Anksiyete Bozukluklarında Kişilik Örgütlenmesi: Yaygın Anksiyete Bozukluğu ve Panik Bozukluğu Karşılaştırılması

Öz

Bu çalışmada yaygın anksiyete bozukluğu (YAB) ve panik bozukluk (PB) hastalarında kişilik örgütlenme düzeylerinin incelenmesi amaçlanmıştır. Çalışma YAB (n=46) ve PB (n=40) tanısıyla izlemi yapılan 86 hasta ile yürütülmüştür. Katılımcılara sosyodemografik veri toplama formu, Kişilik Örgütlenmesi Tanı Formu (KÖTF), Beck Depresyon Ölçeği (BDÖ) ve Beck Anksiyete Ölçeği (BAÖ) uygulanmıştır. YAB ve PB gruplarında KÖTF olgun savunma, anksiyete ve depresyon puanları arasında anlamlı bir farklılık bulunurken, KÖTF kimlik toplam puanı ve ilkel savunma puanları açısından anlamlı bir farklılık bulunmamıştır. Gruplar arasında KÖTF’e göre nesne ilişkilerinin niteliği ve genel kişilik örgütlenmesi düzeyi açısından da anlamlı bir farklılık bulunmamıştır. BDÖ’ye göre katılımcıların %67,4 (n=58)’ünde YAB ve PB’ye komorbid olarak depresif belirtiler saptanmıştır. Komorbid depresif belirtileri olan ve olmayan gruplar arasında KÖTF puanları, nesne ilişkilerinin niteliği ve genel kişilik örgütlenme düzeyi açısından anlamlı bir farklılık bulunmamıştır. Sonuçlar, tedavide primer olarak anksiyete bozukluğu türünün hedef alınması gerektiğine işaret ederken, diğer taraftan YAB ve PB’de kişilik örgütlenme düzeyinin incelenmesinin bireylerin vaka bazında anlaşılmasına, psikoterapi yaklaşımlarının seçilmesine ve tedavi sürecine katkı sağlayabileceğini düşündürmektedir.

Anahtar Kelimeler

• kişilik örgütlenmesi
• kimlik
• yaygın anksiyete bozukluğu
• panik bozukluk

Personality Organization in Anxiety Disorders: Comparison of Generalized Anxiety Disorder and Panic Disorder

Abstract

The objective of this study was to explore the level of personality organization in patients diagnosed with generalized anxiety disorder (GAD) and panic disorder (PD). The study comprised 86 patients undergoing treatment for GAD (n=46) and PD (n=40). Various tools were utilized for data collection including a Sociodemographic Data Collection Form, Personality Organization Diagnostic Form (PODF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A significant difference was observed between the GAD and PD groups regarding the PODF scores for mature defense, anxiety, and depression. However, no significant difference was observed in relation to the PODF identity total score and primitive defense scores. Furthermore, the quality of object relations and the overall level of personality organization according to the PODF did not display any significant differences between the groups. According to the BDI, comorbid depressive symptoms were detected in 67.4% (n=58) of the participants with GAD and PD. There was no significant difference in the PODF scores, quality of object relations, and the overall level of personality organization between the group with comorbid depressive symptoms and the group without it.These findings suggest that while the primary focus of therapeutic interventions should be on targeting the specific type of anxiety disorder, assessing the level of personality organization in patients with GAD and PD could add valuable insights to individual case understanding, selection of psychotherapy approaches, and the treatment process..

Keywords

• personality organization
• identity
• generalized anxiety disorder
• panic disorder

Kaynakça

1. APA (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Washington DC, American Psychiatric Association..
2. APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5). Washington DC, American Psychiatric Association..
3. Albert U. Maina G, Bergesio C, Bogetto F (2006) Axis I and II comorbidities in subjects with and without nocturnal panic. Depress Anxiety, 23:422-428.
4. Alsubaie MM, Stain HJ, Webster LAD, Wadman R (2019) The role of sources of social support on depression and quality of life for university students. Int J Adolesc Youth, 24:484-496.
5. Ansell EB, Pinto A, Edelen MO, Markowitz JC, Sanislow CA, Yen S et al. (2011) The association of personality disorders with the prospective 7-year course of anxiety disorders. Psychol Med, 41:1019–1028.
6. Barlow DH, DiNardo PA, Vermilyea BB, Vermilyea J, Blanchard EB (1986) Co-morbidity and depression among the anxiety disorders. Issues in diagnosis and classification. J Nerv Ment Dis, 174:63–72.
7. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol, 56:893–897.
8. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry, 4:561–571.

