Kunik, Lauren (1/15) An investigation of the relationship between panic disorder and conflicted aggression (Philip S. Wong, Ph.D.;Kevin B. Meehan, Ph.D.; Nicole M. Cain, Ph.D.; Barbara Milrod, M.D. Weill Cornell Medical College)
Contemporary psychodynamic theories have proposed that patients with panic disorder are conflicted about aggression, but research has yet to assess this. It was hypothesized that the sample of panic disorder patients would demonstrate one of two styles of difficulties with aggression: 1) low assertiveness, or 2) a tendency to be overly controlling. Panic patients with low assertiveness were predicted to have higher rates of clinically significant depression, agoraphobia, social phobia, and avoidant personality disorder. "Conflicted aggression" was defined as a discrepancy in ratings of difficulties with aggression between self-report and independent rater assessment. Subjects were 176 patients with a primary diagnosis of panic disorder with or without agoraphobia, or agoraphobia with panic attacks. Cluster analysis of the self-report data revealed three interpersonal subgroups: vindictive, nonassertive, and overly nurturant. The vindictive group rated highest on interview items assessing overt aggression and the nonassertive group rated highest on interview items assessing low assertiveness. The nonassertive group had the highest incidence of comorbid avoidant personality disorder. There was a statistically significant discrepancy between self-reported and independent rater assessment of low assertiveness and overt aggression, providing evidence for a `conflict' about aggression. There was a positive correlation between a discrepancy in ratings and panic disorder severity. These results provide a more three-dimensional picture of panic disorder patients in terms of difficulties with aggression and suggest directions for future research and treatment with panic disorder populations.
