Journal of Anxiety Disorders 21 (2007) 526539

Abnormal personality and the mood and anxiety

disorders: Implications for structural models
of anxiety and depression
Wakiza Gamez a,*, David Watson a, Bradley N. Doebbeling b
a

Department of Psychology, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242, United States
b
Department of Internal Medicine, Indiana University School of Medicine, Regenstrief Institute,
and Indianapolis Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States
Received 15 March 2006; received in revised form 6 July 2006; accepted 1 August 2006

Abstract
Substantial overlap exists between the mood and anxiety disorders. Previous research has suggested that
their comorbidity can be explained by a shared factor (negative emotionality), but that they may also be
distinguished by other unique components. The current study explicated these relations using an abnormal
personality framework. Current diagnoses of major depression and several anxiety disorders were assessed
in 563 Gulf War veterans. Participants also completed the schedule for nonadaptive and adaptive personality
(SNAP) to determine how these disorders relate to abnormal personality traits. Analyses of individual
diagnoses indicated that depression, generalized anxiety disorder (GAD), and post-traumatic stress disorder
(PTSD) were more strongly related to personality than were other anxiety disorders. The Self-Harm Scale
distinguished major depression from all other disorders, highlighting its significance for future structural
models. Our results add to a growing body of evidence suggesting that GAD and PTSD have more in
common with major depression than with their anxiety disorder counterparts.
# 2006 Elsevier Ltd. All rights reserved.
Keywords: SNAP; Structural model; Personality; Depression and anxiety

1. Introduction
The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (American Psychiatric
Association, 1994) establishes a basic distinction between the mood disorders and the anxiety
disorders. It is clear, however, that substantial overlap/comorbidity exists between these two

* Corresponding author. Tel.: +1 319 335 2406; fax: +1 319 335 0191.
E-mail address: wakiza-gamez@uiowa.edu (W. Gamez).
0887-6185/$ see front matter # 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.janxdis.2006.08.003

W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

527

diagnostic classes (Brown & Barlow, 1992; Brown, Campbell, Lehman, Grisham, & Mancill,
2001). In response to this evidence, Mineka, Watson, and Clark (1998) proposed the integrative
hierarchical model wherein each syndrome contains both a common and a unique component. The
shared component represents broad individual differences in general distress and negative
emotionality. In addition, each disorder also includes a unique component that differentiates it from
all of the others. Specifically, low positive emotionality is posited to be specific to depression (and
possibly social phobia), whereas autonomic arousal is characteristic of panic disorder.
Despite these advances, much research still needs to be done to clarify both the links between
disorders and the specific dimensions that differentiate them. In the current study, we investigate
these issues by examining how the mood and anxiety disorders relate to a broad range of
personality traits, including this shared component of negative emotionality.
1.1. Models of personality
This paper will focus primarily on the Big Three model of personality. This model consists of the
higher order dimensions of Neuroticism/Negative Emotionality, Extraversion/Positive Emotionality, and Disinhibition (or Psychoticism) versus Constraint (Clark & Watson, 1999; Eysenck &
Eysenck, 1991; Tellegen, 1982), and has been found to encompass normal and abnormal (i.e.,
personality disorder) traits (Clark, 1993). We should also note that this Big Three scheme has been
linked both conceptually and empirically to the prominent Big Five model (Costa & McCrae,
1992a; Goldberg, 1993), and it is clear that they define very similar structures (see Clark & Watson,
1999; Costa & McCrae, 1992b; Draycott & Kline, 1995; Watson, Clark, & Harkness, 1994). The
Big Five model includes the general traits of Neuroticism, Extraversion, Openness, Agreeableness,
and Conscientiousness. Neuroticism and Extraversion map directly onto the first two dimensions of
the Big Three model, whereas Agreeableness and Conscientiousness both are related primarily to
the Disinhibition/Constraint factor (with Conscientiousness being the more strongly related of the
two; see Clark, Simms, Wu, & Casillas, in press; Clark & Watson, 1999; Draycott & Kline, 1995;
Markon, Krueger, & Watson, 2005; Watson et al., 1994).
1.2. Previous research on the Big Three
In the literature examining relations between personality and the mood and anxiety disorders,
the most robust finding is that levels of Neuroticism/Negative Emotionality are elevated across a
broad range of syndromes (Bienvenu et al., 2001; Clark, Watson, & Mineka, 1994; Krueger,
Caspi, Moffitt, Silva, & McGee, 1996; Trull & Sher, 1994; Widiger & Trull, 1992). However,
although these disorders all share this common link with Neuroticism/Negative Emotionality,
some syndromes may be distinguished by the relative amount of the trait that they evidence
(Mineka et al., 1998). For instance, Trull and Sher (1994) reported particularly high levels of
Neuroticism in those with major depression and post-traumatic stress disorder. In contrast, those
with specific phobia were found to have relatively lower elevations on the Neuroticism
dimension. More generally, major depression, dysthymia, and generalized anxiety disorder are
characterized by a particularly large negative affective component (Mineka et al., 1998).
In contrast to Neuroticism, levels of Extraversion/Positive Emotionality appear to be
somewhat lower than normal in all of the unipolar mood and anxiety disorders (Widiger & Trull,
1992). As with Neuroticism, however, certain disorders evidence particularly strong links to this
trait. More specifically, low Extraversion has been found to be associated particularly with major
depression and social phobia (Brown, Chorpita, & Barlow, 1998; Clark & Watson, 1991; Clark

