Interpersonal Subtypes Within Generalized Anxiety Disorder

Department of Psychosomatic Medicine and Psychotherapy, Georg-August-University Goettingen, Germany.
Journal of Personality Assessment (Impact Factor: 1.84). 06/2008; 90(3):292-9. DOI: 10.1080/00223890701885076
Source: PubMed


In this study, we addressed the heterogeneity in interpersonal problems across patients with generalized anxiety disorder (GAD). We assessed interpersonal problems by the Inventory of Interpersonal Problems (IIP–C; Horowitz, Alden, Wiggins, & Pincus, 200023.

Horowitz , L. M. ,
Alden , L. E. ,
Wiggins , J. S. and
Pincus , A. L. 2000. Inventory of interpersonal problems manual, San Antonio, TX: Psychological Cooperation. View all references) in a sample of 78 GAD patients. We used IIP–C profiles describing interpersonal characteristics of the total GAD sample as well as clustered GAD interpersonal subtypes. Although the overall sample was located in the friendly submissive quadrant of the circumplex model, this was true only for the Exploitable cluster, which includes more than 50% of the patients. Importantly, clusters of GAD patients with other locations reporting predominantly Cold, Nonassertive, or Intrusive interpersonal problems were also identified. The 4 clusters did not differ in terms of gender, comorbid disorders, or the severity of depression or anxiety. Thus, the assessment of interpersonal problems provides additional diagnostic information covering the heterogeneity of GAD patients. This information could be used for differential indication and individual case formulation in GAD.

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    • "The scale consists of 10 items to be answered using a 6-point Likert scale (1 " applies completely " to 6 " does not apply at all " ). 4. Interpersonal problems and Attachment: The German version of the Inventory of Interpersonal Problems (IIP-D) measures self-rated difficulties with other people. Sixty-four items are subsumed under eight scales (eight items each related to the interpersonal circumplex): overly domineering, vindictive, cold, socially avoidant, nonassertive, exploitable, nurturant, and intrusive[20,33,34]. In order to reduce the number of variables, only the two major dimensions of the interpersonal circle were analysed[35]. "
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    ABSTRACT: Objectives: Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. Research design and methods: In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Results: Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. Conclusions: We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Trial registration:
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "), generalized anxiety disorder (Przeworski et al., 2011; Salzer et al., 2008), posttraumatic stress disorder (Thomas et al., 2014), and eating pathology (Ambwani & Hopwood, 2009; Hopwood, Clarke, & Perez, 2007). Interpersonal pathoplasticity has also been used to predict variability in response to psychotherapy within a disorder (Cain et al., 2010). "
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    ABSTRACT: The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.
    Full-text · Article · Mar 2015 · Journal of Personality Assessment
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    • "Those with GAD also have relational processes marked by difficulty balancing individuality and togetherness. For example, Salzer et al. (2008) found four aggregate interpersonal style groups of GAD: intrusive, exploitable, cold and nonassertive. Salzer, Pincus, Winkelbach, Leichsenring, and Leibing (2011)found four groups, but with a slightly different clustering pattern: overly nurturant , modestly nurturant, socially avoidant, and nonassertive. "
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    ABSTRACT: Many individuals with generalized anxiety disorder (GAD) do not respond well to currently available treatments. Moreover, treatments are less effective when GAD is accompanied by romantic relationship distress. In order to develop effective treatments for GAD and relationship distress, it is necessary to conduct theory-based research to identify links common to both GAD and romantic relationship distress. Drawing on Bowen's family systems theory, the roles of family abuse/violence and differentiation in GAD and romantic relationship distress were examined using existing data from the National Comorbidity Survey Replication (n = 2,312; 2005). As predicted, family abuse/violence was directly linked to both GAD and romantic relationship distress. Differentiation mediated the relationship between family abuse/violence and GAD, and partially mediated the relationship between family abuse/violence and romantic relationship distress. Findings suggest that current and past relationship processes may help maintain chronic anxiety and that Bowen's theory may be a useful framework for developing couple therapy treatment of GAD and romantic relationship distress.
    Full-text · Article · Dec 2013 · Journal of Marital and Family Therapy
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