Anxiety sensitivity: a potential vulnerability factor for compulsive hoarding.

Compulsive hoarding is defined as the accumulation of and failure to discard a large number of possessions that appear to be useless or limited in value. Severe hoarding can result in illnesses due to unsanitary conditions, social isolation, work disability, and even death. Despite the severity of impairment associated with this clinical syndrome, research examining potential vulnerability factors is limited. Two independent studies have demonstrated that hoarding behaviors are significantly associated with anxiety sensitivity (AS), a well-known risk factor for anxiety pathology. However, the relationship between AS subfactors and hoarding behaviors is somewhat unclear. The primary aim of this investigation was to examine the relationships between hoarding and AS subfactors utilizing the anxiety sensitivity index-3, a measure designed to more accurately assess AS subfactors. Participants consisted of 279 college students, as well as 210 non-selected clinical participants. Consistent with initial predictions, hoarding behaviors were significantly associated with overall AS. Moreover, when looking at the relationships among hoarding behaviors and specific AS subfactors, hoarding was significantly associated with the physical concerns subscale. Finally, when examining the relationships among overall AS and specific hoarding facets, results indicated that the difficulty discarding subfactor of hoarding was associated with overall AS. Implications for future research and treatment are discussed.

Intolerance of uncertainty as a vulnerability factor for hoarding behaviors.

BACKGROUND: Intolerance of uncertainty (IU) has been identified as a key vulnerability factor among numerous anxiety related conditions. It has been suggested that individuals engage in uncertainty-motivated behaviors such as avoidance, as a way to cope with ambiguous and potentially distressing situations. Patterns of behavioral avoidance have also been observed in a substantial number of hoarding patients and are thought to directly contribute to the avoidance of discarding. However, no studies to date have examined the potential relationship between IU and hoarding. The primary aim of the current investigation was to examine the association between IU and hoarding behaviors. METHOD: Participants consisted of 279 college students from a large southern university. RESULTS: Results revealed that IU was a significant predictor of hoarding severity after controlling for relevant covariates. Moreover, when looking at the relationships among IU subfactors and hoarding, results indicated that Factor 1 was significantly associated with hoarding severity whereas Factor 2 was not. LIMITATIONS: Future research should attempt to replicate the findings within clinical populations. Additionally, due to the cross sectional nature of the study, future work should utilize a longitudinal design. CONCLUSIONS: The current study provides additional evidence that IU is an important individual difference variable associated with various anxiety related conditions. Moreover, our findings revealed that IU is a unique and robust predictor of hoarding behaviors. Increasing our knowledge of vulnerability factors in compulsive hoarding has important implications for the classification of this disorder within DSM-V. Additionally, this information could inform future research and treatment programs.

Anxiety sensitivity cognitive concerns predict suicidality among smokers.

BACKGROUND: Anxiety along with anxiety-related risk factors is receiving increased attention in regard to its role in elevated suicidality. One such risk factor, anxiety sensitivity (AS), refers to a fear of anxiety-related symptoms. Emerging research indicates that components of AS, particularly the AS subfactor focused on cognitive arousal concerns, are significantly associated with elevated suicidality in samples of diverse clinical outpatients, clinical outpatients with PTSD symptoms, and Air Force cadets undergoing a stressful life experience. Cigarette smokers represent another relevant population for this line of research due to recent reports indicating that cigarette smoking and nicotine dependence may be related to elevated suicidality. METHODS: Study 1 examined the role of AS and the AS subfactors in a large sample (n=343) of community adult smokers. Study 2 examined the role of AS and AS subfactors in a sample of "pack-a-day" adult smokers (n=78) who were seeking outpatient treatment for substance abuse issues. RESULTS: Study 1 results were consistent with our a priori hypothesis that AS cognitive concerns would be significantly associated with suicidality. Additionally, after covarying for relevant substance use variables, Study 2 results were also consistent with our hypothesis that AS cognitive concerns were significantly associated with suicidality. LIMITATIONS: Limitations included the use of suicide related outcomes, not death by suicide, and cross-sectional design. CONCLUSIONS: These findings suggest that suicide potential in cigarette smokers may be related to AS cognitive concerns and add to the emerging literature suggesting AS cognitive concerns are a risk factor for suicidality.

Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history.

