Christina J. Riccardi

Anxiety disorders and suicidality in the National Comorbidity Survey-Replication

OBJECTIVE The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide. METHOD Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed. RESULTS Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men. CONCLUSIONS Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.

Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication

Research has accumulated over the past several years demonstrating a relationship between childhood abuse and anxiety disorders. Extant studies have generally suffered from a number of methodological limitations, including low sample sizes and without controlling for psychiatric comorbidity and parental anxiety. In addition, research has neglected to examine whether the relationships between anxiety disorders and childhood abuse are unique to physical abuse as opposed to sexual abuse and vice versa. The current study sought to examine the unique relationships between anxiety disorders and childhood physical and sexual abuse using data from the National Comorbidity Survey-Replication. Participants (n=4141) completed structured interviews from which data on childhood abuse history, lifetime psychiatric history, parental anxiety, and demographics were obtained. After controlling for depression, other anxiety disorders, and demographic variables, unique relationships were found between childhood sexual abuse and social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD); in contrast, physical abuse was only associated with PTSD and specific phobia (SP). Further, among women, analyses revealed that physical abuse was uniquely associated with PTSD and SP, while sexual abuse was associated with SAD, PD, and PTSD. Among men, both sexual and physical abuse were uniquely associated with SAD and PTSD. Findings provide further evidence of the severe consequences of childhood abuse and help inform etiological accounts of anxiety disorders.

Anxiety Symptomatology: The Association With Distress Tolerance and Anxiety Sensitivity

Research focused on psychological risk factors for anxiety psychopathology has led to better conceptualization of these conditions as well as pointed toward preventative interventions. Anxiety sensitivity (AS) has been well-established as an anxiety risk factor, while distress tolerance (DT) is a related construct that has received little empirical exploration within the anxiety psychopathology literature. The current investigation sought to extend the existing literature by examining both DT and the relationship between DT and AS across a number of anxiety symptom dimensions, including panic, generalized anxiety, social anxiety, and obsessive-compulsive anxiety. Participants (N=418) completed a number of measures that assessed DT, AS, anxiety symptomatology, and negative affect. Findings indicated that DT was uniquely associated with panic, obsessive compulsive, general worry, and social anxiety symptoms, but that DT and AS were not synergistically associated with each of these symptom dimensions. These findings indicate that an inability to tolerate emotional distress is associated with an increased vulnerability to experience certain anxiety symptoms.

Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality

Excessive reassurance-seeking (ERS) is hypothesized to play a key role in emotional disorders but has been studied mostly in relation to depression. Study 1 reports a new measure of reassurance seeking that assessed ERS related to general and evaluative threats in a non-clinical student sample, and its factor structure was further examined in Study 2. In Study 3, the scale, along with other symptom-related measures and an existing measure of depressive ERS, was administered to an undergraduate sample at two different time points, one month apart. Greater ERS was associated with greater symptoms of social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder (OCD), even after controlling for trait anxiety, depression, and intolerance of uncertainty. Among OCD symptoms, only thoughts of harm were uniquely related to ERS, a finding consistent with emerging literature. ERS involving general threats also predicted changes in social anxiety and GAD symptoms one month later. Overall, the findings implicate an important role for ERS across anxiety disorders.

A Taxometric Exploration of the Latent Structure of Hoarding.

Despite controversy regarding the classification and diagnostic status of hoarding disorder, there remains a paucity of research on the nosology of hoarding that is likely to inform the classification debate. The present investigation examined the latent structure of hoarding in three, large independent samples. Data for three well-validated measures of hoarding were subjected to taxometric procedures, including MAXimum EIGenvalue, Mean Above Minus Below A Cut, and Latent-Mode factor. Two symptom measures, one of which closely mirrors the proposed diagnostic criteria for hoarding disorder, and a measure of hoarding beliefs were analyzed. Sample 1 (n=2,501) was representative of the general German population, while Samples 2 (n=1,149) and 3 (n=500) consisted of unselected undergraduate students. Findings across all three samples and taxometric procedures provided converging evidence that hoarding is best conceptualized as a dimensional construct, present in varying degrees in all individuals. Results have implications across research and treatment domains, particularly with respect to assessment approaches, treatment response determination, and policy decisions. These findings underscore the need for further investigations on the nosology of hoarding, to help validate this construct as we move forward with respect to our research and treatment efforts, as well as the potential inclusion of hoarding disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2012).

Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: a comparison of three models.

