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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    • "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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    • "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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    • "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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