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Stubbornness, Perfectionism May Raise Risk of Anxiety Disorders

May 15, 1991 GMT

NEW ORLEANS (AP) _ Stubbornness, perfectionism and indecision will probably not make you very popular, and a study says they may also raise your risk of developing an anxiety disorder.

Excessive devotion to work and a reduction in the ability to express emotions also appear to contribute, researchers said.

The work also found that, at least in urban areas, nearly 12 percent of people show ″severe″ stubbornness and about 8 percent show a high level of perfectionism.

The research is to be presented Thursday at the annual meeting of the American Psychiatric Association Orleans by Dr. Gerald Nestadt, an assistant professor of psychiatry at the Johns Hopkins School of Medicine in Baltimore.

He noted that the study cannot prove that the personality traits cause the anxiety problems, but can only show an association between them. But it is certainly plausible that the traits, which probably came first, contribute to the development of anxiety disorders, he said Wednesday.

″It looks like in this case clinical judgment is being proven correct,″ said Dr. Bruce Pfohl, an expert on personality disorders at the University of Iowa College of Medicine.

Results are based on interviews lasting 90 minutes to three hours with 759 residents of east Baltimore. They were drawn from 3,481 subjects interviewed in a random sampling. Some had shown a psychiatric problem in the first screening, while others were chosen randomly.

Researchers assessed each person on a 0-3 scale for severity for each of five traits: perfectionism, stubbornness, excessive work devotion, indecision and what psychiatrists call emotional constriction, which is reduced ability to express emotions.

The greater the total number of points accumulated, the higher the person’s risk of having any of a number of anxiety disorders, analysis showed.

The disorders included obsessive compulsive disorder, in which a person has persistent intrusive thoughts or impulses, or does things like repetitive hand-washing in response to his obsessions or in some stereotyped way.

Another was generalized anxiety disorder, which is unrealistic or excessive anxiety about two or more life circumstances for six months or more.

Also linked were agoraphobia - the fear of being alone in a public place from which the person thinks escape would be difficult or help unavailable if he were incapacitated; or so-called ″simple″ phobia, in which a person persistently fears other specific things.

Researchers found that a person with 8 points on their scale ran 15 times the risk for generalized anxiety disorder than a person with a score of 0. The degree of risk for the other anxiety disorders was similar.

Nestadt said the personality traits might promote anxiety disorders by causing conflict with peers and family members. Another possibility is that some biologic vulnerability produces both the traits and the anxiety problems, he said.

Researchers also calculated the prevalence of the traits in the general population of east Baltimore. Nestadt said these findings probably would pertain to urban areas in the United States.

Some 27.8 percent of the population has some degree of stubbornness and 11.7 percent shows a severe level, researchers estimated. Severe stubbornness is a general tendency to hold views so strongly that a person gets into frequent arguments, Nestadt said.

Perfectionism was estimated to appear in 30.8 percent of the general population, including 7.7 percent at a severe level. Mild perfectionism would not cause much distress or inconvenience unless a person is stressed or particulary concerned about a project, while severe perfectionism embraces ″all aspects of one’s life,″ consuming excess time and causing conflict, Nestadt said.

Excessive work devotion appears in 14.4 percent of the population, including 4.3 percent with a severe form, researchers said. The severe form causes irritation in the family or is so preoccupying the person has little chance for leisure or pleasure, Nestadt said. ″There’s a pressure or a constant impulse to work exceptionally hard,″ he said.

A more moderate level causes family distress only sporadically, as when a particular project comes up, he said.

Indecision was estimated to appear in 8.8 percent of the population with 2.3 percent having a severe level, and emotional constriction in 16 percent with 4.4 percent at a severe level.

The study makes a good case for higher risk of anxiety disorders with more points on the personality trait scale, said Pfohl. That makes sense, given the general experience of psychiatrists, he said.