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W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

et al., 1994; Trull & Sher, 1994; Watson, Clark, & Carey, 1988). In addition, some studies have
found agoraphobia (Bienvenu et al., 2001; Trull & Sher, 1994) to be characterized by low
Extraversion.
Finally, the available data do not establish any strong, consistent associations between
Disinhibition/Constraint and the mood and anxiety disorders (Bienvenu et al., 2001; Krueger
et al., 1996). Generally speaking, this trait shows much stronger links to the externalizing
disorders (such as substance abuse/dependence and antisocial personality) than to depression
and anxiety (Krueger, McGue, & Iacono, 2001). However, low conscientiousness was found to be
associated with major depression in one study (Trull & Sher, 1994).
1.3. Overview of the current study
The current study extends the existing literature by providing a more comprehensive analysis
of the associations between personality and the mood and anxiety disorders. It does so by
examining relations between a broad range of diagnoses and both higher order and lower order
personality traits. The study had three basic goals. First, previous work has clearly established
that Neuroticism/Negative Emotionality and Extraversion/Positive Emotionality both are
significantly linked to the mood and anxiety disorders. It currently is not clear, however, whether
other traits also have significant, incremental links to these disorders. We investigated this issue
by examining whether other trait scales provide significant predictive power beyond that
attributable to these higher order dimensions.
Second, we sought to replicate and extend previous work suggesting that there are important
quantitative variations in these relations, such that Neuroticism/Negative Emotionality is more
strongly related to some disorders (especially major depression, generalized anxiety, and posttraumatic stress disorder) than to others (e.g., specific phobia).
To date, few studies in this area have compared more than two mood/anxiety disorders
simultaneously. In order to allow for direct comparisons across syndromes, we assessed a broad
range of mood and anxiety disorder diagnoses (major depression, generalized anxiety disorder,
social phobia, panic disorder, agoraphobia, specific phobia, and post-traumatic stress disorder).
Because of research demonstrating retrospective recall biases (Fredrickson & Kahneman, 1993;
Wright, 1993) and the questionable stability of lifetime diagnoses (Nelson & Rice, 1997;
Vandiver & Sher, 1991), we examined current diagnoses in our analyses.
The schedule for nonadaptive and adaptive personality (SNAP; Clark, 1993) was used to
assess personality in our study. The SNAP was developed originally to measure the basic
personality traits underlying the broad domain of personality disorders. It provides scales
assessing the Big Three traits, as well as 12 relatively distinct lower order scales; this
differentiated structure offers an enhanced opportunity to discriminate between specific
diagnoses. To date, few studies have examined relations between multiple mood/anxiety
diagnoses and lower order personality traits (Bienvenu et al., 2001; Rector, Hood, Richter, &
Bagby, 2002). Finally, it should be noted that the SNAP scales have not been extensively
examined in relation to a broad range of specific Axis I syndromes (see Clark, Vittengl, Kraft, &
Jarrett, 2003); consequently, our data represent a noteworthy extension to the existing literature.
We examined whether the SNAP scales were differentially related to individual diagnoses. We
derived several hypotheses from our earlier review of the literature. Specifically, we hypothesized
that the SNAP Negative Temperament Scale would be significantly associated with all of the
assessed diagnoses, but that its strongest links would be to major depression, generalized anxiety
disorder, and post-traumatic stress disorder. In contrast, specific phobia should be more weakly

