Two studies sought to elucidate the components of emotion and its dysregulation and examine their role in both the overlap and distinctness of the symptoms of 3 highly comorbid anxiety and mood disorders (i.e., generalized anxiety disorder, major depression, and social anxiety disorder). In Study 1, exploratory factor analyses demonstrated that 4 factors—heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotions, and maladaptive management of emotions—best reflected the structure of 4 commonly used measures of emotion function and dysregulation. In Study 2, a separate sample provided support for this 4-factor model of emotion dysregulation. Poor understanding, negative reactivity, and maladaptive management were found to relate to a latent factor of emotion dysregulation. In contrast, heightened intensity of emotions was better characterized separately, suggesting it may relate more strongly to dispositional emotion generation or emotionality. Finally, the 4 components demonstrated both common and specific relationships to self-reported symptoms of generalized anxiety disorder, major depression, and social anxiety disorder.
Approaches to understanding and treating anxiety and mood disorders have advanced considerably since the advent of DSM-III ( American Psychiatric Association, 1980), at which time the overarching diagnostic syndromes of neuroses were first divided into discrete categories based on symptom content. For generalized anxiety disorder (GAD), major depressive disorder (MDD), and social anxiety disorder (SAD), which are the most impairing disorders outside of substance use ( Kessler, Chiu, Demler, Merikangas, & Walters, 2005), the diagnostic movement toward greater specificity provided an opportunity for delineation of core elements of these conditions, including worry in GAD, anhedonia in MDD, and fear of evaluation in SAD. Increased precision in conceptual focus also led to greater success in treatments for these disorders (e.g., Borkovec and Costello, 1993, Heimberg et al., 1998 and Jacobson et al., 1996).
Despite these advances, GAD, MDD, and SAD are characterized by high levels of comorbidity, particularly with one another. In fact, the high rate of comorbidity between GAD and MDD has led to calls to combine these disorders in DSM-V into a “distress disorder” category (e.g., Watson, 2005). SAD is the next most frequent comorbid condition for both GAD and MDD. Further, SAD can be a difficult differential diagnosis when these other disorders are present given its characteristics of social worry ( Mennin, Heimberg, & Jack, 2000) and lack of positive affect ( Brown et al., 1998 and Kashdan, 2004), components central to GAD and MDD, respectively. Comorbidity among these disorders has been associated with greater symptom severity and poorer functioning (e.g., Mennin et al., 2000 and Stein and Heimberg, 2004). This high level of comorbidity also challenges the notion of these disorders as purely independent entities and suggests that delineation of both common and specific factors may provide further explanation of the nature of these conditions.
Studies of the anxiety and mood disorders, utilizing structural modeling, offer evidence for the importance of emotional processes common to these conditions (Brown et al., 1998, Shankman and Klein, 2003, Watson et al., 1988 and Zinbarg and Barlow, 1996). These investigations offer support for the tripartite model of emotional disorders, wherein a higher-order factor of negative affect or neuroticism accounted for much of the overlap among anxiety and mood disorders, particularly for the most strongly comorbid disorders, such as GAD and MDD ( Mineka, Watson, & Clark, 1998). These findings suggest that emotional factors can aid in understanding the interplay of these disorders. In addition to being an index of commonality, however, affective features can also distinguish GAD, MDD, and SAD. The tripartite model demonstrates that anxious arousal appears to be more specific to fear-based disorders such as SAD and low positive affect appears more relevant for MDD and SAD ( Watson, 2005). Also, each of these disorders is associated with a prominent, central, emotional element—fear in SAD, anxiety in GAD, and sadness in MDD—suggesting that although some emotional characteristics may be common to these disorders, others may help distinguish them. Delineating core emotional features may help clarify both the overlap and uniqueness among these disorders.
