Physiological hyperarousal as a specific correlate of symptoms of anxiety among young psychiatric inpatients

Gencoz, Faruk

Neuropsychological, cognitive, and factor-analytic models of anxiety and depression consistently view the physiological hyperarousal (PH) factor as a specific component of anxiety disorders and symptoms. In the present study, young psychiatric inpatients were assessed on self report measures of PH, anxiety, and depression. PH was associated with symptoms of anxiety, but not depressive symptoms, consistent with the specificity of PH to symptoms of anxiety.

Although. anxiety and mood disorders are viewed as discrete, it is often hard to find persons who are purely either depressed or anxious in clinical settings (Bakish, 1999). Indeed, the correlations between self reported measures of depressive symptoms and symptoms of anxiety are usually greater than .60. Accordingly, approaches that facilitate valid discrimination between anxious and depressive states are theoretically and clinically important.

Physiological arousal is a key concept in discriminating between anxiety and depression. Physiological arousal generally involves increased activity in the sympathetic division of the autonomic nervous system, a main adaptive function of which is to mobilize resources in response to threat. Excessive or inappropriate forms of physiological arousal, however, comprise hallmarks of anxiety disorders and symptoms.

Support for the potential discriminating power of physiological arousal regarding depression and anxiety, emerges in several different areas of research. From a neuropsychological standpoint, increased activation of the right parietotemporal region characterizes physiological arousal and anxiety states; in depressive states, this activity is inhibited (Heller, 1998). From this perspective, then, physiological hyperarousal is expected to be more specific to anxiety than to depression.

Similarly, from a cognitive perspective, the content specificity hypothesis suggests that cognition in anxiety disorders is characterized by perceived threat (Clark, Beck, & Stewart, 1990), which, in turn, is associated with increased arousal to cope with the threatening stimulus. By contrast, depressive cognitions often involve loss, failure, rejection, and hopelessness which, in turn, may lead to underarousal (cf. anhedonia). Here again, hyperarousal is expected to characterize anxiety rather than depression.

The covariance structure of self report measures of anxiety and depression further strengthen the discriminative role of physiological arousal. Physiological hyperarousal (PH) emerges as a discrete factor in factor-analytic research, and is more associated with anxiety than with mood disorders (see Brown, Chorpita, & Barlow, 1998).

The present study sought to extend these lines of research. The authors tested whether PH scores would display specificity to symptoms of anxiety versus depressive symptoms among young psychiatric inpatients.

METHOD

PARTICIPANTS AND PROCEDURE

Participants included 37 children and adolescents (16 boys, 21 girls), ages 9 to 17 years (M= 14.34, SD = 1.78) with a wide array of psychiatric diagnoses. The majority of participants were Caucasian (82%). Parental consent and child assent to participation were obtained.

Within four days of admission, patients were administered the measures listed below by a trained masters-level psychometrist. Measures were administered individually, and were completed in the presence of, and immediately checked by, the psychometrist (there were thus no missing data).

MEASURES

Physiological Hyperarousal Scale for Children (PH-C; Laurent, Catanzaro, & Joiner, 1998). The PH-C is an 18-item measure designed to assess physiological hyperarousal, defined as bodily manifestations of autonomic arousal. Example items include, "sweaty hands;' "heart pounding;' and "can't catch breath." The subjects indicated on a 5-point scale (1 = very slightly or not at all to 5 = extremely) how often they had felt or experienced these symptoms during the last two weeks.

In the present study the alpha coefficient of PH-C was .93.

Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1985). The RCMAS assesses general anxiety (see Reynolds & Richmond, 1985 for reliability and validity data). To avoid overlap between the PH and RCMAS measures, somatic anxiety items were removed from the RCMAS before computing total scores.

Children's Depression Inventory (CDI; Kovacs, 1992). The CDI is a reliable and well-validated 27-item self report measure of depressive symptoms.