W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

529

related to Negative Temperament relative to the other disorders. In addition, we predicted that the
SNAP Positive Temperament Scale would be negatively related to both major depression and
social phobia (e.g., Brown et al., 1998; Clark et al., 1994). Because the limited existing evidence
has failed to establish any strong and consistent associations between the mood and anxiety
disorders and Disinhibition/Constraint, we made no formal predictions regarding this trait.
Finally, because prior studies have not compared individual SNAP scales across Axis I diagnoses,
no predictions were made regarding specific lower order trait scales.
2. Method
2.1. Participants
Participants originally completed a phone interview that was designed to assess different
health-related characteristics among military veterans who served during the Gulf War (Time 1,
conducted between 1995 and 1996). Participants were considered eligible if they: (1) served as
active duty or activated National Guard or U.S. Army Reserve during the Gulf War between
August 2, 1990 and July 31, 1991 and (2) listed Iowa as their state of residence at the time of
enlistment. A stratified random sample was drawn from each of four domains: deployed active
duty or National Guard/Reserve and non-deployed active duty or National Guard/Reserve.
Within each domain, further stratifying was done (on the basis of age, sex, race, military branch,
and rank), which resulted in a total of 64 strata. Samples from each stratum were drawn
proportionally, and oversampling of small strata was performed. Of the 4886 who were sampled
via this procedure, 3695 (75.6%) participated in the structured telephone interview. Details of the
original study methodology can be found elsewhere (Doebbeling et al., 2002).
A follow-up study (Time 2, conducted between 1999 and 2002) was designed to evaluate a
subset of the original veteran sample who met criteria for cognitive dysfunction, chronic
widespread pain (e.g., fibromyalgia, fibrositis), or depression at Time 1 (case group). Cognitive
dysfunction was defined as self-reported distress resulting from memory impairment, confusion,
disorientation, forgetfulness, or difficulty concentrating. A control group (comprising 38% of the
final sample) who did not meet criteria for any of the three aforementioned conditions at time 1
also was included in this Time 2 assessment. Inclusion criteria for both groups required that each
individual have his or her address in Iowa or in one of Iowas six surrounding states (IL, MO, NE,
SD, MN, and WI). A total of 563 participants completed the measures described below. Roughly
three-quarters of the total sample was deployed in the Gulf during the War. The large majority of
participants were male (88%) and Caucasian (97%) (mean age = 39.2 years).
2.2. Measures
Participants underwent a full day of assessment at The University of Iowa General Clinical
Research Center. Assessment consisted of the administration of several self-report questionnaires
designed to measure aspects of personality and physical, social, and mental well being; a
neuropsychological testing battery; a semi-structured psychiatric interview; and a complete
medical examination. For the purposes of this study, the following measures were examined.
2.2.1. Structured clinical interview for DSM-IV-patient edition (SCID-I/P)
The SCID (First, Spitzer, Gibbon, & Williams, 1997) is a semi-structured interview designed
to assess current psychiatric disorders according to DSM-IV criteria. SCIDs were administered

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W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