9. Blashfield R, Noyes R, Reich J, Woodman C, Cook BL, Garvey M (1994) Personality disorder traits in generalized anxiety and panic disorder patients. Compr Psychiatry, 35:329–334.
10. Brown TA, Barlow DH (2009) A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment. Psychol Assess, 21:256–271.
11. Caligor E, Kernberg OF, Clarkin JF (2007) Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology. Washington DC, American Psychiatric Publishing.
12. Caligor E, Clarkin JF (2010) An object relations model of personality and personality pathology. In Psychodynamic Psychotherapy for Personality Disorders: A Clinical Handbook (Eds JF Clarkin, P Fonagy, GO Gabbard). Washington DC, American Psychiatric Press.
13. Chen MH, Tsai SJ (2016) Treatment-resistant panic disorder: clinical significance, concept and management. Prog Neuropsychopharmacol Biol Psychiatry, 70:219–226.
14. Cierpiałkowska L, Jańczak M (2013) Patologia organizacji osobowości w teorii relacji z obiektem O. Kernberga. Czasopismo Psychologiczne, 19:47–56.
15. Clarkin JF, Caligor E, Sowislo JF (2020) An object relations model perspective on the alternative model for personality disorders (DSM-5). Psychopathology, 53:141–148.
16. Cloninger CR (1986) A unified biosocial theory of personality and its role in the development of anxiety states. Psychiatr Dev, 4:167–226.
17. Cloninger CR (1987) A systematic method for clinical description and classification of personality variants: a proposal. Arch Gen Psychiatry, 44:573–588.
18. Cloninger CR (2000) A practical way to diagnosis personality disorder: a proposal. J Pers Disord, 14:99–108.
19. Conroy K, Curtiss JE, Barthel AL, Lubin R, Wieman S, Bui E et al. (2020) Emotion regulation flexibility in generalized anxiety disorder. J Psychopathol Behav Assess, 42:93–100.
20. de Jonge P, Roest AM, Lim CCW, Florescu SE, Bromet EJ, Stein DJ et al. (2016) Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depress Anxiety, 33:1155–1177.
21. Diguer L, Hebert E´, Gamache, D, Laverdie`re O, Daoust JP, Pelletier S (2006) Personality Organization Diagnostic Form:Manual for scoring. Quebece, Canada, Universite´Laval.
22. Doering S, Blüml V, Parth K, Feichtinger K, Gruber M, Aigner M et al. (2018) Personality functioning in anxiety disorders. BMC Psychiatry, 18:294.
23. Doubková N, Heissler R, Preiss M, Sanders E (2022) Differences in personality functioning impairment in mood, anxiety, and personality disorders: a cluster analysis. BMC Psychiatry, 22:315.
24. Dyck IR, Phillips KA, Warshaw MG, Dolan RT, Tracie Shea M, Stout RL et al. (2001) Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia. J Pers Disord, 15:60–71.
25. Eckhardt-Henn A, Heuft G, Hochapfel G, Hoffmann SO (2009) Neurotische Störungen und Psychosomatische Medizin. Stuttgart, Schattauer.
26. Fassino S, Amianto F, Sobrero C, Abbate Daga G (2013) Does it exist a personality core of mental illness? A systematic review on core psychobiological personality traits in mental disorders. Panminerva Med, 55:397–413.
27. Ferster CB (1973) A functional analysis of depression. Am Psychol, 28:857.
28. Fischer-Kern M, Kapusta ND, Doering S, Hörz S, Mikutta C, Aigner M (2011) The relationship between personality organization and psychiatric classification in chronic pain patients. Psychopathology, 44:21–26.
29. Friborg O, Martinussen M, Kaiser ., Øvergård KT, Rosenvinge JH (2013) Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research. J Affect Disord, 145:143–155.
30. Fritz CO, Morris PE, Richler JJ (2012) Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen, 141:2–18.
31. Garyfallos G, Adamopoulou A, Karastergiou A, Voikli M, Milis V, Donias S et al. (1999) Psychiatric comorbidity in greek patients with generalized anxiety disorder. Psychopathology, 32:308–318.
32. Górska D (2021) The role of the level of personality organization in emotional processing in generalized anxiety disorder. Pers Individ Dif, 181:111020.
