(106) Do specific anxiety subtypes predict impairment in youth with functional abdominal pain?

Abstract

Functional abdominal pain (FAP) is a common pediatric disorder associated with recurrent pain and significant impairment in functioning. Anxiety is common in youth with FAP, and is associated with increased disability. Current literature examining anxiety subtypes in youth with FAP are based on limited sample sizes. Based on these prior investigations, the most common DSM-IV subtypes of anxiety in youth with FAP are: generalized anxiety, separation anxiety, and social anxiety. However, the role of specific anxiety subtypes in relation to impairment has not been investigated. Thus, the purpose of this investigation is to examine the rates and subtypes of anxiety in a larger sample. Additionally, the relationship between anxiety subtypes and impairment in youth with FAP was explored conducting multiple regressions based on parent and child report. Seventy-seven patients with FAP between the ages of 8 and 18 who presented to a pediatric gastroenterology clinic with their primary caregiver completed measures of pain intensity, pain-related disability, and anxiety. High anxiety levels in youth with FAP were noted, with patients reporting higher rates (53.2%) than parents (32.5%). Consistent with previous findings, the most common DSM subtypes were generalized anxiety, separation anxiety, and social anxiety, and anxiety subtypes predicted impairment controlling for pain (F = (4, 64) = 7.53, p<0.001). Of these subtypes, patient-reported generalized anxiety predicted increased impairment in youth when controlling for pain (beta =0.35, p <0.01, explaining 8.9% model variance) whereas the other anxiety subtypes did not predict impairment. Generalized anxiety may correspond to increased impairment, as it may reflect a global tendency for anxiety in a variety of situations, whereas anxiety in a specific domain may be less likely to impact global functioning. Use of a brief anxiety screening measure may help identify patients at greatest risk. Tailored behavioral treatments for pain and anxiety may reduce pain-related disability.