The theoretical model of Brown and Barlow (2009) of the
classifi cation of emotional disorders emphasizes the similarities of
anxiety and mood disorders and suggests that emotion regulation
plays an important role in the psychopathology of these psychological
disorders (Campbell-Sills & Barlow, 2007; Gross, 2007). These
authors propose a common classifi cation for them (Barlow, 1991,
2002). The similarity in psychopathology is due to two genetically
established temperament dimensions that determine the aetiology
and course of emotional disorders: Neuroticism/negative affect
and extraversion/positive affect. The scientifi c literature supports
the role of these vulnerability constructs in the onset, overlap, and
maintenance of anxiety and mood disorders (e.g., Barlow, 2002;
Brown, 2007; Blanco et al., 2013).
Researchers who have studied personality characteristics from
a clinical model have found a high prevalence of personality
disorders (PeD) in panic disorder (PD) and panic disorder with
agoraphobia (PDA) samples, which shows the close relationship
between both mental disorders. Recent studies provide data on
comorbidity ranging between 33.3 and 76.8% (Albert, Maina,
Bergesio, & Bogetto, 2006; Iketani et al., 2004; Marchesi, Cantón,
Fonito, Giannelli, & Maggini, 2005; Marchesi et al., 2006). As we
can see, there is unanimity in linking PeD with PD/PDA although
there is also a high variability in prevalence rates. With respect to
the specifi city of the PeD found in clinical samples of PD/PDA,
researchers have found a close relationship between cluster C and
PD/PDA, particularly with avoidant PeD (Iketani et al., 2004;
Telch, Kamphuis, & Schmidt, 2011), dependent PeD (Albert et
al., 2006; Starcevic et al., 2008) and obsessive-compulsive PeD
(Marchesi et al., 2005, 2006). With regard to the hypothesis that
ISSN 0214 - 9915 CODEN PSOTEG
Copyright © 2014 Psicothema
Personality disorders among patients with panic disorder
and individuals with high anxiety sensitivity
Jorge Osma1, Azucena García-Palacios2, Cristina Botella2 and Juan Ramón Barrada1
1 Universidad de Zaragoza and 2 Universitat Jaume I
Background: No studies have been found that compared the
psychopathology features, including personality disorders, of Panic
Disorder (PD) and Panic Disorder with Agoraphobia (PDA), and a
nonclinical sample with anxiety vulnerability. Method: The total sample
included 152 participants, 52 in the PD/PDA, 45 in the high anxiety
sensitivity (AS) sample, and 55 in the nonclinical sample. The participants
in PD/PDA sample were evaluated with the structured interview ADIS-
IV. The Brief Symptom Inventory and the MCMI-III were used in all
three samples. Results: Statistically signifi cant differences were found
between the PD/PDA and the nonclinical sample in all MCMI-III scales
except for antisocial and compulsive. No signifi cant differences were
found between PD/PDA and the sample with high scores in AS. Phobic
Anxiety and Paranoid Ideation were the only scales where there were
signifi cant differences between the PD/PDA sample and the high AS
sample. Conclusions: Our fi ndings showed that people who scored high
on AS, despite not having a diagnosis of PD/PDA, were similar in regard to
psychopathology features and personality to individuals with PD/PDA.
Keywords: Panic disorder, panic disorder with agoraphobia, anxiety
sensitivity, personality disorders, MCMI-III.
Trastornos de personalidad en pacientes con trastorno de pánico y en
personas con alta sensibilidad a la ansiedad. Antecedentes: no se han
encontrado estudios que comparen variables psicopatológicas, incluyendo
trastornos de personalidad, entre pacientes con Trastorno de pánico (TP)
y Trastorno de pánico con agorafobia (TPA), y una muestra no clínica
con vulnerabilidad a la ansiedad. Método: la muestra total fue de 152
participantes, 52 en la muestra de TP/TPA, 45 en la muestra no clínica
con alta sensibilidad a la ansiedad (SA) y 55 en la no clínica con baja SA.
