Risa B. Weisberg

Clinical features of body dysmorphic disorder in adolescents and adults

Body dysmorphic disorder (BDD) usually begins during adolescence, but its clinical features have received little investigation in this age group. Two hundred individuals with BDD (36 adolescents; 164 adults) completed interviewer-administered and self-report measures. Adolescents were preoccupied with numerous aspects of their appearance, most often their skin, hair, and stomach. Among the adolescents, 94.3% reported moderate, severe, or extreme distress due to BDD, 80.6% had a history of suicidal ideation, and 44.4% had attempted suicide. Adolescents experienced high rates and levels of impairment in school, work, and other aspects of psychosocial functioning. Adolescents and adults were comparable on most variables, although adolescents had significantly more delusional BDD beliefs and a higher lifetime rate of suicide attempts. Thus, adolescents with BDD have high levels of distress and rates of functional impairment, suicidal ideation, and suicide attempts. BDDs clinical features in adolescents appear largely similar to those in adults.

Chronicity in posttraumatic stress disorder and predictors of the course of posttraumatic stress disorder among primary care patients.

The present study examined the course of posttraumatic stress disorder (PTSD) in a sample of 84 primary care patients. More specifically, this study investigated the role of Axis I comorbidity, psychosocial impairment, and treatment participation in the maintenance of an episode of chronic PTSD and whether patients at follow-up met criteria for PTSD (full remission) or continued to exhibit residual PTSD symptoms and impairment (partial PTSD). Diagnostic structured interviews established all clinical diagnoses and information on the course of anxiety disorder symptoms, psychosocial functioning, and treatment status. Using a prospective, longitudinal design, this study found that during the first 2 years of follow-up, the probability of no longer meeting full DSM-IV criteria for PTSD was .69, and .18 for full remission from PTSD. The number of comorbid anxiety disorders and degree of psychosocial impairment at intake were significantly related to remission status (i.e., full and partial PTSD). This study suggests that, in a primary care setting, PTSD is a persistent illness, and that many subjects who have recovered from PTSD continue to suffer from subthreshold symptoms of PTSD.

Age of onset, clinical characteristics, and 15-year course of anxiety disorders in a prospective, longitudinal, observational study.

BACKGROUND Age of onset is rarely studied in the anxiety disorders literature. The current study examined age of onset as it relates to clinical characteristics and course of anxiety disorders using a prospective, longitudinal, observational design. METHODS Fifteen-year follow-up data were examined for participants with panic disorder with (PDA) or without (PD) agoraphobia, social phobia (SP), and/or generalized anxiety disorder (GAD) at baseline. Logistic regression analyses were conducted to determine whether age of onset was associated with demographic or clinical variables at baseline. Cox regression analyses were conducted to examine longitudinal course (time to recurrence and recovery, respectively) for each diagnostic group. RESULTS At baseline, PD participants with early onset (i.e., < age 20) were more likely to have comorbid MDD, GAD, and SP relative to late-onset participants (≥ age 20). For PDA, early-onset participants were less likely to be married, and more likely to have both GAD and SP at baseline. With respect to longitudinal course, earlier onset was associated with an increased likelihood of recurrence in participants with PDA. No other models reached significance. LIMITATIONS The sample sizes for some disorders were comparatively small in relation to PDA, and all participants were treatment-seeking, which may limit generalizability. CONCLUSIONS For some anxiety disorders, earlier age of onset appears to be associated with greater severity and worse course, as evidenced by increased risk of recurrence over 15years of follow-up. Early interventions focused on children and adolescents may alleviate some of the public health burden associated with anxiety disorders.

The relationship between sleep disturbance and the course of anxiety disorders in primary care patients

This study examined the relationship between sleep disturbance and the course of anxiety disorders in primary care patients. Participants were part of the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in primary care. Participants completed an intake evaluation and follow-up assessments at 6 months, 12 months, and annually thereafter. Only participants with sleep data at intake were included in the current study (n=533). The majority (74%) reported experiencing sleep disturbance at intake. Those with a diagnosis of generalized anxiety disorder (GAD) or post-traumatic stress disorder (PTSD) were over 2 times more likely to have sleep problems. Sleep disturbance at intake did not relate to the longitudinal course of GAD, social phobia, panic disorder, or obsessive-compulsive disorder. However, it did predict the course of PTSD, controlling for comorbid major depressive disorder (MDD) and having more than one anxiety disorder diagnosis intake, those with sleep disturbance at intake being less likely to remit from PTSD in the 5 years of follow-up. By year 5, only 34% of those with sleep problems at intake remitted from PTSD whereas 56% of those without sleep disturbance remitted from the disorder. The findings suggest that sleep disturbance in PTSD may have prognostic significance and may be important to address in clinical interventions.

Health-related Quality of Life across the anxiety disorders: findings from a sample of primary care patients.

Previous studies have not compared Health-related Quality of Life (HR-QoL) across all DSM-IV anxiety disorders and comorbid conditions. We compared the effects of each anxiety disorder on HR-QoL, controlling for demographic variables, medical conditions, and comorbid Axis I disorders. Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in 539 primary care patients. Each of the anxiety disorders was associated with worse self-reported physical and mental functioning compared to general population means. While all of the anxiety disorders were univariate predictors of specific domains of HR-QoL, only presence of Post-traumatic Stress Disorder (PTSD) and comorbid Depressive Disorder (MDD) uniquely predicted worse functioning on both self-report and interview measures. The current study extends previous research by showing that different anxiety disorders and comorbid conditions may be associated with impairment in specific domains of HR-QoL.

