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. 2023 Jul 12;23(1):501.
doi: 10.1186/s12888-023-04988-2.

Characterization of different types of anxiety disorders in relation to structural integration of personality and adverse and protective childhood experiences in psychotherapy outpatients - a cross-sectional study

Jonathan Nowak  1 , Christoph Nikendei  2 , Ivo Rollmann  2 , Maximilian Orth  2 , Hans-Christoph Friederich  2 , David Kindermann  2
Affiliations

Characterization of different types of anxiety disorders in relation to structural integration of personality and adverse and protective childhood experiences in psychotherapy outpatients - a cross-sectional study

Jonathan Nowak et al. BMC Psychiatry. .

Abstract

Background: Current research has emphasized the role of structural integration of personality and childhood experiences for the understanding of anxiety disorders. In this study, we examined the relationship between anxiety disorders (generalized anxiety disorder vs. panic disorder vs. phobic disorders), the level of structural integration of personality, and negative and protective childhood experiences at the beginning of outpatient psychodynamic psychotherapy treatment. Differences were characterized in comparison to patients with no anxiety disorders.

Methods: The sample included a total of 1646 outpatient psychodynamic psychotherapy treatments, of which 695 treatments included the diagnosis of at least one anxiety disorder. Levels of structural integration of personality were assessed according to the Operationalized Psychodynamic Diagnosis (OPD-2) system. Self-reported negative and protective childhood experiences were examined by using the Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC). Associations were tested using single factor ANOVAs.

Results: Patients with anxiety disorders showed lower levels of structural integration of personality and reported more adverse childhood experiences than patients with no anxiety disorders. Regarding the subscales of structural integration of personality, phobic disorders were associated with impaired external communication, whereas for generalized anxiety disorder, an (uncorrected) association with impaired self-regulation was found. Also, generalized anxiety disorder was associated with sexual abuse and other traumatization (accidents etc.) during childhood, while panic disorder and phobic disorders were associated with emotional neglect, abuse, and fewer protective childhood experiences.

Conclusions: Our findings emphasize the need of considering structural integration of personality and childhood experiences in order to understand and treat various types of anxiety disorders.

Keywords: Adverse childhood experiences; Generalized anxiety disorder; Panic disorder; Phobia; Protective childhood experiences; Structural integration of personality.

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Conflict of interest statement

No conflicts of interest are declared.

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Subgroups of Treatment Cases involving Anxiety Disorders Note. AD = anxiety disorders. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. GAD = generalized anxiety disorder. PAD = panic disorder (± agoraphobia, but no GAD). PHO = phobic disorders (including isolated agoraphobia, social anxiety disorder, specific phobias, but no GAD / no PAD). APC = Questionnaire for the Assessment of Adverse and Protective Childhood Experiences. OPD-LSIA = Operationalized Psychodynamic Diagnosis System, Level of Structural Integration Axis
Fig. 2
Fig. 2
Differences in Structural Integration of Personality between Anxiety disorders Note. For better readability we started the y-axis with 1. NoAD = no anxiety disorders. GAD = generalized anxiety disorder. Error bars indicate standard errors. *p < .05. Markings in red: Not significant after post-hoc correction
Fig. 3
Fig. 3
Differences in Subscales of the APC between Anxiety Disorders Note. APC = Questionnaire for the Assessment of Adverse and Protective Childhood Experiences. NoAD = no anxiety disorders. GAD = generalized anxiety disorder. Error bars indicate standard errors. *p < .05, **p < .01
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References

    1. Angst J, Paksarian D, Cui L, Merikangas KR, Hengartner MP, Ajdacic-Gross V, et al. The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich cohort study. Epidemiol Psychiatr Sci. 2016;25:24–32. doi: 10.1017/S204579601500027X. - DOI - PMC - PubMed
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593. doi: 10.1001/archpsyc.62.6.593. - DOI - PubMed
    1. Moffitt TE, Caspi A, Taylor A, Kokaua J, Milne BJ, Polanczyk G, et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med. 2010;40:899–909. doi: 10.1017/S0033291709991036. - DOI - PMC - PubMed
    1. Somers JM, Goldner EM, Waraich P, Hsu L. Prevalence and incidence studies of anxiety Disorders: a systematic review of the literature. Can J Psychiatry. 2006;51:100–13. doi: 10.1177/070674370605100206. - DOI - PubMed
    1. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, et al. Prevalence and treatment of Mental Disorders, 1990 to 2003. N Engl J Med. 2005;352:2515–23. doi: 10.1056/NEJMsa043266. - DOI - PMC - PubMed

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