Anxiety and Hyperthyroidism January 31, 2011

Anxiety Disorders affect 18% of the American population every year (National Institute of Mental Health, 2009), and is characterized by disproportionate and near-constant stress and worry. Anxiety disorders can include several manifestations including, Panic Attacks, Agoraphobia, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder and Generalized Anxiety Disorder (APA, 2000). To determine a diagnostic hypothesis for Anxiety Disorder, a psychology professional must differentiate between this disorder and other related disorders. Other issues, such as a general medical condition or substance use must be ruled out before determining Anxiety Disorder as a diagnostic hypothesis (First, et al., 2002, Schneider, 2001).
Hyperthyroidism is a medical condition that is caused by an overactive thyroid gland which can cause a variety of symptoms. Hyperthyroidism may mimic an anxiety disorder as symptoms can include difficulty concentrating, nervousness and restlessness which can be misconstrued as an anxiety disorder (National Institutes of Health, 2010). Additionally, the thyroid hormones elevated by hypothyroidism can cause anxiety disorders (Asland et al, 2005).
The hypothesis of hyperthyroidism and increased mental complaints is a topic studied by many researchers. In associated studies, the relationship between increased anxiety, other mental and physical disorders and hypothyroidism was researched thoroughly. A study initiated by Aslan et al. found that in patients studied, dysfunction of the tyroid is associated with mental disorder, however, there was no support for a clinical association of hypothyroidism and anxiety (2005). Interestingly, Grabe et al. and Aslan et al. who directly studied this relationship as well determined that despite their initial hypothesis, there was little relationship between hyperthyroidism and anxiety disorder (2005). Engum et al., determined through their study that despite this lack of association, a history of hypothyroidism or hyperthyroidism was associated. Additionally, it is indicated that the relationship between anxiety and thyroid disorder may still need to be studied (2002). All studies presented empirical first hand research with strong theoretical analysis of all research presented. However, as it is indicated that this topic still needs significant study to persuade. As hypothyroidism has been presented as a medical condition which can cause anxiety, it would be misguided to simply rule out the possibility. It is clear that much more studies on this topic must be completed.

Additionally Hyperthyroidism should be ruled out by a full medical evaluation before diagnosing an anxiety disorder. It is possible that a hyperthyroidism or another medical condition may be causing or mimicking an anxiety disorder.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision, DSM-IV-TR). Washington, D.C.: Author

Aslan, S., Ersoy, R., Kuruoglu, A., Karakoc, A., & Cakir, N. (2005). Psychiatric symptoms and diagnoses in thyroid disorders: A cross-sectional study. International Journal of Psychiatry in Clinical Practice, 9(3), 187-192.

Engum, A., Bjøro, T., Mykletun, A., & Dahl, A. (2002). An association between depression, anxiety and thyroid function – a clinical fact or an artefact?. Acta Psychiatrica Scandinavica, 106(1), 27-34.

Elmore, K., Schneider, R.K. (2001). Medical Mimics of Anxiety Disorders. Retrieved from http://www.eric.vcu.edu
First, M.B., Frances, A. & Pincus, H.A. (2002). DSM-IV-TR handbook of differential diagnosis. Arlington, VA: American Psychiatric Publishing

Grabe, H. J., Völzke, H. H., Lüdemann, J. J., Wolff, B. B., Schwahn, C. C., John, U. U., & … Freyberger, H. J. (2005). Mental and physical complaints in thyroid disorders in the general population. Acta Psychiatrica Scandinavica, 112(4), 286-293

Moutier, C.Y., Stein, M.B. (1999). The history, epidemiology, and differential diagnosis of social anxiety disorder. Journal of Clinical Psychiatry, 60, 4-8.
National Institutes of Health (2010). Hyperthyroidism. Retrieved from http://www.nlm.nih.gov

National Institute of Mental Health. (1999). Mental Health: A Report of the Surgeon General—Executive Summary. Retrieved from http://www.surgeongeneral.gov
National Institute of Mental Health. (2009). Anxiety Disorders. [Online version]. Retrieved from http://www.nimh.nih.gov/

Self – Report Limitations January 22, 2011

xx Relying on clients to describe issues honestly or self-report on certain aspects of their life or their symptoms is an integral part of the clinical assessment process. Clients inform psychology professionals about issues are troublesome, family histories, medical histories, mental health information, symptoms and much more. However, there are some limitations in relying on self reporting. Inaccuracies may occur in self-reporting due to many issues. Such inaccuracies may result from deliberate deception, response biases, cultural tendencies or diathesis-stress issues.