Los participantes con TP/TPA fueron evaluados a través de la entrevista
estructurada ADIS-IV. Administramos el Inventario Breve de Síntomas y
el MCMI-III en las tres muestras. Resultados: se encontraron diferencias
estadísticamente signifi cativas entre la muestra con TP/TPA y la no clínica
con baja SA en todas las escalas salvo en la antisocial y compulsiva. No
encontramos diferencias signifi cativas entre la muestra con TP/TPA y la
muestra no clínica con alta SA. Las únicas escalas psicopatológicas que
diferencian las muestras clínica y con alta SA fueron la Ansiedad Fóbica
y la Ideación Paranoide. Conclusiones: nuestros resultados muestran que
las personas que puntúan alto en SA, a pesar de no tener un diagnóstico
de TP/TPA, son muy similares a los pacientes con TP/TPA en variables
psicopatológicas y de personalidad.
Palabras clave: trastorno de pánico, trastorno de pánico con agorafobia,
sensibilidad a la ansiedad, trastornos de personalidad, MCMI-III.
Psicothema 2014, Vol. 26, No. 2, 159-165
Received: August 13, 2013 • Accepted: January 20, 2014
Corresponding author: Jorge Osma López
Facultad de Ciencias Sociales y Humanas
Universidad de Zaragoza
44003 Teruel (Spain)
Jorge Osma, Azucena García-Palacios, Cristina Botella and Juan Ramón Barrada
pathological personality traits constitute risk factors for PD/PDA,
Bienvenu et al. (2009), indicated that features such as avoidant,
dependent, and other related traits (i.e., shyness), predict the onset
of PD, AG, or both.
The high percentages of PeD and specifi c personality
pathological profi les (cluster C), and the presence of high levels of
neuroticism and lower levels of extraversion in PD/PDA samples
(Carrera et al., 2006; Kotov, Gamez, Schmidt, & Watson, 2010)
corroborate Brown and Barlow’s (2009) theory on temperamental
vulnerability factors of higher order in emotional disorders.
Besides the temperamental vulnerability factors described,
other vulnerability factors have been proposed as playing a role
in the onset, course and maintenance of PD/PDA, such as anxiety
sensitivity (AS – Drost et al., 2012; Schmidt et al., 2010; Weems,
Costa, Watts, Taylor, & Cannon, 2007). AS refers to the tendency
to respond with fear to anxiety-related sensations (Reiss, Peterson,
Gursky, & McNally, 1986). Maller and Reiss (1992) were the fi rst
authors to explore whether people with high AS are at risk of
developing PD. To answer this question, they conducted a three-
year follow-up study with 151 high school students without PD
history and found that Anxiety Sensitivity Index scores (ASI;
Reiss et al., 1986) at baseline predicted the frequency and intensity
of panic attacks in the follow-up period. In addition, participants
with higher levels of AS were fi ve times more likely to develop an
anxiety disorder. Since this study, many others have confi rmed
that people who score high on the ASI are at increased risk for
experiencing panic attacks compared with those who score lower
(Plehn & Peterson, 2002).
The aim of this study is to explore the similarities and
differences in personality pathology and clinical features among
three different samples, PD/PDA sufferers, a non-clinical sample
with high levels of AS, and a non-clinical sample with low levels
of AS. If people with high scores on the ASI are at greater risk of
developing anxiety and panic (Plehn & Peterson, 2002), and there
are specifi c personality features linked to PD/PDA individuals, we
hypothesized that the personality profi le of the sample with high
levels of AS will be more similar to that of people with a diagnosis
of PD/PDA than people without clinical pathology and low levels
of AS. We consider that this type of studies may be relevant to
shed further light on the study of risk factors in PD/PDA.
The total sample was composed of 152 participants (52 in
the PD/PDA sample, 55 in the non-clinical sample with low AS
scores and 45 in the sample with high AS scores). Table 1 shows
the composition and demographic characteristics of the three
groups. Group comparisons indicated the existence of statistically
signifi cant differences in age and employment status.
Data from the following measures were collected:
Anxiety Disorders Interview Schedule. The ADIS-IV (Brown
et al., 1994) is a structured diagnostic interview designed to
comprehensively evaluate anxiety disorders according to the
DSM-IV-TR (2000). Test-retest reliability varies, depending on
the study, from .68 to 1. The ADIS-IV is a useful interview that
exhaustively traces the symptoms of anxiety and is sensitive to
changes after treatment (Antony & Swinson, 2000).
Anxiety Sensitivity Index. The ASI (Reiss et al., 1986; Spanish
version by Sandín, Chorot, & McNally, 1996) is a questionnaire
containing 16 items that measure fear of anxiety symptoms. Each
item is rated along a 5-point Likert scale ranging from 0 (very
little) to 4 (very much). There is good evidence of the reliability
and validity of the ASI with a Cronbach’s alpha of .84.