RESULTS AND DISCUSSION

Two regression equations were conducted. In the first, RCMAS anxiety scores were the dependent variable. To control for the variance accounted for by depression symptoms, CDI scores were entered into the equation first. Subsequently, PH scores were entered. As expected, PH scores were significantly associated with RCMAS scores, even after controlling for CDI scores (partial correlation (pr] = .36, t (34) = 2.29, p

In the second equation, CDI scores were the dependent variable. RCMAS scores were entered into the equation first, followed by PH scores. Again as expected, PH scores were not significantly associated with CDI scores, after controlling for RCMAS scores (pr = .11, t (34) = 0.63, p = ns).

PH was specifically associated with symptoms of anxiety versus depressive symptoms. These findings are consistent with factor analytic studies that have identified a PH factor specific to anxiety symptoms and disorders in diverse samples. Moreover, these results converge with neuropsychological and cognitive perspectives on the distinction between symptoms of anxiety and depressive symptoms. To the authors' knowledge, this is among the first studies to examine this question among a clinical sample of young people.

Importantly, Brown et al. (1998) found that a hyperarousal factor was not a general characteristic of the anxiety disorders, but instead specifically characterized panic disorder (Joiner et al., 1999 reported similar findings). Therefore, although PH appears to represent a specific marker of anxiety symptoms and disorders as compared to mood disorders and symptoms, it may show differential relations within anxiety disorders and syndromes. This question deserves continued attention in future research.

REFERENCES

Bakish, D. (1999). The patient with comorbid depression and anxiety: The unmet need Journal of Clinical Psychiatry, 60, 20.24.

Brown, T A., Chorpita, B. F 8c Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology,107, 179-192.

Clark, D. A., Beck, A. T. & Stewart, B. (1990). Cognitive specificity and positive-negative affectivity: Complementary or contradictory views on anxiety and depression. Journal of Abnormal Psychology, 99, 148-155.

Heller, W. (1998). The puzzle of regional brain activity in depression and anxiety: The importance of subtypes and comorbidity. Cognition and Emotion,12, 421-447.

Joiner. T. E., Steer, R. A., Beck A. T., Schmidt, N. B., Rudd, M. D. & Catanzaro, S. J. (1999). Physiological Hyperarousal: Construct validity of a central aspect of the tripartite model of depression and anxiety. Journal of Abnormal Psychology,108, 290.298.

Kovacs, M. (1992). Children's Depression Inventory Manual. Los Angeles: Western Psychological Services.

Laurent, J., Catanzaro, S. J. & Joiner, T. (1998, April/May). A child measure of the tripartite model: Initial development and validation of the Physiological Hyperarousal-Positive and Negative Affect Scale for Children. In S.J. Catanzaro (Chair), The tripartite model of anxiety and depression: Current research and future prospects. Symposium conducted at the 70th Annual Meeting of the Midwestern Psychological Association, Chicago, IL.

Reynolds, C. R. & Richmond, B. O. (1985). Revised Children's Manifest Anxiety Scale (RCMAS) Manual. Los Angeles: Western Psychological Services.

FARUK GENCOZ AND TULIN GENCOZ

Middle East Technical University, Turkey

THOMAS E. JOINER, JR.

Florida State University, USA

Faruk Gencoz, Ph.D., Department of Psychology and Tulip Gencoz, Middle East Technical University, Ankara, Turkey, and Thomas E. Joiner, Jnr, Florida State University, USA.

This work was supported, in part, by the Turkish Academy of Sciences and by the National Alliance for Research on Schizophrenia and Depression (NARSAD).

Acknowledgement is due to reviewers including: Brad Schmidt, Ph.D., Department of Psychology, The Ohio State University, USA, Dr. Peter Muris, Department of Psychology, Maastricht University, The Netherlands, and Egil Andersson, Ph.D., Goteborgs University, Oscarsberg, Sweden.

Please address correspondence and reprint requests to: Faruk Gencoz, Ph.D., Department of Psychology, Middle East Technical University, Ankara 06531, Turkey. Phone: 90 (312) 210 5107; Fax: 90 (312) 210 1288; Etnail:

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