Abstract
We investigated whether panic disorder (PD), obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD) patients differ in the perception of their illnesses and whether these differences can be ascribed to levels of anxiety sensitivity. We performed a cross-sectional study comparing responses from 36 PD patients, 38 OCD, and 34 SAD patients in the Illness Perception Questionnaire-Mental Health (IPQ-MH). A MANCOVA model with the diagnostic group as the fixed factor, the IPQ-MH items as dependent variables, and the Anxiety Sensitivity Index-Revised (ASI-R) score as a covariate, was created. Significant differences were observed between the groups with respect to illness perception. PD patients showed significantly higher levels of anxiety sensitivity than other groups. However, after controlling for anxiety sensitivity as a covariate, patients with PD had significant lower scores in “personal control” and “treatment control” than patients with SAD. OCD patients did not differ significantly from both groups. PD, OCD, and SAD patients have both common and different perceptions regarding their illnesses. Differences between PD and SAD are related to controllability of symptoms, but seem not to be mediated by anxiety sensitivity. Future studies should investigate whether illness perceptions in OCD and anxiety disorders have therapeutic implications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Albert, U., Maina, G., Bergesio, C., & Bogetto, F. (2005). Nocturnal panic and recent life events. Depression and Anxiety, 22(2), 52–58. https://doi.org/10.1002/da.20126.
Alkozei, A., Creswell, C., Cooper, P. J., & Allen, J. J. (2015). Autonomic arousal in childhood anxiety disorders: associations with state anxiety and social anxiety disorder. Journal of Affective Disorders, 175, 25–33. https://doi.org/10.1016/j.jad.2014.11.056.
Amorim, P. (2000). Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Revista Brasileira de Psiquiatria, 22, 106–115.
Asselmann, E., Stender, J., Grabe, H. J., Konig, J., Schmidt, C. O., Hamm, A. O., & Pane-Farre, C. A. (2018). Assessing the interplay of childhood adversities with more recent stressful life events and conditions in predicting panic pathology among adults from the general population. Journal of Affective Disorders, 225, 715–722. https://doi.org/10.1016/j.jad.2017.08.050.
Baines, T., & Wittkowski, A. (2013). A systematic review of the literature exploring illness perceptions in mental health utilising the self-regulation model. Journal of Clinical Psychology in Medical Settings, 20(3), 263–274. https://doi.org/10.1007/s10880-012-9337-9.
Bakker, A., Spinhoven, P., van der Does, A. J., van Balkom, A. J., & van Dyck, R. (2002). Locus of control orientation in panic disorder and the differential effects of treatment. Psychotherapy and Psychosomatics, 71(2), 85–89. https://doi.org/10.1159/000049350.
Bentley, K. H., Gallagher, M. W., Boswell, J. F., Gorman, J. M., Shear, M. K., Woods, S. W., & Barlow, D. H. (2013). The interactive contributions of perceived control and anxiety sensitivity in panic disorder: a triple vulnerabilities perspective. Journal of Psychopathology and Behavioral Assessment, 35(1), 57–64. https://doi.org/10.1007/s10862-012-9311-8.
Calkins, A. W., Otto, M. W., Cohen, L. S., Soares, C. N., Vitonis, A. F., Hearon, B. A., & Harlow, B. L. (2009). Psychosocial predictors of the onset of anxiety disorders in women: results from a prospective 3-year longitudinal study. Journal of Anxiety Disorders, 23(8), 1165–1169. https://doi.org/10.1016/j.janxdis.2009.07.022.
Chan, R. C. H., & Mak, W. W. S. (2016). Common sense model of mental illness: Understanding the impact of cognitive and emotional representations of mental illness on recovery through the mediation of self-stigma. Psychiatry Research, 246, 16–24. https://doi.org/10.1016/j.psychres.2016.09.013.
Cloitre, M., Heimberg, R. G., Liebowitz, M. R., & Gitow, A. (1992). Perceptions of control in panic disorder and social phobia. Cognitive Therapy and Research, 16(5), 569–577. https://doi.org/10.1007/bf01175142.