Brief Symptom Inventory. The BSI (Derogatis & Melisaratos,
1983; validated for Spanish population by Ruipérez et al., 2001)
is a 49-item inventory measuring general psychopathology. It
provides information on 6 subscales: Depression, phobic anxiety,
paranoid ideation, obsession-compulsion, somatization, and
hostility/aggressivity. Responses are obtained through a 5-point
Likert scale ranging from 0 (none) to 4 (much). The different
scales offer high reliability in non-clinical samples (Cronbach’s
alpha ranging from .70 to .91).
Millon Clinical Multiaxial Inventory-III. The MCMI-III
(Millon, Davis, & Millon, 2007; adapted and validated for Spanish
population by Cardenal & Sánchez, 2007). The MCMI-III consists
of 175 items and provides a profi le according to 14 scales: Schizoid,
avoidant, depressive, dependent, histrionic, narcissistic, antisocial,
aggressive, compulsive, negativistic, self-defeating, schizotypal,
borderline, and paranoid. Prevalence scores equal to or higher
than 75 indicate the presence of personality traits, and equal to or
higher than 85 indicate the presence of a personality disorder. The
MCMI-III has shown good psychometric properties.
In Figure 1, we offer the participant fl ow. Participants in the
clinical sample (n = 80) were invited to participate in the study
when they were going through the assessment in their clinical
Sociodemographic data in the different study groups
Mean ageb* (SD)32 (10.4) 26.9 (9.4)31.8 (8.2)
Divorced or separated
a Independence tested with a χ2 test; b mean differences tested with a one-way ANOVA;
* p<.05; AS: Anxiety Sensitivity
Personality disorders among patients with panic disorder and individuals with high anxiety sensitivity
center (PREVI center in Valencia and Castellón, CREOS,
centro de psicoterapia y formación [center of psychotherapy and
formation] in Castellón, and Psychological Assistance Service
at the Universitat Jaume I in Castellón). All the participants in
this sample were diagnosed of PD/PDA by the clinicians with the
ADIS-IV (Brown, et al., 1994). The invitation was made when
it was confi rmed that they met the inclusion criteria and before
starting the psychological treatment. The fi nal clinical sample
included 52 participants, 44 met criteria for PDA and 8 for PD.
The mean duration of the disorder was 5.0 years (SD = 5.0 years;
range from 4 months to 17 years). If the participants agreed to
participate, they voluntarily signed an informed consent. The study
had the approval of the ethical committees of all the centers who
participated in this study. The participants fi lled out the MCMI-
III, the BSI and the ASI.
All participants in the non-clinical samples were undergraduate
and postgraduate students at Universitat Jaume I and employees
of different companies in Castellon; all of them were volunteers
and they signed an informed consent (n = 173). The assessment of
the non-clinical samples was done by the author J. O. They fi lled
out the MCMI-III, the BSI and the ASI in a single session. In the
same session, they were asked whether they had received or were
receiving psychological or psychiatric treatment.
For all groups under study, the exclusion criterion established
was being younger than 18 years. Also, for the clinical sample:
diagnosis of schizophrenia or bipolar I disorder, diagnosis
of severe organic disease, diagnosis or history of substance
dependence, diagnosis of mental retardation or developmental
disorder, and currently receiving psychological treatment for
PD/PDA. For the non-clinical samples: History or currently
suffering any psychiatric disorder (this was assessed by a
question in the assessment protocol). Additionally, to divide the
non-clinical sample between those with high or low AS, as the
ASI (Reiss et al., 1986) does not provide a cut-off score, we used
the range offered by Peterson and Reiss (1992) for non-clinical
population, between 14.2 and 22.5 to set the cut-off at 23.
Participants who score equal to or higher than 23 were assigned
to the non-clinical with high AS sample and participants with
lower scores than 23 were assigned to the non-clinical with low
To analyze the data, parametric statistics were used from
the Statistical Package for Social Sciences (SPSS) 19.0 (SPSS
19.0, SPSS Inc, Chicago, IL). To compare the samples regarding
demographics, chi-square statistic was used with categorical
variables, and analysis of variance (ANOVA) was used to compare
means. ANOVAs were performed to compare the clinical
sample and the other study groups in the different measures.