Gathering information on a client through written survey may produce less than advantageous results as such self-reporting tactics may result in varying response styles, such as: inconsistent responding, acquiescence, negativism, extreme responding, or moderacy. Inconsistent responding involves answering in a random manner. For example, an inconsistent responder may vary their answers for similar questions without reason. Acquiescent respondents tend to choose positive choices, while negativism responders will choose to prefer negative choices, for instance, when asked if they like something, the acquiescent responder will say yes; the negative responder will say no, regardless of the statement’s validity. Additionally, there is extreme responding, where the respondent will tend to respond in extremes, and moderacy, where the respondent will neutralize answers (McGrath et al., 2010). These are examples of self-reporting biases in measurement, generally found in written questionnaires, however, there are also biases that occur in verbal assessments that are used in diagnosing mental disorders.

Biases in verbal assessment that may occur are: positive impression management, negative impression management, inaccurate responding cultural tendencies, or diathesis-stress issues. Positive impression management involves the respondent omitting or underreporting information that may not be desirable for their self-image. For instance, a client who does not disclose the full severity of their symptoms because they want to give a good impression (Hunsley, et al.,1996; McGrath, et al, 2010; Paulhus, 1984). Negative impression management involves the respondent exaggerating or over-reporting information. For instance, a client that makes up symptoms to qualify for disability insurance (Hunsley, et al.,1996; McGrath, et al, 2010). Inaccurate respondents lack the required self-awareness to be fully informed about their symptoms (McGrath, et al., 2010; Siebert, et al., 2010). The inability to respond in a helpful manner is not based on a desire to deceive, yet may be due to a psychopathology, or substance or alcohol abuse that makes it impossible to respond honestly (Seibert, et al., 1996). Cultural tendencies involve a response style that is manifested through learned behavior of a particular culture. For example, a client who responds in a dialectic thinking style that may appear contradictory (Hamamura, Heine & Paulhus, 2008). Diathesis-stress issues may occur when a client has a predisposition for a disorder, i.e., depression in women, cause the respondent to answer in a way that is concurrent with their predisposition (Driscoll, Lopez, & Kistner, 2009).

Psychology professionals place great importance on determining truth. The truth from their clients assist in producing truthful diagnoses. As shown, there are many complications that may cause errors in the assessment process of clients. Many different bias indicator tests have been developed for use in assessment to reduce misrepresentations, however it has been hypothesized that simply inconsistent responding may be a clear indicator for biases in self-reporting (McGrath et al. 2010). At any rate, It is important for psychology professionals to be aware of the many ways self-reporting may cause inaccuracies as it directly affects diagnosis of disorders.

References

Driscoll, K.A., Lopez, C.M., & Kistner, J.A. (2009). A diathesis-stress test of response styles in children. Journal of Social and Clinical Psychology, 28(8), 1050-1070.

Hamamura, T., Heine, S.J., & Paulus, D.L. (2008). Cultural differences in response styles: The role of dialectical thinking. Personality and Individual Differences, 44, 932-942.

Hunsley, J., Vito, D., Pinsent, C., James, S., & Lefebvre, M. (1996). Are self-report measures of dyadic relationships influenced by impression management biases? Journal of Family Psychology, 10(3), 322-330.

McGrath, R.E., Michell, M., Kim, B.H., & Hough, L. (2010). Evidence for response bias as a source of error variance in applied assessment, 136(3), 450-470.

Paulhus, D.L. (1984). Two-component models of socially desirable responding. Journal of Personality and Social Psychology, 46(3), 598-609.

Seibert, L.A., Miller, J.D., Few, L.R., Zeichner, A., & Lynam, D.R. (2010). An examination of the structure of self-report psychopathy measures and their relations with general traits and externalizing behaviors. Personality Disorders: Theory, Research, and Treatment.