by one of two trained interviewers. Separate, blind diagnoses were made on 30 separate
occasions from audiotapes of the SCID interviews (kappa >.80). All diagnoses were then
reviewed by one of two clinicians who utilized all available information from the aforementioned
assessment battery to derive a best-estimate diagnosis (this included the original SCID diagnoses,
but did not involve any information from the SNAP). This method attempts to maximize the
validity of each clinical diagnosis. Diagnostic ratings were recorded as 1 (presence of a
diagnosis) or 0 (absence of a diagnosis).
Current diagnoses of major depression and six anxiety disorders (generalized anxiety
disorder, post-traumatic stress disorder, panic disorder, agoraphobia, social phobia, and specific
phobia) were included in subsequent analyses. Unfortunately, very low base-rates (n = 7)
precluded the inclusion of obsessive-compulsive disorder. In addition, dysthymia was only
assessed if a diagnosis of major depression was not met. As a result of this atypical comorbidity
pattern (i.e., there was no overlap between the two diagnoses), dysthymia was not included in the
subsequent analyses.
Table 1 displays the prevalence rates for each disorder included in the study. Major depression
and generalized anxiety disorder (GAD) both were relatively common in this sample, whereas
panic disorder and agoraphobia showed the lowest prevalence rates. The relatively high
prevalence of post-traumatic stress disorder (PTSD) is predictable given the nature of this veteran
sample.
2.2.2. Schedule for nonadaptive and adaptive personality (SNAP)
The SNAP (Clark, 1993) is a 375-item, factor analytically derived self-report inventory with a
true-false format. As noted previously, the SNAP consists of three general temperament scales
(Negative Temperament, Positive Temperament, and Disinhibition) and 12 lower order trait
scales (see Table 2 for descriptions of each of the scales). The temperament scales are not
composites or weighted sums of the trait scales, but rather, are standalone scales that were
developed independently as part of the general temperament survey (GTS; Clark & Watson,
1990). The temperament scales are typically the strongest markers of the three factors underlying
the SNAP, with the trait scales also loading primarily on one of these three dimensions (Clark,
1993; see Table 2). Finally, it should be noted that the temperament and trait scales do not share
item content (with the exception of Disinhibition, which shares some item content with the
Impulsivity, Propriety, and Workaholism Trait Scales).
The scales validity has been substantiated in a number of studies (e.g., Ready, Watson, &
Clark, 2002; Reynolds & Clark, 2001; Vittengl, Clark, Owens-Salters, & Gatchel, 1999).
Table 1
Prevalence rates of current best estimate diagnoses
Diagnosis

Major depression
Post-traumatic stress disorder
Generalized anxiety disorder
Specific phobia
Social phobia
Agoraphobia
Panic disorder
Any anxiety disorder

52
41
39
32
28
16
12
118

9.2
7.3
6.9
5.7
5.0
2.8
2.1
20.9

Note. N = 563.

W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

531

Table 2
Description of the 12 trait scales included in the Schedule for Nonadaptive and Adaptive Personality (SNAP)
Trait scale

Description

1.
2.
3.
4.
5.
6.

Pervasive suspiciousness and cynical attitudes towards others

Willingness to use people for personal gain
The experience and expression of anger and related behaviors
Low self-esteem, parasuicidal behaviors and suicidal ideation
Unusual perceptions, cognitions, and beliefs
Low self-reliance and confidence in decision making

Mistrust
Manipulativeness
Aggression
Self-Harm
Eccentric Perceptions
Dependency

7. Exhibitionism
8. Entitlement
9. Detachment

Overt attention seeking

Unrealistically positive self-regard; expectations of special treatment
Emotional and interpersonal distance

10. Impulsivity
11. Propriety
12. Workaholism

Tendency to act without thinking or planning ahead

Preference for traditional, conservative morality
Tendency to perfectionism and self-imposed demands for excellence

Note. Scales 16 load primarily on the Negative Temperament factor; Scales 79 load primarily on the Positive
Temperament factor; Scales 1012 load primarily on the Disinhibition factor (Clark, 1993).

Moreover, they have demonstrated good internal consistency, discriminant validity, and test
retest reliability across multiple samples (Clark et al., in press).
3. Results
3.1. Relations among diagnoses
Table 3 displays Pearsons correlation coefficients between each of the best estimate
diagnoses as well as the actual number of comorbid cases between diagnoses. It should be noted
that the observed correlations may be somewhat attenuated as a result of the dichotomous nature
of the diagnostic variables (see MacCallum, Zhang, Preacher, & Rucker, 2002; Whitehead,
1993)particularly when these variables show significantly different prevalence rates (as is
typically the case with categorical diagnostic data). In general, the correlations are fairly low. The
two exceptions to this are the associations between major depression and GAD (r = .39), and
between panic disorder and agoraphobia (r = .46). These correlations are consistent with prior
findings in this area (e.g., Krueger, 1999; Vollebergh et al., 2001; Watson, 2005). However, it
Table 3
Correlations and number of comorbid cases among current best estimate diagnoses