(n = 253)
n = 80 (17.22%)
n = 173 (68.38%)
Excluded (n = 28; 35%)
– Current depression (n = 5)
– Current psychological treatment (n = 13)
– Incomplete assessment (n = 10)
Excluded (n = 73; 42.19%)
– History of depression or anxiety disorder
(n = 31)
– Current depression or anxiety disorder (n
– Incomplete assessment (n = 16)
ASI scores <23
Assigned to low AS sample
ASI scores ≥23
Assigned to high AS sample
in low AS sample
n = 55 (31.79%)
in hihg AS sample
n = 45 (26.01%)
in clinical sample
n = 52 (65%)
Figure 1. Participant fl ow chart
Jorge Osma, Azucena García-Palacios, Cristina Botella and Juan Ramón Barrada
Homoscedasticity assumption was checked with Levene’s statistic.
When the hypothesis of equality of means was rejected, p-values
of the ANOVA were computed with the Welch and Brown
and Forsythe tests (in all the cases where variances were not
homogeneous, the conclusion of the hypothesis testing of equality
of means never changed with the common ANOVA test and the
robust alternatives). Post-hoc analyses were also performed.
The test selected was Tukey with a level of p<.05 to determine
statistical signifi cance. To set the effect size in mean comparisons,
Cohen’s d tests were performed.
As can be seen in Table 1, there were statistically signifi cant
differences between the samples in age, F(2, 149) = 4.412, p = .014,
adjusted R2 = .043, and employment status, χ2(6, N =152) = 17.88,
p = .007. These differences could be attributed mainly to the fact
that the high AS sample was composed of university students. The
mean and standard deviation of the ASI in the PD/PDA sample
were 30.67 (SD = 11.06), for the high AS sample 25.56 (SD = 2.17)
and for the non-clinical sample 10.49 (SD = 4.47).
Taking into account the results in personality traits, using 75
as the cut-off point, 44 participants (80%) in the non-clinical
sample with low AS presented personality traits in compulsive,
histrionic, narcissistic and avoidant scales. In the non-clinical
sample with higher AS, 40 participants (88.89%) obtained scores
indicating depressive, compulsive, avoidant, dependent and
histrionic personality traits. Finally, 48 participants (92.31%)
in the clinical sample obtained scores indicative of avoidant,
compulsive, histrionic and dependent personality traits. With
respect to the identifi ed PeD, using 85 as the cut-off point, 3
participants (21.43%) in the non-clinical sample with low AS
presented narcissistic, histrionic and obsessive PeD. Only 2
participants (14.28%) in the non-clinical sample with higher
AS presented obsessive and avoidant PeD, and 4 participants
(28.57%) in the PD/PDA sample presented histrionic, obsessive,
avoidant and paranoid PeD.
The ANOVAs showed statistically signifi cant differences in
the comparison between the three study samples in all the MCMI-
III personality pathology scales with the exception of antisocial
and compulsive. The post-hoc tests revealed that the differences
were only statistically signifi cant in the comparisons between the
PD/PDA and the non-clinical with high AS scores sample with
the non-clinical with low AS scores sample. Between the PD/PDA
and the high AS sample, there were no statistically signifi cant
differences in any personality disorder scale. Individuals with PD/
PDA, in comparison with the non-clinical with low AS sample,
showed signifi cant differences in all personality scales except
for the Antisocial and Compulsive scales. The high AS sample,
in comparison with the low AS sample, showed signifi cant
differences in all personality scales except for the Narcissistic,
Antisocial and Compulsive scales.
Finally, Table 3 shows the means obtained in the BSI (Derogatis
& Melisaratos, 1983) scales in the three samples and the comparison
among them. The scores of the non-clinical sample with low AS
were lower than the scores of the normative group provided by
the authors of the questionnaire, confi rming that participants
belonging to this group, although presenting high scores in some
of the personality pathology profi les of the MCMI-III (histrionic,
narcissistic, and compulsive), did not present signifi cant symptoms
of Axis I psychopathology. The average rating for the PD/PDA and
the high AS sample were very similar (signifi cant differences were
not found) except for the Phobic Anxiety and Paranoid Ideation
scales where signifi cant differences were found (p<.001 and p<.05,
respectively). The scores in the PD/PDA sample were signifi cantly
higher in Phobic Anxiety and lower in paranoid ideation than the
ones found in the high AS sample. The comparisons between the
PD/PDA and the high AS samples with the low AS sample offered
statistically signifi cant differences in all BSI scales with a high
effect size (ranging from 0.74 to 2.17).