33. Hébert É, Diguer L, Descôteaux J, Daoust JP, Rousseau JP, Normandin L et al. (2010) The Personality Organization Diagnostic Form (PODF): a preliminary report on ıts validity and ınterrater reliability. Psychother Res. 13:243-254.
34. Hendriks SM, Spijker J, Licht CMM, Beekman ATF., Hardeveld F, de Graaf R et al. (2014) Disability in anxiety disorders. J Affect Disord, 166:227–233.
35. Hengartner MP, Zimmermann J, Wright AGC (2018) Personality pathology. In The SAGE Handbook Of Personality And Individual Differences: Volume III: Applications of Personality and Individual Differences (Eds V Zeigler-Hill, T Shackelford):3–35. London, Sage.
36. Hickey D, Carr A, Dooley B, Guerin S, Butler E, Fitzpatrick L (2005) Family and marital profiles of couples in which one partner has depression or anxiety. J Marital Fam Ther 31:171–182.
37. Hisli N (1988) Beck Depresyon Ölçeği’nin bir Türk örnekleminde geçerlilik ve güvenilirliği. Psikoloji Dergisi, 6:118-122.
38. Hörz-Sagstetter S, Caligor E, Preti E, Stern BL, De Panfilis C, Clarkin JF (2018) Clinician-guided assessment of personality using the structural interview and the structured interview of personality organization (STIPO). J Pers Assess, 100:30–42.
39. Jylhä P, Ketokivi M, Mantere O, Melartin T, Suominen, K, Vuorilehto M et al. (2013) Temperament, character and personality disorders. Eur Psychiatry, 28:483–491.
40. Kampman O, Poutanen O (2011) Can onset and recovery in depression be predicted by temperament? A systematic review and meta-analysis. J Affect Disord, 135:20–27.
41. Kampman O, Viikki M, Järventausta K, and Leinonen E (2014) Meta-analysis of anxiety disorders and temperament. Neuropsychobiology, 69:175–186.
42. Kampman O, Viikki M, Leinonen E (2017) Anxiety disorders and temperament-an update review. Curr Psychiatry Rep, 19:27.
43. Kernberg OF (1996) A psychoanalytic theory of personality disorders. In Major Theories of Personality Disorder (Eds JF Clarkin, MF Lenzenweger):106–140. New York, Guilford Press.
44. Kernberg OF, Caligor E (2005) A psychoanalytic theory of personality disorders. In Major Theories of Personality Disorder (Eds MF Lenzenweger, JF Clarkin): 114–156. New York, Guilford Press.
45. Kim HJ, Kim JE, Lee SH (2021) Functional impairment in patients with panic disorder. Psychiatry Investig, 18:434–442.
46. Kim HY (2017) Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restor Dent Endod, 42:152–155.
47. Komasi, S, Rezaei F, Hemmati A, Rahmani K, Amianto F, Miettunen J (2022) Comprehensive meta-analysis of associations between temperament and character traits in Cloninger’s psychobiological theory and mental disorders. J Int Med Res, 50:3000605211070766.
48. Kupferberg A, Bicks L, Hasler G (2016) Social functioning in major depressive disorder. Neurosci Biobehav Rev, 69:313–332.
49. Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJLM et al. (2011) Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry, 72:341–348.
50. Marchesi C, Cantoni A, Fontò S, Giannelli MR, Maggini C (2005) The effect of pharmacotherapy on personality disorders in panic disorder: a one year naturalistic study. J Affect Disord, 89:189–194.
51. Mauri M, Sarno N, Rossi VM, Armani A, Zambotto S, Cassano GB et al. (1992) Personality disorders associated with generalized anxiety, panic, and recurrent depressive disorders. J Pers Disord, 6:162–167.
52. McKnight PE, Monfort SS, Kashdan TB, Blalock DV, Calton JM (2016) Anxiety symptoms and functional impairment: A systematic review of the correlation between the two measures. Clin Psychol Rev, 45:115–130.
53. Millon T, Grossman S, Millon C, Meagher S, Ramnath R (2004) Personality Disorders in Modern Life, 2nd ed. Hoboken, NJ, Wiley.
54. Mochcovitch MD, Baczynski TP, Silva AC, Nardi AE (2015) Treatment effect on temperament and character in panic disorder: a prospective randomized double-blind study. Medical Express (San Paulo), 2:M150303.