Major depression
Generalized anxiety disorder
Post-traumatic stress disorder
Social phobia
Panic disorder
Agoraphobia
Specific phobia

MDD

GAD

PTSD

SP

PD

AGOR

PHOB

.39
.26
.15
.11
.19
.08

20

.22
.20
.19
.15
.02

15
11

.12
.22
.25
.12

8
8
6

.06
.18
.04

3
4
5
1

.46
.01

6
4
7
4
6

.05

6
3
7
3
1
2

Note. The lower triangle displays correlations among diagnoses. The upper triangle displays the number of comorbid
cases (i.e., those that met criteria for both diagnoses). Correlations j.09j are significant at P < .05; correlations j.11j are
significant at P < .01; N = 563.

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W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

should be noted that both social phobia and specific phobia diagnoses evidence weaker than
expected associations with the remaining disorders (e.g., specific phobia correlated significantly
only with PTSD).
3.2. Diagnostic relations with the SNAP
Pearsons correlation coefficients between individual best-estimate diagnoses and the
personality scales are presented in Table 4. As described earlier, because these diagnoses are
assessed dichotomously (i.e., present vs. not present), the associations among the personality and
diagnostic variables may be somewhat attenuated (see Watson, Gamez, & Simms, 2005).
We will summarize key findings in each of the Big Three domains. First, the results regarding
the SNAP Negative Temperament Scale were generally consistent with our predictions. As
hypothesized, its strongest associations were with major depression (r = .38), PTSD (r = .35),
and GAD (r = .31). In order to compare differences between correlations more systematically,
the Williams modification of the Hotelling Test for two correlations with one common variable
was conducted (Kenny, 1987). Consistent with our prediction, correlations of Negative
Temperament with these three disorders (major depression, PTSD, and GAD) were significantly
higher than those for social phobia, panic disorder, agoraphobia, and specific phobia (across the
12 individual comparisons, the zs ranged from 2.10 to 4.86; all Ps < .05, two-tailed). As
expected, Negative Temperament was most weakly related to specific phobia (r = .12); it should
be noted, however, that this correlation was not significantly lower than those for social phobia
(r = .16), panic disorder (r = .18), or agoraphobia (r = .20) (zs ranged from .69 to 1.40, all
Ps > .05).
This same basic pattern was observed across the other scales within the Negative
Temperament domain. Generally speaking, these scales all correlated more strongly with major
depression, GAD, and PTSD than with the other diagnoses. Collapsing across the seven SNAP
Table 4
Correlations between current best estimate diagnoses and the Schedule for Nonadaptive and Adaptive Personality (SNAP)
Diagnoses
Negative Temperament
Mistrust
Manipulativeness
Aggression
Self-Harm
Eccentric Perceptions
Dependency
Positive Temperament
Exhibitionism
Entitlement
Detachment
Disinhibition
Impulsivity
Propriety
Workaholism

MDD

GAD

PTSD

SP

PD

AGOR

PHOB

.38
.31
.09
.21
.41
.18
.16

.31
.22
.10
.20
.31
.14
.16

.35
.29
.08
.26
.25
.28
.08

.16
.12
.04
.07
.19
.16
.08

.18
.08
.11
.11
.12
.08
.06

.20
.15
.09
.16
.17
.10
.01

.12
.07
.06
.08
.06
.08
.01

.25
.10
.07
.24

.22
.07
.05
.20

.13
.10
.03
.23

.16
.12
.08
.17

.11
.05
.03
.14

.10
.08
.08
.15

.05
.08
.04
.07

.10
.07
.03
.13

.07
.10
.01
.10

.09
.07
.00
.16

.04
.06
.02
.04

.06
.05
.06
.05

.11
.04
.07
.00

.01
.02
.05
.01

Note. Correlations j.09j are significant at P < .05; correlations j.11j are significant at P < .01. All correlations j.20j
are highlighted; MDD, major depression; GAD, generalized anxiety disorder; PTSD, post-traumatic stress disorder; SP,
social phobia; PD, panic disorder; AGOR, agoraphobia; PHOB, specific phobia.