Means, standard deviations, mean differences (Tukey’s statistical) signifi cance and effect size on the MCMI-III in the different study groups
Mean (SD) Mean (SD)Mean (SD)FDifferencedDifferenced Differenced
Squizoid43.82 (22.59) 42.82 (20.68)31.58 (19.33) 5.61***1.000.05 12.24** 0.58 11.24*0.56
Avoidant 53.78 (25.63)54.73 (20.31) 29.76 (25.23)18.20***-0.94 -0.0424.03*** 0.94 24.97***1.09
Depressive46.75 (21.46)49.35 (26.90)19.56 (18.40) 28.80***-2.60-0.1027.18*** 1.36 29.79***1.19
Dependent52.30 (22.30)54.02 (20.07)30.47 (19.48)21.14***-1.71 -0.0821.83***1.0423.55*** 1.19
Histrionic 46.94 (24.94)40.73 (22.38)59.25 (17.26)9.63*** 6.210.26-12.31*-0.57 -18.52***-0.93
Narcissistic 51.51 (15.30)54.75 (17.12)61.94 (17.40)5.51**-3.24-0.20-10.43***-0.64-7.19-0.42
Antisocial40.69 (20.65)46.29 (18.06)38.47 (20.97)1.95-5.59-0.2220.127.116.110.4
Agressive44.28 (19.24) 45.95 (19.66) 30.98 (21.71)8.53***-1.67-0.0813.31***0.6514.97***0.72
Compulsive57.84 (16.61)51.02 (20.09)59.40 (20.37)2.61 6.820.37 -1.55 -0.08-8.38-0.41
Negativistic46.30 (22.70) 52.89 (17.68)31.93 (18.95) 14.68***-6.58 -0.3214.38*** 0.69 20.96***1.14
Self-defeating38.80 (26.04) 41.27 (22.36)15.44 (18.09)21.30*** -2.46 -0.123.37*** 1.0425.83*** 1.27
Squizotypal39.36 (24.57)44.58 (21.49)17.02 (18.67) 23.62***-5.21 -0.2322.35***1.02 27.56***1.37
Borderline38.57 (20.32)47.53 (20.88) 19.04 (17.91) 27.99***-8.98-0.4319.52*** 1.0228.49***1.46
Paranoid40.13 (25.22)42.84 (25.73)24.60 (24.84)7.91*** -2.71-0.11 15.53**0.6218.24*** 0.72
* p<.05; ** p<.01; *** p<.005; AS: Anxiety Sensitivity
Personality disorders among patients with panic disorder and individuals with high anxiety sensitivity
The results obtained by several researchers in their quest to
determine whether there are specifi c personality pathology profi les
for PD/PDA are similar to those found in our study, which shows
that the more frequent personality pathology profi les in the PD/PDA
sample were avoidant, dependent and obsessive-compulsive (Albert
et al., 2006; Iketani et al., 2004; Marchesi et al., 2005, 2006).
The use of a non-clinical sample with high AS in the study
of personality characteristics in patients with PD/PDA has not
been included in any other study that we have reviewed; our work
represents a contribution in this regard. No statistically signifi cant
differences between PD/PDA and the high AS sample were found
when using the MCMI-III. These results support the new proposals
in the conceptualization and classifi cation of emotional disorders,
which states that there are basic characteristics common to all,
indicating a dimensional structure of the emotional disorders
(Brown & Barlow, 2009). It could be that people belonging to the
high AS sample share with the clinical group a vulnerability to
suffer emotional disorders. If the characteristics of personality
and AS were similar in both groups, we may have evaluated those
individuals at a time when the disorder had not yet been activated.
In our study, the high AS sample is younger than the clinical group,
and it could be argued that the differences found between these
groups could be explained by this age difference (maybe the high
AS sample was too young to have developed PD/PDA). However,
the studies that have attempted to fi nd clinical differences in PD/
PDA depending on the age of onset have used 18 (Seguí et al.,
1999), 20 (Goldstein, Wickramaratne, Horwath, & Weismann,
1997) or 25 years old (Iketani et al., 2004) to determine the early
or late onset of the disorder. Given that the mean age of the high
AS sample is almost 27 years (26.9), we could say that they have
exceeded the usual age of onset of PD/PDA.