55. Ng HM, Bornstein RF (2005) Comorbidity of dependent personality disorder and anxiety disorders: A meta-analytic review. Clin Psychol (New York), 12:395–406.
56. Osma J, García-Palacios A, Botella C, Barrada JR (2014) Personality disorders among patients with panic disorder and individuals with high anxiety sensitivity. Psicothema, 26:159–165.
57. Oussi A, Hamid K, Bouvet C (2023) Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping. J Behav Ther Exp Psychiatry, 79:101835.
58. Ozkan M, Altindag A (2005) Comorbid personality disorders in subjects with panic disorder: do personality disorders increase clinical severity? Compr Psychiatry, 46:20–26.
59. Perna, G, Caldirola D (2017) Management of treatment-resistant panic disorder. Curr Treat Options Psychiatry, 4:371–386.
60. Pilarska A, Suchańska A (2015) The sense of identity and symptoms of personality disorders - The results of a non-clinical population study. Psychiatria Pol, 49:599–613.
61. Reich J, Perry JC, Shera D, Dyck I, Vasile R, Goisman RM et al. (1994) Comparison of personality disorders in different anxiety disorder diagnoses: panic, agoraphobia, generalized anxiety, and social phobia. Ann Clin Psychiatry, 6:125–134.
62. Ruscio AM, Hallion LS, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, et al. (2017) Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiatry, 74:465–475.
63. Saha S, Lim CCW, Cannon DL, Burton L, Bremner M, Cosgrove P, et al. (2021) Comorbidity between mood and anxiety disorders: A systematic review and meta-analysis. Depress Anxiety, 38:286–306.
64. Salters-Pedneault K, Roemer L, Tull M, Rucker L, Mennin D (2006) Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognit Ther Res, 30:469–480.
65. Sciuto G, Diaferia G, Battagilia M, Perna G, Gabriele A, Bellodi L (1991) DSM-III-R personality disorders in panic and obsessive-compulsive disorder: A comparative study. Compr Psychiatry, 32:450–457.
66. Sibilla F, Imperato C, Mancini T, Musetti A (2022) The association between level of personality organization and problematic gaming: anxiety, depression, and motivations for playing as mediators. Addict Behav, 132:107368.
67. Skodol AE, Geier T, Grant BF, Hasin DS (2014) Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depress Anxiety, 31:721–728.
68. Ulusoy M, Hisli Sahin N, Erkmen H (1998) Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cogn Psychother, 12:163-172.
69. Valkonen H, Lindfors O, Knekt P (2012) Association between the Rorschach Ego Impairment Index and the Level of Personality Organization interview assessment in depressive and anxiety disorder patients. Psychiatry Res, 200:849–856.
70. Weissman MM (1990) Panic and generalized anxiety: Are they separate disorders? J Psychiatr Res, 24:157–162.
71. Widiger TA, Oltmanns JR (2017) Neuroticism is a fundamental domain of personality with enormous public health implications. World Psychiatry, 16:144-145.
72. WHO (2018) International Classification of Diseases, 11th Revision (ICD-11). Geneva, World Health Organization
73. Wright AGC (2011) Qualitative and quantitative distinctions in personality disorder. J Pers Assess, 93:370–379.
74. Yang X, Fang Y, Chen H, Zhang T, Yin X, Man J et al. (2021) Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiol Psychiatr Sci, 30:e36.
75. Yılmaz Y, Sayğılı İ, Bilge D, Çınar S, Bodur NE, Bayrak A et al. (2012) Erenköy Kişilik Örgütlenmesi Tanı Formu faktör yapısı Güvenirliği ve geçerliği. 48.Ulusal Psikiyatri Kongresi, 9-13 Ekim 2012 Bursa, Türkiye.
76. Zeigler-Hill V, Marcus DK (2016) Introduction: a bright future for dark personality features? in the dark side of personality: science and practice In Social, Personality, and Clinical Psychology (Eds V Zeigler-Hill, DK Marcus):3–22. Washington DC, American Psychological Association