Anxiety Symptoms in Women and Men
Studies report that early experiences may lead to anxiety focused on specific somatic anxiety symptoms as adults. For example, Whitehead, Winget, Fedoravicius, Wooley, and Blackwell (1982), in a retrospective study of over 800 subjects, found that adults who more often sought medical help and missed work or school because of perceived illnesses reported that when they were children, their parents attended much more closely to similar symptoms and reinforced them (with toys or special food, etc.) when ill. In a follow-up study about anxiety in children, Whitehead, Bush, Heller, and Costa (1986) found a more direct relationship between the types of illness-related symptoms to which parents paid special attention and help-seeking behavior when the women became adults.
This study was particularly well done, since subjects' retrospective reports were independently corroborated by their parents. For example, if parents of these women expressed substantial concern focused on the physical consequences of menstruation during adolescence, the women as adults would seek medical attention more often, and miss work or school more frequently, because of menstrual symptoms. Similarly, if these females were taught to be very careful of colds as children, they would seek medical help and miss work/school with these symptoms as adults. Finally, Turkat (1982) found in another retrospective study that a group of 27 individuals with diabetes tended to display greater sick role behavior, including avoiding work, if their parents had engaged in illness-related avoidance behavior themselves.
The consequence of these early learning experiences seems to be a tendency to focus anxiety on bodily sensations, particularly unexplained bodily sensations, and to develop beliefs about the dangers of these symptoms or sensations. A number of questionnaires have been developed to capture this network of beliefs. Some of these questionnaires, such as the Body Sensations Questionnaire (Chambless, Caputo, Bright, 6c Gallagher, 1984), have been designed to assess specifically anxiety focused on bodily sensations in panic disorder and have proved useful for this purpose.
A questionnaire that has attracted somewhat more interest is the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, 6c McNally, 1986), mentioned briefly in previous chapters. This questionnaire purports to measure a set of beliefs that anxiety and its associated symptoms, (particularly somatic symptoms) may cause deleterious physical, psychological, or social consequences that go beyond any immediate physical discomfort. Generally, anxiety sensitivity has been found to be normally distributed in the population, suggesting that it is a dimensional construct.
Research has begun to appear examining the utility of the ASI in predicting later anxiety-related problems, particularly panic attacks. Schmidt, Lxrew, and Jackson (1997) related problems, particularly panic attacks. Schmidt, Lerew, and Jackson (1997) administered the ASI to military recruits and found that higher initial scores on the scale predicted greater anxiety and depression after a stressful course of basic military training, as well as a greater number of panic attacks during the training.
In a second study, Schmidt, Lerew, and Jackson (1999) replicated these results, finding a somewhat stronger relationship with later anxiety and panic than with later depression. These are the first studies to successfully predict the occurrence of an initial panic attack in individuals who had heretofore not experienced panic attacks; therefore, the finding is relevant to an analysis of factors contributing to the origins of panic. However, Schmidt and colleagues caution that the results were relatively weak in this sample of well-adjusted military recruits and accounted for a rather small percentage of the variance--for example, 2% of the variance in predicting unexpected panic attacks in the Schmidt et al. (1999) study. Furthermore, it seems that anxiety sensitivity does not bear a unique relationship to the etiology of panic attacks, since high ASI scores also predicted later anxiety and depression more generally. Nevertheless, the evidence now seems clear that early experiences sensitizing individuals to the potential dangers of physical symptoms and sensations may well contribute to a specific vulnerability to develop panic attacks and panic disorder.
This study was particularly well done, since subjects' retrospective reports were independently corroborated by their parents. For example, if parents of these women expressed substantial concern focused on the physical consequences of menstruation during adolescence, the women as adults would seek medical attention more often, and miss work or school more frequently, because of menstrual symptoms. Similarly, if these females were taught to be very careful of colds as children, they would seek medical help and miss work/school with these symptoms as adults. Finally, Turkat (1982) found in another retrospective study that a group of 27 individuals with diabetes tended to display greater sick role behavior, including avoiding work, if their parents had engaged in illness-related avoidance behavior themselves.
The consequence of these early learning experiences seems to be a tendency to focus anxiety on bodily sensations, particularly unexplained bodily sensations, and to develop beliefs about the dangers of these symptoms or sensations. A number of questionnaires have been developed to capture this network of beliefs. Some of these questionnaires, such as the Body Sensations Questionnaire (Chambless, Caputo, Bright, 6c Gallagher, 1984), have been designed to assess specifically anxiety focused on bodily sensations in panic disorder and have proved useful for this purpose.
A questionnaire that has attracted somewhat more interest is the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, 6c McNally, 1986), mentioned briefly in previous chapters. This questionnaire purports to measure a set of beliefs that anxiety and its associated symptoms, (particularly somatic symptoms) may cause deleterious physical, psychological, or social consequences that go beyond any immediate physical discomfort. Generally, anxiety sensitivity has been found to be normally distributed in the population, suggesting that it is a dimensional construct.
Research has begun to appear examining the utility of the ASI in predicting later anxiety-related problems, particularly panic attacks. Schmidt, Lxrew, and Jackson (1997) related problems, particularly panic attacks. Schmidt, Lerew, and Jackson (1997) administered the ASI to military recruits and found that higher initial scores on the scale predicted greater anxiety and depression after a stressful course of basic military training, as well as a greater number of panic attacks during the training.
In a second study, Schmidt, Lerew, and Jackson (1999) replicated these results, finding a somewhat stronger relationship with later anxiety and panic than with later depression. These are the first studies to successfully predict the occurrence of an initial panic attack in individuals who had heretofore not experienced panic attacks; therefore, the finding is relevant to an analysis of factors contributing to the origins of panic. However, Schmidt and colleagues caution that the results were relatively weak in this sample of well-adjusted military recruits and accounted for a rather small percentage of the variance--for example, 2% of the variance in predicting unexpected panic attacks in the Schmidt et al. (1999) study. Furthermore, it seems that anxiety sensitivity does not bear a unique relationship to the etiology of panic attacks, since high ASI scores also predicted later anxiety and depression more generally. Nevertheless, the evidence now seems clear that early experiences sensitizing individuals to the potential dangers of physical symptoms and sensations may well contribute to a specific vulnerability to develop panic attacks and panic disorder.