The similarity of personality characteristics between the
two groups may indicate that the high AS sample could have
“protective” factors for the development of the PD/PDA. If we
consider the diathesis-stress models, in spite of having psychological
vulnerability factors, stressful life events are necessary to develop
a psychological disorder. Perhaps participants in our sample with
high SA have not suffered major life stressors or have managed
to deal with them through psychological (emotional regulation
strategies) and social resources. It would be interesting to conduct
a more extensive and detailed assessment of this sample to help
identify which aspects make the difference between the high AS
sample and the clinical sample. These fi ndings would be of great
importance fi rst, to identify individuals at risk, second, to implement
preventive programs, third, to help clinicians to improve the
assessment and treatment protocols, and fi nally, to improve effi cacy
and effectiveness of the clinical interventions for PD/PDA.
We found no signifi cant differences among the three groups
regarding two personality pathology scales, Antisocial and
Compulsive. From a dimensional perspective, it would not be
surprising to obtain high scores on personality pathology in
individuals without a diagnosis of personality disorder or Axis
I disorders, because a more complete clinical assessment should
consider other aspects such as interference, frequency, distress,
number and intensity of symptoms or severity. It would be
interesting to study whether specifi c personality pathology profi les
appear more frequently in the normal population. If this option
were true, we might consider whether some personality pathology
traits may be being reinforced in our society, causing, on one hand,
a higher prevalence of these disorders and, on the other, a growing
standardization of them. For example, the promotion in our society
of individualism, competitiveness or fast success could lead to
histrionic, compulsive or narcissistic patterns of functioning that
could somehow be socially supported.
The scores obtained in the BSI indicated that the high AS sample
presented a similar profi le of psychopathology than the PD/PDA
group in all scales but Phobic Anxiety and Paranoid Ideation. PD/
PDA patients scored higher (p<.001) in phobic anxiety and lower
(p<.05) in paranoid ideation. The Paranoid Ideation scale refers to
feelings of distrust, suspicion, irritability, and delusions ideation.
The Phobic Anxiety scale includes aspects such as panic attacks
or intense fear associated with agoraphobic situations. This factor
would essentially include symptoms related to PDA (APA, 1994).
In view of these results, we could argue that moderate scores on
the ASI failed to infl uence the phobic anxiety scores. These data
support the idea that AS is a vulnerability factor, but there are
other variables like phobic anxiety that could be a key element in
the development of anxiety psychopathology.
As hypothesized, participants with high AS not only presented
one vulnerability factor for developing a emotional disorder such
PD/PDA, that is AS (Schmidt et al., 2010; Weems et al., 2007), but
they also presented another source of vulnerability, personality
disorder traits. The neuroticism/negative affect construct raised
by Brown and Barlow’s model (2009) is observed, according to
Means and standard deviations on normative data, means, standard deviations, mean differences (Tukey’s statistical), signifi cance and effect size on the Brief Symptom
Inventory in the different study groups
Mean (SD) Mean (SD)Mean (SD)F DifferencedDifferenced Differenced
Depression 6.04 (6.53)7.68 (6.88)10.55 (6.88)11.69 (7.11)4.67 (4.77)17.98*** -1.14 -0.165.88*** 0.997.02***1.16
Phobic anxiety1.37 (2.55)2.47 (3.55)10.57 (6.26)4.08 (3.34)0.69 (1.47) 74.32***6.49*** 1.299.89***2.17 3.39***1.31
Paranoid ideation 6.98 (6.16)7.82 (6.52)7.13 (5.08)9.66 (6.37)3.61 (3.41) 17.39*** -2.53* -0.44 3.52*** 0.81 6.05*** 1.18
Obsession-compulsion 6.56 (6.00)7.83 (6.52)12.19 (6.46)12.00 (6.76) 4.69 (4.05)28.23*** 0.19 0.03 7.50***1.39 7.31***1.31
Somatization3.79 (3.64)5.32 (4.02) 10.01 (5.48) 8.30 (4.51) 2.76 (2.41)41.39*** 1.71 0.347.25*** 1.71 5.54***1.53
Hostility/Aggressivity2.77 (2.89) 2.71 (3.04)2.88 (3.31)3.05 (3.34) 0.94 (1.64)8.72***-0.17-0.05 1.94*** 0.742.11*** 0.8
ª Reported by Ruipérez et al. (2001); * p<.05; ** p<.01; *** p<.005; AS: Anxiety Sensitivity
Jorge Osma, Azucena García-Palacios, Cristina Botella and Juan Ramón Barrada
this preliminary work, not only in PD/PDA patients, but also
in people with no diagnosis on Axis I or II but with a similar
psychopathology profi le, characterized specially by: (a) high scores
on the ASI, (b) high scores on depression, obsession, and paranoid
psychopathology scales of BSI, and (c) avoidant, dependent and
narcissistic personality traits. Other studies will be required, with
clinical and larger high AS samples, to confi rm the preliminary
results presented in this paper. In addition, it will require more
comprehensive assessment of high AS samples to identify
protective factors that prevent the onset of PD/PDA disorders.