Characteristics and predictors of full and partial recovery from generalized anxiety disorder in primary care patients.

The current study examined the naturalistic course of generalized anxiety disorder (GAD) in a sample of 113 primary care patients across a 2-year period. Initial diagnoses were established using structured clinical interviews according to DSM-IV diagnostic criteria. Results indicated that the majority of patients meeting DSM-IV diagnostic criteria for GAD were still symptomatic to some degree after 2 years of follow-up. Rates of full and partial recovery from GAD, however, were found to be higher than those reported for previous studies of GAD in psychiatric patients. Diagnostic comorbidity, severity of psychosocial impairment, and gender were found to be significantly associated with achieving full or partial recovery from GAD. Psychiatric treatment was not found to be associated with time to full or partial recovery from GAD symptoms, likely due to a treatment-biasing effect. These results underscore that GAD is a chronic and persistent illness in primary care patients.

Determinants of sexual arousal and the accuracy of its self‐estimation in sexually functional males

Men with and without sexual dysfunction present with varying patterns of agreement between subjective estimates of sexual arousal and more objective psychophysiological measures of the same construct. This relative accuracy seems to be associated with sexual function, with men who have sexual dysfunction presenting less accurate estimations (mostly reporting below measured arousal levels). The purpose of this study is to clarify the processes underlying sexual arousal and the accuracy of its self‐estimation. We looked at potential predictors of sexual arousal (subjective and physiological) and accuracy in estimating objective sexual arousal in a sample of 60 sexually functional males. Predictors included pre‐existing sexual attitudes (erotophobia), both trait and state positive and negative affect, self‐focused attention, and interoceptive awareness. Results indicate that this sexually functional sample generally reported below their own erection level. Interestingly, trait negative affect was associated with somewhat lower levels of subjective arousal and higher levels of physiological arousal. On the other hand, state positive affect facilitated both subjective and objective arousal and increased somewhat the accuracy of estimates of erectile responding. Pre‐existing sexual attitudes as well as variations in self‐focused attention and interoceptive awareness evidenced little effect on sexual arousal or the accuracy of its estimation.

Screening and treatment of anxiety disorders in pregnant and lactating women

Untreated anxiety disorders during pregnancy and the postpartum period may pose significant risks to the unborn fetus and interfere with a mothers ability to properly care for her newborn child. As the symptoms of anxiety disorders are often similar to those found in pregnancy, careful screening for anxiety disorders in pregnant women is essential. For women suffering from anxiety disorders during or after pregnancy, safe and effective treatment is needed. In this article, suggestions are offered for thorough assessment of anxiety disorders in pregnant and breastfeeding women. Treatment options are discussed with an emphasis on pharmacologic and cognitive-behavioral treatment.

Longitudinal course of obsessive-compulsive disorder in patients with anxiety disorders: a 15-year prospective follow-up study

BACKGROUND Although obsessive-compulsive disorder (OCD) is typically described as a chronic condition, relatively little is known about the naturalistic, longitudinal course of the disorder. The purpose of the current study was to examine the probability of OCD remission and recurrence as well as to explore demographic and clinical predictors of remission. METHODS This study uses data from the Harvard/Brown Anxiety Disorders Research Program, which is a prospective, naturalistic, longitudinal study of anxiety disorders. Diagnoses were established by means of a clinical interview at study intake. One hundred thirteen Harvard/Brown Anxiety Disorders Research Program participants with OCD were included in the study; all had a history of at least 1 other anxiety disorder. Assessments were conducted at 6-month and/or annual intervals during 15 years of follow-up. RESULTS Survival analyses showed that the probability of OCD remission was .16 at year 1, .25 at year 5, .31 at year 10, and .42 at year 15. For those who remitted from OCD, the probability of recurrence was .07 at year 1, .15 by year 3, and by year 5, it reached .25 and remained at .25 through year 15. In predictors of course, those who were married and those without comorbid major depressive disorder (MDD) were more likely to remit from OCD. By year 15, 51% of those without MDD remitted from OCD compared to only 20% of those with MDD. CONCLUSIONS In the short term, OCD appears to have a chronic course with low rates of remission. However, in the long term, a fair number of people recover from the disorder, and, for those who experience remission from OCD, the probability of recurrence is fairly low.

Socially Anxious Primary Care Patients’ Attitudes toward Cognitive Bias Modification (CBM): A Qualitative Study

BACKGROUND Cognitive bias modification (CBM) is a novel treatment for anxiety disorders that utilizes computerized tasks to train attention and interpretation biases away from threat. To date, attitudes toward and acceptability of CBM have not been systematically examined. METHOD We conducted qualitative interviews with 10 anxious primary care patients to examine attitudes toward and initial impressions of CBM. Interviews explored general impressions, as well as reactions to the treatment rationale and two computer programs, one targeting attention bias and one targeting interpretation bias. Three clinical psychologists independently coded transcripts and collaboratively developed categories and themes guided by grounded theory. RESULTS A number of facilitators and barriers emerged related to engaging in treatment in general, computerized treatment, and CBM specifically. Participants stated that the written rationale for CBM seemed relevant and helpful. However, after interacting with the attention modification program, participants frequently expressed a lack of understanding about how the program would help with anxiety. Participants reported greater understanding and engagement with the interpretation modification program. CONCLUSIONS Participants reported a number of positive characteristics of CBM, but it may need improvements regarding its treatment rationale and credibility. Future qualitative studies with individuals who complete a CBM treatment are warranted. Implications for future CBM development and dissemination are discussed.