Emerging work has identified several related constructs that appear to be relevant to anxiety psychopathology including anxiety sensitivity (AS), distress tolerance (DT) and discomfort intolerance (DI). AS refers to the fear of the consequences of anxiety-related sensations. DT measures tolerance of negative emotions, whereas DI measures tolerance of uncomfortable physical sensations. Questions, however, have been raised regarding the overlap among AS, DT, and DI. The present study conducted confirmatory factor analyses to test three models of emotional and physical tolerance to determine which model provided the best fit for the associations among AS, DT, and DI. Nonclinical individuals (N = 411) and individuals with anxiety psychopathology (N = 253) completed self-report questionnaires. Results supported a hierarchical factor structure with 2 higher order factors with AS as a lower order factor of DT. The implications of these findings for the conceptualization of the relationships among AS, DT, and DI are discussed.

Rats avoid high magnetic fields: Dependence on an intact vestibular system

High strength static magnetic fields are thought to be benign and largely undetectable by mammals. As magnetic resonance imaging (MRI) machines increase in strength, however, potential aversive effects may become clinically relevant. Here we report that rats find entry into a 14.1 T magnet aversive, and that they can detect and avoid entry into the magnet at a point where the magnetic field is 2 T or lower. Rats were trained to climb a ladder through the bore of a 14.1 T superconducting magnet. After their first climb into 14.1 T, most rats refused to re-enter the magnet or climb past the 2 T field line. This result was confirmed in a resistive magnet in which the magnetic field was varied from 1 to 14 T. Detection and avoidance required the vestibular apparatus of the inner ear, because labyrinthectomized rats readily traversed the magnet. The inner ear is a novel site for magnetic field transduction in mammals, but perturbation of the vestibular apparatus would be consistent with human reports of vertigo and nausea around high strength MRI machines.

A meta-analysis of the effectiveness of placebo manipulations in alcohol-challenge studies

Our meta-analysis examined the impact of specific alcohol placebo procedures on two manipulation checks (participant reports of number of alcohol drinks consumed and subjective intoxication) to determine which procedures produced the smallest effect sizes in comparisons between alcohol and placebo conditions. Databases for the years 1990-2007 yielded 44 studies that met inclusion criteria. These were subjected to detailed coding of procedures pertinent to placebo effectiveness. Alcohol versus placebo condition comparisons generally produced large effect sizes for both manipulation checks, but they were moderated by double-blind procedures and by peak breath-alcohol concentration (BrAC) attained in the alcohol condition. Other procedures moderated only the estimated number of alcohol drinks consumed. Implications for selection and assessment of alcohol placebo manipulations and for interpretability of experiments using them are discussed.

Suppression of drinking by exposure to a high-strength static magnetic field

High-strength static magnetic fields of 7 T and above have been shown to have both immediate and delayed effects on rodents, such as the induction of locomotor circling and the acquisition of conditioned taste aversions. In this study, the acute effects of magnet field exposure on drinking were examined. Exposure to a 14.1-T magnetic field for as little as 5 min significantly decreased the amount of a glucose and saccharin solution (G+S) consumed by water-deprived rats over 10 min. The decreased intake could be accounted for largely, but not entirely, by an increase in the latency of magnet-exposed rats to initiate drinking. When intake was measured for 10-60 min after the initiation of drinking, thus controlling for increased latency, magnet-exposed rats still consumed less G+S than sham-exposed rats. The increased latency was not due simply to an inability of magnet-exposed rats to reach the elevated sipper tube of the G+S bottle, providing rats with long tubes that could be reached without raising their heads normalized intake but latency was still increased. The increased latency and decreased intake appeared to be secondary to somatic effects of magnet exposure, however, because during intraoral infusions magnet-exposed rats consumed the same amount of G+S with the same latency to reject as sham-exposed rats. The suppression of drinking by magnetic field exposure is consistent with the acute effects of other aversive stimuli, such as whole-body rotation, on short-term ingestion. These results add to the evidence that high-static strength magnetic fields can have behavioral effects on rodents.

A Case Study Perspective on the Importance of Motivation in the Treatment of Obsessive Compulsive Disorder

Up until three decades ago, obsessive-compulsive disorder (OCD) was deemed treatment resistant—an incurable and chronic disease. However, advent of specific behavioral techniques and new pharmacological agents (serotonin reuptake inhibitors) has altered this course and brought effective relief for many OCD patients. Nonetheless, a substantial number of individuals with OCD are treatment resistant and an even greater number refuse treatment or drop out prematurely. The cognitive-behavioral treatment of a 39-year-old male with OCD is described in this case study. Motivational interviewing (MI) techniques were integrated into treatment to increase adherence, particularly exposure exercises. Frequency and duration of compulsive behaviors were measured over the course of treatment and standard assessment measures were used to assess the severity of OCD symptoms. At posttreatment and follow-up a clinically significant improvement was demonstrated for OCD symptoms. Implications of these data are reviewed, and recommendations about inclusion of MI techniques for clinicians who intend on treating OCD are provided.