Finally, this research should include longitudinal studies that
prove that the vulnerability factors identifi ed in high AS samples
trigger the onset of PD/PDA disorders and whether preventive
interventions could prevent the activation of psychopathological
processes related to anxiety that trigger a PD/PDA disorder.
This study has some limitations. First, the small sample size of
the different samples and the differences observed in demographic
factors suggest caution in the generalization of our results. Second,
it would be necessary to evaluate the absence of Axis I disorders
with clinical structured interviews such as the ADIS-IV in the
non-clinical samples. Finally, it would be interesting to conduct
a more extensive and detailed assessment of the non-clinical
samples to help identify which aspects make a difference between
the high AS sample and the clinical sample.
Funded by Gobierno de Aragón (Dpt. Industria e Innovación),
Fondo Social Europeo and Ministerio de Economía y Competi-
tividad (Spain), Plan Nacional (PSI2010-21423/PSIC).
Albert, U., Maina, G., Bergesio, C., & Bogetto, F. (2006). Axis I and II
comorbidities in subjects with and without nocturnal panic. Depression
and Anxiety, 23, 422-428.
American Psychiatric Association (2000). Diagnostic and Statistical
Manual of Mental Disorders (4th ed., text rev.). Washington, DC:
Antony, M.M., & Swinson, R.P. (2000). Phobic disorders and panic in
adults: A guide to assessment and treatment. American Psychological
Association. Washington, D.C.
Barlow, D.H. (1991). Disorders of emotion. Psychological Inquiry, 2, 58-71.
Barlow, D.H. (2002). Anxiety and its disorders: The nature and treatment
of anxiety and panic, 2nd ed. New York: Guildford Press.
Bienvenu, O.J., Stein, M.B., Samuels, J.F., Onyike, U.C., Eaton, W.W.,
& Nestadt, G. (2009). Personality disorder traits as predictors of
subsequent fi rst-onset panic disorder or agoraphobia. Comprehensive
Psychiatry, 50, 209-214.
Blanco, C., Rubio, J.M., Wall, M., Secades-Villa, M., Beesdo-Baum, K.,
& Wang, S. (2013). The latent structure and comorbidity patterns of
generalized anxiety disorder and major depression disorder: A national
study. Depression and Anxiety, 00, 1-9.
Brown, T.A. (2007). Temporal and structural relationships among
dimensions of temperament and DSM-IV anxiety and mood disorder
constructs. Journal of Abnormal Psychology, 116, 313-328.
Brown, T.A., & Barlow, D.H. (2009). A proposal for a dimensional
classifi cation system based on the shared features of the DSM-
IV anxiety and mood disorders: Implications for assessment and
treatment. Psychological Assessment, 21, 256-271.
Brown, T.A., DiNardo, P., & Barlow, D.H. (1994). Anxiety Disorders
Interview Shedule for DSM-IV. Psychological Corporation. San
Campbell-Sills, L., & Barlow, D.H. (2007). Incorporating emotion
regulation into conceptualizations and treatments of anxiety and mood
disorders. In Gross, J.J. (Ed.), Handbook of Emotion Regulation.
Guildford Press. New York, NY.
Cardenal, V., & Sánchez, M.P. (2007). Adaptación y baremación al
español del Inventario Clínico Multiaxial de Millon-III (MCMI-III).
TEA, Ediciones. Madrid.
Carrera, M, Herrán, A., Ramírez, M.L., Ayestarán, A., Sierra-Biddle,
D., Hoyuela, F., ..., Vázquez-Barquero, J.L. (2006). Personality traits
in early phases of panic disorder: Implications on the presence
of agoraphobia, clinical severity and short-term outcome. Acta
Psychiatrica Scandinavica, 114, 417-425.
Derogatis, L.R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An
introductory report. Psychological Medicine, 13, 595-605.
