Meta-Analysis of Anxiety Disorders and Temperament

Abstract

Background: The aims of the present study were to explore whether symptoms in different anxiety disorders are associated with Cloninger's model temperament dimensions novelty seeking (NS), harm avoidance (HA), reward dependence and persistence compared with control subjects in clinical samples of adults or late adolescents. Method: Literature search in the following databases: Cochrane Library, PubMed (Medline), Web of Science, Psycinfo and PsycArticles. Systematic review, grading the level of evidence and meta-analysis for each disorder by comparing the temperament dimension scores between patient and control samples in single studies. Results: A total of 40 papers fulfilled the inclusion criteria. Meta-analyses were conducted on a total of 24 studies focusing on panic disorder (PD), social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD). The primary finding was a constant and clinically marked positive association between the HA temperament dimension and symptoms of PD, SAD and OCD, with a most marked effect in SAD, and a moderate effect in OCD and PD. Second, less marked and clinically marginal associations between NS score and SAD and OCD (negative associations), but no associations with PD were observed. The meta-analyses revealed heterogeneity between the results of individual studies, especially in the analyses including SAD and OCD. Conclusions: PD, SAD and OCD share a marked and state-dependent avoidant behavioral pattern, which is common for all anxiety disorders. However, PD showed a different pattern of arousal to novel stimuli from that of SAD and OCD. The findings are state dependent and based on cross-sectional studies.

Are obsessive–compulsive symptoms impulsive, compulsive or both?

“…One explanation could be that higher obsessive-compulsive symptoms reflect a disposition towards harm avoidance type temperament. Meta-analyses have demonstrated that harm avoidance is more common in women,39 and also that harm avoidance links OCD, panic disorder, and social anxiety disorder 40…”

The erring brain: Error‐related negativity as an endophenotype for OCD—A review and meta‐analysis

“…Increased ERN amplitudes are not OCD specific and were observed in generalized anxiety disorder (GAD, e.g., Weinberg, Olvet, & Hajcak, ; Xiao et al, ), social anxiety (e.g., Endrass et al, ), health anxiety (Riesel et al, ), and less consistently in depression (Gillan et al, ; Manoach & Agam, ). These disorders are frequently comorbid (Kessler et al, ; Krueger & Markon, ; Ruscio et al, ) and share clinical features such as heightened harm avoidance (Kampman, Viikki, Jarventausta, & Leinonen, ), worry (Dar & Iqbal, ; Yook, Kim, Suh, & Lee, ), reassurance seeking and checking behavior (Halldorsson & Salkovskis, ; Kobori & Salkovskis, ; Weinberg, Kotov, & Proudfit, ). These symptoms have also been related to hyperactive neural error signals (e.g., Cavanagh & Shackman, ; Moser et al, ; Weinberg, Kotov et al, ).…”

Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning

“…SAD and AN additionally share preoccupation with how one is perceived by others as a central feature [35]. Anxious personality traits, including elevated neuroticism, perfectionism and harm avoidance as well as decreased novelty-seeking are frequently observed in OCD, SAD and AN [12,13] and may represent a common pathway for the development of both anxiety disorders and AN. In AN, anxious, perfectionistic and obsessional personality traits appear to underlie heritability [32,36], worsen with starvation [37][38][39], persist after recovery [4,[40][41][42] and portend a poorer prognosis [43].…”

“…The successful treatment of AN may well require both interruption of excessive exercise and dietary restraint, as well as extinction of the heightened A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 13 anxiety and meal avoidant behaviors that characterize the disorder. Indeed, pre-meal anxiety has been found to be inversely related to food intake at a standardized meal in individuals with AN [101].…”

“…The mechanism for this A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 4 relationship may pertain to estrogen's regulation of gene transcription within neurotransmitter systems relevant to food reward, stress vulnerability or anxiety and is likely to differ in new onset and chronic cases. Trait anxiety has been linked to risk for eating disorders [12], to predisposition to anxiety disorders [13] and to impaired fear conditioning, fear extinction or safety learning [14][15][16][17]. Impaired fear conditioning has in turn, been proposed as a potential mechanism to explain the rapid development and persistence of calorie restriction and fear of fatness in AN [18].…”