W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

533

scales comprising this domain, 13 of the 21 correlations (61.9%) with major depression, GAD
and PTSD were .20 or greater, and 6 (28.6%) were .30 or greater; in sharp contrast, only 1 of the
28 correlations (3.6%) with social phobia, panic disorder, agoraphobia, and specific phobia was
as high as .20.
Many of the scales showed relatively non-specific associations with multiple disorders. For
instance, paralleling Negative Temperament, Mistrust had very similar correlations with major
depression (.31) and PTSD (.29). Two scales, however, showed specific links to particular
disorders. First, Eccentric Perceptions had a significantly stronger correlation with PTSD (.28)
than with any other diagnosis (rs ranged from .08 to .18) (across the six individual comparisons,
the zs ranged from 2.03 to 3.70; all Ps < .05, two-tailed). Second, Self-Harm was the strongest
correlate of major depression (r = .41) and was associated more strongly with depression than
with any other disorder (zs ranged from 2.36 to 6.61; all Ps < .05, two-tailed).
Consistent with expectations, depression (r = .25) and social phobia (r = .16) both were
significantly related to the SNAP Positive Temperament Scale. Unexpectedly, however, Positive
Temperament also correlated moderately with GAD (r = .22). Supporting the predictions of the
integrative hierarchical model (Mineka et al., 1998), Positive Temperament had a stronger
negative correlation with major depression than with PTSD, panic disorder, agoraphobia, and
specific phobia (zs ranged from 2.40 to 3.59, all Ps < .05, two-tailed); the comparisons
involving GAD (z = .67) and social phobia (z = 1.69) failed to reach significance, however. In
contrast, social phobias association with Positive Temperament did not differ significantly from
any other disorder, with the single exception of specific phobia (z = 1.98, P < .05, two-tailed).
With regard to the other scales within this domain, only Detachment showed moderate links to
the diagnoses, correlating most strongly with major depression (.24), PTSD (.23), and GAD
(.20). Exhibitionism and Entitlement displayed consistently weak associations, with no
coefficient exceeding j.15j.
Finally, the Disinhibition domain clearly showed the weakest links to these disorders. Only 6
of the 28 correlations (21.4%) were as high as j.10j and only one coefficient (3.6%) exceeded
j.15j.
3.2.1. Partial correlations controlling for Negative Temperament
Do the other SNAP scales contain incremental predictive power beyond that attributable to
general Neuroticism/Negative Emotionality? We investigated this issue by computing partial
correlations between the best-estimate diagnoses and the SNAP scales, controlling for Negative
Temperament; these partial correlations are presented in Table 5. The results indicate that
controlling for Negative Temperament eliminated a substantial portion of the predictive power of
these other scales. Note, for example, that only 1 of the 42 correlations (2.4%) between the SNAP
scales and panic disorder, agoraphobia, and specific phobia remained statistically significant after
controlling for Negative Temperament. Overall, only 4 of the 98 correlations (4.1%) were j.15j or
greater. Specifically, Self-Harm correlated .26 with major depression and .17 with GAD, Positive
Temperament correlated .16 with major depression, and Eccentric Perceptions correlated .15
with PTSD.
As mentioned previously, low levels of Extraversion/Positive Emotionality have been found to
be fairly common among those with unipolar mood and anxiety disorders. In addition, Bienvenu
et al. (2001) found that controlling for both Neuroticism and Extraversion eliminated a
considerable amount of comorbidity. As a result, we computed correlations that also partialled
out the effects of Positive Temperament. This analysis resulted in slightly lowered correlations,
but did not significantly change the findings presented in Table 5.

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W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

Table 5
Correlations between current best estimate diagnoses and the Schedule for Nonadaptive and Adaptive Personality (SNAP)
(controlling for Negative Temperament)
Diagnoses

MDD

GAD

PTSD

SP

PD

AGOR

PHOB

Negative Temperament
Mistrust
Manipulativeness
Aggression
Self-Harm
Eccentric Perceptions
Dependency

.12
.05
.01
.26
.01
.03

.04
.02
.02
.17
.00
.06

.10
.05
.08
.07
.15
.05

.03
.02
.03
.12
.10
.02

.03
.05
.02
.03
.00
.01

.04
.02
.06
.07
.01
.07

.01
.01
.01
.02
.02
.05

Positive Temperament
Exhibitionism
Entitlement
Detachment

.16
.07
.07
.09

.14
.05
.04
.07

.03
.07
.02
.10

.12
.11
.08
.12

.06
.04
.02
.07

.04
.07
.07
.07

.01
.07
.03
.02

Disinhibition
Impulsivity
Propriety
Workaholism

.01
.01
.02
.04

.02
.04
.04
.02

.01
.01
.05
.08

.00
.03
.00
.00

.02
.02
.08
.00

.06
.00
.10
.06

.03
.05
.04
.03

Note. Correlations j.09j are significant at P < .05; correlations j.11j are significant at P < .01. All correlations j.20j
are highlighted.