Drost, J., Van der Does, A.J.W., Antypa, N., Zitman, F.G., Van Dyck, R.,
& Spinhoven, P. (2012). General, specifi c and unique cognitive factors
envolved in anxiety and depresión disorders. Cognitive Therapy and
Research, 36, 621-633.
Goldstein, R.B., Wickramaratne, P.J., Horwath, E., & Weismann, M.M.
(1997). Familial aggregation and phenomenology of ’early’-onset (at
or before age 20 years) panic disorder. Archives of General Psychiatry,
Gross, J.J. (2007). Handbook of emotion regulation. Guildford Press. New
Iketani, T., Kiriike, N., Stein, M.B., Nagao, K., Minamikawa, N, Shidao,
A., & Fukuhara, H. (2004). Patterns of Axis II comorbidity in early-
onset versus late-onset panic disorder in Japan. Comprehensive
Psychiatry, 45, 114-120.
Kotov, R., Gamez, W., Schmidt F., & Watson, D. (2010). Linking “big”
personality traits to anxiety, depressive, and substance use disorders:
A meta-analysis. Psychological Bulletin, 136, 768-821.
Maller, R.G., & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic
attacks in 1987. Journal of Anxiety Disorders, 6, 241-247.
Marchesi, C., Cantón, A., Fonito, S., Giannelli, M.R., & Maggini, C.
(2005). The effect of pharmacotherapy on personality disorders in
panic disorder: A one year naturalistic study. Journal of Affective
Disorders, 89, 189-194.
Marchesi, C., De Panfi lis, C., Cantón, A., Fonito, S., Giannelli, M.R., &
Maggini, C. (2006). Personality disorders and response to medication
treatment in panic disorder: A 1-year naturalistic study. Progress in
Neuro-Psychopharmacology and Biological Psychiatry, 30, 1240-1245.
Millon, T., Davis, R., & Millon, C. (2007). MCMI-III Inventario Clínico
Multiaxial de Millon-III. Manual. TEA Ediciones: Madrid.
Peterson, R.A., & Reiss, R.J. (1992). Anxiety Sensitivity Index Manual
(2nd ed.). Worthington, OH: International Diagnostic Systems.
Plehn, K., & Peterson, RA. (2002). Anxiety sensitivity as a predictor of the
development of panic symptoms, panic attacks, and panic disorder: A
prospective study. Journal of Anxiety Disorders, 16, 455-474.
Reiss, S., Peterson, R.A., Gursky D.M., & McNally, R.J. (1986). Anxiety
sensitivity, anxiety frequency, and the prediction of fearfulness.
Behaviour Research and Therapy, 24, 1-8.
Ruipérez, M.A., Ibáñez, M.I., Lorente, E., Moro, M., & Ortet, G. (2001).
Psychometric properties of the Spanish version of the BSI. Contributions
to the relationship between personality and psychopathology. European
Journal of Psychological Assessment, 17, 241-250.
Sandín, B., Chorot, P., & McNally, R.J. (1996). Anxiety Sensitivity Index:
Normative data and its differentiation from trait anxiety. Behaviour
Research and Therapy, 39, 213-219.
Schmidt, N.B., Keough, M.E., Mitchell, M.A., Reynolds, E.K.,
MacPherson, L., Zvolensky, M.J., & Lejuez, C.W. (2010). Anxiety
sensitivity: Prospective prediction of anxiety among early adolescents.
Journal of Anxiety Disorders, 24, 503-508.
Personality disorders among patients with panic disorder and individuals with high anxiety sensitivity Download full-text
Seguí, J., Márquez, M., García, L., Canet, J., Salvador-Carulla, L., & Ortiz,
M. (1999). Differential clinical features of early-onset panic disorder.
Journal of Affective Disorders, 54, 109-117.
Starcevic, V., Latas, M., Kolar, D., Vucinic-Latas, D., Bogojevic, G., &
Milovanovic, S. (2008). Co-occurrence of Axis I and Axis II disorders
in female and male patients with panic disorder with agoraphobia.
Comprehensive Psychiatry, 49, 537-543.
Telch, M.J., Kamphuis, J.H., & Schmidt, N.B. (2011). The effects of
comorbid personality disorders on cognitive behavioral treatment for
panic disorder. Journal of Psychiatric Research, 45, 469-474.
Weems, C.F., Costa, N.M., Watts, S.E., Taylor, L.K., & Cannon, M.F.
(2007). Anxiety control beliefs their unique and specifi c associations
with childhood anxiety symptoms. Behavior Modifi cation, 31, 174-