the relationship between Cloninger’s temperament and character dimensions and symptoms of depression and anxiety. Method: One hundred and sixty-one healthy subjects filled out Cloninger’s Temperament Character Inventory (TCI), a Metacognitions Questionnaire (MCQ), the Beck Depression Inventory (BDI) and the State and Trait Anxiety Inventory (STAI). Correlation and mediation analysis according to Baron and Kenny’s method were performed. Results: Harm avoidance (HA) and self-directedness (SD) were related to depression and anxiety. HA was related to negative beliefs about uncontrollability of thoughts and to beliefs about cognitive confidence. SD was associated with the same types of meta-cognitive beliefs and with general negative beliefs. Cooperativeness (CO) was related to positive beliefs about worry, beliefs about cognitive confidence and to general negative beliefs. Self-transcendence (ST) was related to all types of meta-cognitive beliefs. Mediation analysis revealed that the relationship between HA and depression and anxiety is partially mediated by certain types of meta-cognitive beliefs. The same results were obtained for the relationship between SD and depression and anxiety. General negative beliefs fully mediated the relationship between CO and depression and the relationship between ST and anxiety. Conclusions: Meta-cognitive beliefs mediate the relationship between temperament and character dimension and depressive and anxiety symptoms, thus providing further evidence for the meta-cognitive theory of emotional disorders as presented by Wells and Matthews (Behav Res Ther 1996;32:867-870).
    Comprehensive Psychiatry 03/2014; 55:1029-1037. DOI:10.1016/j.comppsych.2013.10.013 · 2.25 Impact Factor
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    • "Importantly, development of these social attachments necessitated the modulation of older defense-related systems: deactivation of amygdala (Moriceau and Sullivan, 2005), regulation of sympathetic tone via myelenated vagus (Porges and Carter, 2012), " inhibited temperament " ) and demonstrate increased physiological responsiveness and behavioral inhibition to mild threat can be used in translational research in animals and very young (preverbal) humans (i.e. Oler et al., 2010) Attachment anxiety A trait measure of sensitivity to or worry about rejection or loss of relationships with intimates (Brennan et al., 1998) Bartz et al. (2011), Kiss et al. (2011), Love et al. (2012) and Weisman et al. (2013a) Along with attachment avoidance, one of the two attachment parameters demonstrated in some studies to moderate certain individual responses to oxytocin (see text) Trait anxiety Measured with STAI, trait version Stuebe et al. (2013) and Weisman et al. (2013a) One of a cluster of terms (see also " harm avoidance " and " anxious temperament " ) describing trait-like tendency toward tension, anxiety, and negative affectivity Harm avoidance A heritable temperamental trait assessed with Cloninger's temperament and character inventory (Cloninger, 1987), and associated with excessive worrying, cautiousness, pessimism, shyness and fearfulness Stankova et al. (2012) and Wang et al. (2013) Harm avoidance is associated with anxiety disorders (Ball et al., 2002; Wachleski et al., 2008), and a number of parameters of neurobiology (see text) A variety of terms are used in the literature pertaining to OT's role in human fear, anxiety, and anxiety disorders. References in table refer to OT studies relating to that aspect of anxiety. "
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    ABSTRACT: A growing literature suggests that the oxytocin (OT) system may play a role in human anxiety states, anxiety-related traits, and moreover, that this system may be a target for the development of novel anxiolytic treatments. However, studies of OT's acute and chronic effects on various aspects of anxiety have produced mixed results. In this forward-looking review, we discuss the myriad phenomena to which the term "anxiety" is applied in the OT literature and the problem this presents developing a coherent picture of OT's role in anxiety. We then survey several different fields of research that support the role of the OT system in human anxiety, including evolutionary perspectives, translational and neuroimaging research, genetic studies, and clinical trials of intranasal OT. As an outgrowth of this data, we propose a "bowtie" model of OT's role at the interface of social attachment and anxiety. We next direct attention to understudied brain regions and neural circuits which may be important to study in OT experiments in humans anxiety disorders. Finally, we conclude by proposing questions and priorities for studying both the clinical potential of OT in anxiety, as well as mechanisms that may underlie this potential. Crucially, these priorities include targeted proof-of-concept clinical trials of IN OT in certain anxiety disorders, including investigations of individual moderators of OT's anxiolytic effects (i.e. sex, genetic factors, and early experience).
    Brain research 01/2014; 1580. DOI:10.1016/j.brainres.2014.01.025 · 2.84 Impact Factor
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