4. Discussion
4.1. Summary of results
As expected, Negative Temperament was significantly related to all of the assessed diagnoses
(although minimally so in the case of specific phobia). Positive Temperament also showed its
hypothesized relations with depression and social phobia. One unexpected finding, however, was
that GAD was similarly related to Positive Temperament; this association most likely reflects the
relatively high comorbidity between depression and GAD (see Table 3). Finally, Disinhibition
showed no meaningful associations with any of the disorders included in the study.
Consistent with our expectations, although every disorder was significantly related to Negative
Temperament, the magnitude of these correlations varied widely. As predicted, Negative
Temperament had significantly stronger correlations with depression, GAD, and PTSD than with
panic disorder, agoraphobia, social phobia, and specific phobia. Furthermore, this same basic
pattern was observed across all of the SNAP scales comprising the Negative Temperament domain.
In general, the lower order SNAP personality traits did not show specific associations with
particular disorders. However, two traits (Self-Harm and Eccentric Perceptions) evidenced true
specificity, in that they had significantly stronger correlations with one disorder relative to all of
the others. Although they were not initially hypothesized, the findings regarding Self-Harm are
consistent with prior research that generally has found suicidality to be highest for those with
depression, relative to other disorders (e.g., Wilson, Nathan, OLeary, & Clark, 1996). In
addition, Clark, McEwen, Collard, and Hickok (1993) specifically linked chart-rated depressed
mood and vegetative signs to suicide proneness. This finding is particularly salient, given that the
correlation between Self-Harm and depression remained significant and moderate in magnitude,
even after controlling for a powerful general predictor of psychopathology (Negative
Temperament; see Table 5).

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535

As noted earlier, Eccentric Perceptions was found to be a specific predictor of PTSD (see
Tables 4 and 5). Paralleling the pattern observed with Self-Harm, it is noteworthy that this scale had
incremental predictive power beyond that attributable to Negative and Positive Temperament. This
result is perhaps not surprising, in light of the fact that the DSM-IV Cluster B symptom criteria for
PTSD involves several odd and unusual experiences (e.g., hallucinations, illusions, and dissociative
flashback episodes). In addition, several studies have found that dissociative experiences predict the
onset of PTSD (Harvey & Bryant, 1999; Marmar et al., 1994).
Of course, these results require replication in future research. To date, there have been few
factors that have been found to distinguish between individual mood and anxiety disorders. If
Self-Harm and Eccentric Perceptions are indeed shown to be relatively specific markers of
depression and PTSD, respectively, they may provide important insights that can contribute
toward a better understanding of these disorders, as well as the future development of improved
structural models of anxiety and depression.
4.2. Implications for diagnostic organization
Our results add to a growing body of evidence that has potentially important implications for
the organization of the mood and anxiety disorders in DSM-V. Extensive data establish that GAD
is more closely linked to major depression than to the other current anxiety disorders (e.g.,
Brown, Campbell et al., 2001; Mineka et al., 1998) and that both disorders may share a common
genetic diathesis (Kendler, Neale, Kessler, Heath, & Eaves, 1992; Kendler et al., 1995; Kendler,
Prescott, Myers, & Neale, 2003). Our data contribute to this evidence by demonstrating that
depression and GAD (a) were strongly comorbid and (b) generally showed very similar
associations with the SNAP scales.
Furthermore, findings from the current study suggest that PTSD can be linked conceptually to
both depression and GAD. Namely, depression, GAD, and PTSD show particularly strong
correlations with Negative Temperament (significantly higher than any of the other diagnoses
included in our study). These common links may be largely explained by an examination of the
diagnostic criteria for these disorders. That is, depression, GAD, and PTSD all prominently
feature a number of symptoms that assess non-specific distress.
4.3. Strengths and limitations
This study had several notable strengths. First, the simultaneous examination of several
different mood and anxiety disorders allowed for a direct examination of the specificity versus
non-specificity of relations across multiple disorders. Second, the use of the SNAP scales
permitted a more comprehensive and detailed analysis of personality-disorder relations than in
most previous studies in this area. Third, our use of current diagnoses eliminated problems
associated with retrospective recall biases. Fourth, we were able to establish the incremental
predictive power of Self-Harm and Eccentric Perceptions by controlling for the non-specific
influence of Negative Temperament. Finally, the large size of our sample (N = 563) gave us
sufficient statistical power to examine these issues in a precise and rigorous manner.
At the same time, however, we also must acknowledge three significant limitations of our
study. First, our sample consisted entirely of Gulf War veterans. In addition, our participants were
predominantly male and almost exclusively Caucasian. As a result, it is unclear how well our
results would generalize to other samples, such as community-dwelling adults or clinical
patients. Accordingly, it will be important to replicate these results in other samples. Second, we