Cohen, J. N., Potter, C. M., Drabick, D. A. G., Blanco, C., Schneier, F. R., Liebowitz, M. R., & Heimberg, R. G. (2015). Clinical presentation and pharmacotherapy response in social anxiety disorder: the effect of etiological beliefs. Psychiatry Research, 228(1), 65–71. https://doi.org/10.1016/j.psychres.2015.04.014.
Dusseldorp, E., Spinhoven, P., Bakker, A., van Dyck, R., & van Balkom, A. J. (2007). Which panic disorder patients benefit from which treatment: cognitive therapy or antidepressants? Psychotherapy and Psychosomatics, 76(3), 154–161. https://doi.org/10.1159/000099842.
Faravelli, C. (1985). Life events preceding the onset of panic disorder. Journal of Affective Disorders, 9(1), 103–105.
Faravelli, C., & Pallanti, S. (1989). Recent life events and panic disorder. The American Journal of Psychiatry, 146(5), 622–626. https://doi.org/10.1176/ajp.146.5.622.
Fernandez de la Cruz, L., Kolvenbach, S., Vidal-Ribas, P., Jassi, A., Llorens, M., Patel, N., . . . Mataix-Cols, D. (2016). Illness perception, help-seeking attitudes, and knowledge related to obsessive-compulsive disorder across different ethnic groups: a community survey. Social Psychiatry and Psychiatric Epidemiology, 51(3), 455–464. doi:https://doi.org/10.1007/s00127-015-1144-9.
Fontenelle, L. F., Domingues, A. M., Souza, W. F., Mendlowicz, M. V., de Menezes, G. B., Figueira, I. L., & Versiani, M. (2007). History of trauma and dissociative symptoms among patients with obsessive-compulsive disorder and social anxiety disorder. The Psychiatric Quarterly, 78(3), 241–250. https://doi.org/10.1007/s11126-007-9043-1.
Freeman, D., Dunn, G., Garety, P., Weinman, J., Kuipers, E., Fowler, D., . . . Bebbington, P. (2013). Patients’ beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis. Psychological Medicine, 43(2), 269–277. doi:https://doi.org/10.1017/s0033291712001225.
Goldstein, B., & Rosselli, F. (2003). Etiological paradigms of depression: the relationship between perceived causes, empowerment, treatment preferences, and stigma. Journal of Mental Health, 12(6), 551–563. https://doi.org/10.1080/09638230310001627919.
Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the common-sense model of illness representations. Psychology & Health, 18(2), 141–184. https://doi.org/10.1080/088704403100081321.
Hofmann, S. G., Curtiss, J., & McNally, R. J. (2016). A complex network perspective on clinical science. Perspectives on Psychological Science, 11(5), 597–605. https://doi.org/10.1177/1745691616639283.
Johnson, J. G., Cohen, P., Pine, D. S., Klein, D. F., Kasen, S., & Brook, J. S. (2000). Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. Jama, 284(18), 2348–2351.
Klauke, B., Deckert, J., Reif, A., Pauli, P., & Domschke, K. (2010). Life events in panic disorder-an update on “candidate stressors”. Depression and Anxiety, 27(8), 716–730. https://doi.org/10.1002/da.20667.
Lam, D. C., & Salkovskis, P. M. (2007). An experimental investigation of the impact of biological and psychological causal explanations on anxious and depressed patients’ perception of a person with panic disorder. Behaviour Research and Therapy, 45(2), 405–411. https://doi.org/10.1016/j.brat.2006.03.005.
Laposa, J. M., Collimore, K. C., Hawley, L. L., & Rector, N. A. (2015). Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of Anxiety Disorders, 33, 8–14. https://doi.org/10.1016/j.janxdis.2015.04.003.
Leventhal, H., Nerenz, D. R., & Purse, J. (1984). Illness representations and coping with health threats.
Lynch, J., Moore, M., Moss-Morris, R., & Kendrick, T. (2015). Do patients illness beliefs predict depression measures at six months in primary care; a longitudinal study. Journal of Affective Disorders, 174, 665–671. https://doi.org/10.1016/j.jad.2014.12.005.
Manfro, G. G., Otto, M. W., McArdle, E. T., Worthington 3rd, J. J., Rosenbaum, J. F., & Pollack, M. H. (1996). Relationship of antecedent stressful life events to childhood and family history of anxiety and the course of panic disorder. Journal of Affective Disorders, 41(2), 135–139.
