Severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders Part 1: Relationships between clinical, psychosocial and demographic factors in pharmacoresistant panic disorder patients

OBJECTIVES: Little is known about the relation between severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders. The aim of this study is to look for the intercorrelations between these factors. METHOD: The study explores the relation between clinical, demographic and social factors in panic disorder using cross sectional design. The inpatients with pharmacoresistant panic disorder with and without agoraphobia were included in the study. Participants were also assessed for comorbidity with other anxiety or personality disorder. The Clinical Global Impression (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Internalized Stigma of Mental Illness (ISMI), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Panic Disorder Severity Scale (PDSS) and demographic data were used as measurement tools. RESULTS: A total of 142 pharmacoresistant patients with panic disorder with or without agoraphobia were admitted for 6-week cognitive behavioral therapy inpatient program in psychotherapeutic department between November 2015 and July 2019. One hundred and five inpatients (33 males and 72 females) with mean age 37.8 + 12.1 years were included in the study. Sixty-nine patients suffer from additional comorbid anxiety disorder and 43 had comorbid personality disorder. Patients with comorbid personality disorder had earlier onset of the disorder, were more depressed (BDI-II), dissociated (DES; DES-T), suffered from higher self-stigma and experienced more adverse events in childhood (CTQ-total), especially higher emotional abuse and emotional neglect. According to a regression analysis, the level of dissociation and pathological dissociation were explained mostly by early onset of the disorder, social withdrawal and severity of anxiety symptoms. The severity of self-stigma was significantly explained by emotional neglect in childhood and severity of depressive symptoms. The earlier development of the disorder is linked to higher score in childhood adverse events, higher level of dissociation and pathological dissociation, and higher level of self-stigma. CONCLUSIONS: Higher rate of aversive childhood events, level of dissociation, and level of self-stigma are associated with earlier onset of the disorder. Patients with comorbid personality have earlier onset of the disorder, were more depressed, dissociated, self-stigmatized and experienced more adverse events in childhood, especially higher emotional abuse and emotional neglect.