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W. Gamez et al. / Journal of Anxiety Disorders 21 (2007) 526539

were not able to include diagnoses of obsessive-compulsive disorder and dysthymia in the
analyses. Third, the cross-sectional nature of the study precludes us from drawing causal
conclusions or teasing apart state and trait effects. Finally, it is important to note that some
diagnoses exhibited relatively low base rates (i.e., panic disorder and agoraphobia; see Table 1).
These low base rates may have served to attenuate the observed correlations between these
disorders and the SNAP (see discussions by MacCallum et al., 2002; Whitehead, 1993).
4.4. Future research
Because Self-Harm was shown to have considerable predictive power in the current study,
future research should examine what other psychological constructs or disorders may be
associated with this potentially important dimension. More generally, additional research is
needed to clarify how the SNAP scales are related to psychopathology. Finally, the relations
between the mood and anxiety disorders and the specific lower order traits included in other
prominent Big Three and Big Five inventories, such as the Multidimensional Personality
Questionnaire (Tellegen, 1982) and the Revised NEO Personality Inventory (Costa & McCrae,
1992b) also should be examined.
Although the current study examined personalitys association with different mood and
anxiety disorders, we are unable to draw any conclusions regarding vulnerability. In this regard,
studies have shown that personality measures may be influenced by ongoing affective states, such
as current depression (Du, Bakish, Ravindran, & Hrdina, 2002; Griens, Jonker, Spinhoven, &
Blom, 2002; Liebowitz, Stallone, Dunner, & Fieve, 1979) and anxiety (Reich, Noyes, Coryell, &
OGorman, 1986). Interestingly, Clark et al. (2003) demonstrated that state and trait effects could
be separated and that only the trait variance was able to predict treatment outcome. Additional
longitudinal research that measures personality before the onset of overt psychopathology (e.g.,
Hirschfeld et al., 1999) would play a valuable role in teasing apart these state and trait effects.
Future studies also should examine relations between personality and dimensional measures
of psychopathology. To date, almost all of the research in this area has focused on categorical
diagnoses. These dichotomous classifications can result in a substantial loss of information (see
Brown, Campbell et al., 2001; Watson, 2005). Moreover, dimensional analyses can circumvent
the base rate problems discussed earlier (Watson et al., 2005) and would likely result in stronger
observed associations among personality and psychopathology variables. Consequently,
dimensionally based research that focuses on symptom level analyses may provide a somewhat
clearer perspective on the relations between personality and psychopathology (see Watson et al.,
2005).
Finally, although the current study adds to our knowledge about the structure of depression and
the anxiety disorders, further research needs to be conducted to explicate these findings further.
Clarifying the structure of these disorders obviously has broad and important implications for the
future diagnostic organization of these syndromes. Moreover, further articulation of the unique
components of the mood and anxiety disorders will enhance our understanding of these disorders
and lead to improvements in our ability to diagnose and treat them.
Acknowledgments
This work was partially supported by CDC Cooperative Agreement U50/CCU711513 and
Department of Defense Grant DAMD17-97-1. We would like to thank Lee Anna Clark, Michael
OHara, Donald Black, and Valerie Forman for their help in the preparation of this manuscript.

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537

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