Moitra, E., Dyck, I., Beard, C., Bjornsson, A. S., Sibrava, N. J., Weisberg, R. B., & Keller, M. B. (2011). Impact of stressful life events on the course of panic disorder in adults. Journal of Affective Disorders, 134(1–3), 373–376. https://doi.org/10.1016/j.jad.2011.05.029.
Nieuwsma, J. A., & Pepper, C. M. (2010). How etiological explanations for depression impact perceptions of stigma, treatment effectiveness, and controllability of depression. Journal of Mental Health, 19(1), 52–61. https://doi.org/10.3109/09638230903469095.
Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis. Psychological Bulletin, 135(6), 974–999. https://doi.org/10.1037/a0017428.
Pedley, R., Bee, P., Berry, K., & Wearden, A. (2017). Separating obsessive-compulsive disorder from the self. A qualitative study of family member perceptions. BMC Psychiatry, 17(1), 326. https://doi.org/10.1186/s12888-017-1470-4.
Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11(2), 141–153. https://doi.org/10.1016/0272-7358(91)90092-9.
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24(1), 1–8.
Roy-Byrne, P. P., Geraci, M., & Uhde, T. W. (1986). Life events and the onset of panic disorder. The American Journal of Psychiatry, 143(11), 1424–1427. https://doi.org/10.1176/ajp.143.11.1424.
Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106(3), 355–364.
Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. Journal of Abnormal Psychology, 108(3), 532–537.
Schmidt, N. B., Lerew, D. R., & Joiner Jr., T. E. (2000). Prospective evaluation of the etiology of anxiety sensitivity: test of a scar model. Behaviour Research and Therapy, 38(11), 1083–1095.
Scocco, P., Barbieri, I., & Frank, E. (2007). Interpersonal problem areas and onset of panic disorder. Psychopathology, 40(1), 8–13. https://doi.org/10.1159/000096384.
Stahl, S. M. (1988). Basal ganglia neuropharmacology and obsessive-compulsive disorder: the obsessive-compulsive disorder hypothesis of basal ganglia dysfunction. Psychopharmacology Bulletin, 24(3), 370–374.
Taylor, S., & Cox, B. J. (1998). An expanded anxiety sensitivity index: evidence for a hierarchic structure in a clinical sample. Journal of Anxiety Disorders, 12(5), 463–483.
Waikar, S. V., Bystritsky, A., Craske, M. G., & Murphy, K. (1994). Etiological beliefs and treatment preferences in anxiety-disordered patients. Anxiety, 1(3), 134–137.
Weinman, J., Petrie, K. J., Moss-morris, R., & Horne, R. (1996). The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychology & Health, 11(3), 431–445. https://doi.org/10.1080/08870449608400270.
Whittle, P. (1996). Psychiatric disorder and the development of a causal belief questionnaire. Journal of Mental Health, 5(3), 257–266. https://doi.org/10.1080/09638239650036929.
Witteman, C., Bolks, L., & Hutschemaekers, G. (2011). Development of the illness perception questionnaire mental health. Journal of Mental Health, 20(2), 115–125. https://doi.org/10.3109/09638237.2010.507685.
Zvolensky, M. J., & Leventhal, A. M. (2016). Affect and health behavior co-occurrence: the emerging roles of transdiagnostic factors and sociocultural factors. Behavior Modification, 40(1–2), 3–6. https://doi.org/10.1177/0145445515627307.
Acknowledgments
We are indebted to our volunteers for participation in this study.
Funding
This work was supported by the “Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) under Grants E-26/201.305/2014 & E-26/010.001411/2015; and “Conselho Nacional de Desenvolvimento Científico e Tecnológico” (CNPq)] under grant 308237/2014-5.
Author information
Authors and Affiliations
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dias, R.V., Stangier, U., Laurito, L.D. et al. Illness Perceptions Across Obsessive-Compulsive Disorder, Social Anxiety Disorder, and Panic Disorder Patients. J Cogn Ther 11, 434–443 (2018). https://doi.org/10.1007/s41811-018-0034-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41811-018-0034-9