BACKGROUND: Anxiety along with anxiety-related risk factors has been increasingly implicated in suicidal ideation and suicide attempts. One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related sensations. Subfactors of AS, notably physical and cognitive concerns, seem to be relevant to acquired capability, a risk factor for death by suicide from Joiner's (2005) Interpersonal-Psychological Theory of Suicide. METHODS: This study examined the effect of Anxiety Sensitivity Index (ASI) total score and subfactor scores on suicidal ideation and suicide attempt history in a very large, moderately severe outpatient sample (N = 1,378). RESULTS: Analyses were consistent with our a priori predictions about ASI cognitive concern and suicidal ideation. In contrast, ASI physical concerns did not predict previous suicide attempt as well as ASI cognitive or social concerns. However, ASI physical concerns did moderate the relationship between ASI social concerns and previous suicide attempt. CONCLUSIONS: These findings suggest that suicide potential may be related to cognitive risk factors for anxiety.

Childhood Abuse and Current Health Problems among Older Adults: The Mediating Role of Self-Efficacy.

OBJECTIVES: Child abuse has negative consequences on health functioning and the self-concept. Prior studies have garnered support for these relationships in younger adults; yet few studies have looked at the effects of abuse on health in older adults and the psychosocial variables, specifically self-efficacy, that may influence the abuse-health relationship. METHODS: Data obtained from the Physical Health and Disability Study were used to explore the impact of child abuse on current medical problems among older adults who were screened on physical disability status (N=1396, Mean age = 67, SD = 10.2). The study was conducted in South Florida and employed a multiethnic sample that is representative of the general population in this area. RESULTS: Child abuse was associated with the number of current medical problems and disability. Child abuse was also related to lower self-efficacy, and self-efficacy explained the relationship between abuse and the number of health problems. CONCLUSIONS: There are far reaching effects of child abuse on older adults' health and self-concept. Health care providers and gerontologists need to be aware that child abuse is a life-long risk factor for increased disability and specific health problems, especially among the elderly. Future research should examine treatments designed to increase self-efficacy, especially among those who experienced child abuse, and observe any positive effects on health functioning.

The long-term impact of childhood abuse on internalizing disorders among older adults: the moderating role of self-esteem.

OBJECTIVES: First, to determine if childhood experiences of abuse have an impact on internalizing disorders (e.g., anxiety and depressive disorders) among older adults. Second, we wish to determine if self-esteem plays a role in explaining the relationship between abuse and internalizing disorders. METHOD: First, we conducted an analysis on a population sample of participants aged 50 years or older (mean age = 67 years; SD = 10.3) assessed at two time points, three years apart (Wave 1, N = 1460; Wave 2, N = 1090). We examined the relationship between reports of childhood abuse (physical, emotional, and sexual) and internalizing disorders. Second, we determined the role self-esteem played in explaining the relationship. RESULTS: We found that childhood experiences of abuse assessed at Wave 1 predicted the number of DSM-IV internalizing disorders occurring three years later. Demonstrating the specificity of self-esteem; we found self-esteem, but not emotional reliance, to moderate the relationship between abuse and internalizing disorders such that childhood abuse had more negative effects on those with low self-esteem compared to those with higher self-esteem. Contrary to prediction, self-esteem did not mediate the relationship between abuse and internalizing disorders. CONCLUSION: The negative effects of childhood abuse persist for many years, even into older adulthood. However, contrary to the findings in younger adults, self-esteem was not correlated with childhood abuse in older adults. Moreover, childhood abuse only had a negative effect on those who had low self-esteem. It may be through the process of lifespan development that some abused individuals come to separate out the effects of abuse from their self-concept.

Predictors of parental physical abuse: the contribution of internalizing and externalizing disorders and childhood experiences of abuse.

BACKGROUND: The deleterious effects of childhood abuse have been a focus of much research; however, the causes of parental physical abuse are less well documented. Research with clinical samples suggests that individuals who display abusive behaviors are more likely to have a history of childhood abuse and higher rates of internalizing and externalizing disorders. Whether childhood abuse and psychopathology contribute independently to parental abusive behaviors or if the association between childhood abuse and the parental physical abuse is mediated by the individual's psychopathology has not been studied empirically. METHODS: The current study is based on data from a representative sample (N=4141). Lifetime psychiatric diagnoses, childhood experiences of sexual and physical abuse, and physically abusive behaviors exhibited towards children were assessed. RESULTS: Internalizing and externalizing disorders partially mediated the association between childhood abuse and parental abuse. Nonetheless, the participant's internalizing disorders, externalizing disorders, and previous experiences of childhood abuse each independently predicted parental abuse. Further, the influence of childhood abuse was greater for women than men. LIMITATIONS: The data is cross-sectional, thus clear conclusions regarding causality cannot be made. CONCLUSIONS: There are multiple pathways in the etiology of parental abusive behaviors. Previous experiences of childhood abuse, internalizing disorders, and externalizing disorders each contribute to parental abuse. Individuals with psychiatric disorders or a history of childhood abuse are at an increased risk for abusive behaviors towards children in their care. Identifying such high-risk parents and providing parent training programs may be effective in lowering rates of child abuse.