Characterization of different types of anxiety disorders in relation to structural integration of personality and adverse and protective childhood experiences in psychotherapy outpatients - a cross-sectional study.

BACKGROUND: Current research has emphasized the role of structural integration of personality and childhood experiences for the understanding of anxiety disorders. In this study, we examined the relationship between anxiety disorders (generalized anxiety disorder vs. panic disorder vs. phobic disorders), the level of structural integration of personality, and negative and protective childhood experiences at the beginning of outpatient psychodynamic psychotherapy treatment. Differences were characterized in comparison to patients with no anxiety disorders. METHODS: The sample included a total of 1646 outpatient psychodynamic psychotherapy treatments, of which 695 treatments included the diagnosis of at least one anxiety disorder. Levels of structural integration of personality were assessed according to the Operationalized Psychodynamic Diagnosis (OPD-2) system. Self-reported negative and protective childhood experiences were examined by using the Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC). Associations were tested using single factor ANOVAs. RESULTS: Patients with anxiety disorders showed lower levels of structural integration of personality and reported more adverse childhood experiences than patients with no anxiety disorders. Regarding the subscales of structural integration of personality, phobic disorders were associated with impaired external communication, whereas for generalized anxiety disorder, an (uncorrected) association with impaired self-regulation was found. Also, generalized anxiety disorder was associated with sexual abuse and other traumatization (accidents etc.) during childhood, while panic disorder and phobic disorders were associated with emotional neglect, abuse, and fewer protective childhood experiences. CONCLUSIONS: Our findings emphasize the need of considering structural integration of personality and childhood experiences in order to understand and treat various types of anxiety disorders.

Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy.

To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy.We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor.The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate.Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.

Examining childhood experiences and personality functioning as potential predictors for the speed of recovery during psychotherapy of patients with anxiety disorders.

Background: Adverse childhood experiences were previously identified as relevant risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The objective of this study was to investigate adverse and protective childhood experiences as well as personality functioning, as defined by the Operationalized Psychodynamic Diagnosis system, as potential predictors for the speed of recovery during psychotherapy for patients with anxiety disorders. Methods: The sample consisted of n = 312 completed psychotherapies. The speed of recovery, defined as symptom abatement over time, was calculated using a two-stage hierarchical linear model. The effects of adverse and protective childhood experiences as well as personality functioning on the speed of recovery during psychotherapy were then examined using a structural equation model. Results: The presence of adverse childhood experiences predicted a lower speed of recovery during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict the speed of recovery during psychotherapy. Conclusions: Among patients with anxiety disorders, adverse childhood experiences lead to a lower speed of recovery during psychotherapy. Therefore, childhood adversity should be routinely assessed before and thoroughly addressed during psychotherapy in patients with anxiety disorders.