The mediating role of disgusting sensitivity in the relationship between temperamental dimensions and panic disorder

Document Type : Original Article


1 Ph.D. Student, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran.

2 Professor, Department of Clinical Psychology, University of Tabriz, Tabriz, Iran.


Aim: The objective of the current study was to explore the mediating role of disgust sensitivity in the association between temperament dimensions and panic disorder.
Method: This research utilized a descriptive-correlational design. The statistical population comprised all students of Urmia University during the academic year 2017-2018. A sample of 377 students was selected through multi-stage cluster sampling. Participants completed the Temperament and Character Inventory (Cloninger, Svrakic & Przybeck, 1993), the Disgust Scale (Haidt, 1994), and the Panic-Associated Symptom Scale (Liebowitz, 1984). Structural equation modeling was employed for data analysis, and the Smart-PLS software facilitated data classification, processing, analysis, and hypothesis testing.
Results: In this study, the indirect path coefficient between reward dependency (p< 0.01, β = -0.309) and perseverance (p< 0.01, β = 0.096) exhibited significance with a negative association with panic disorder at the 0.01 level. The indirect path coefficient between harm avoidance (p< 0.01, β = 0.135) and panic disorder was positively and significantly associated at the 0.01 level.
Conclusion: The findings support the role of temperament in contributing to panic disorder and highlight the importance of considering biological factors in the treatment of panic disorder. The proposed pathological model can enhance understanding of the role of disgust in psychological trauma and the effectiveness of cognitive-behavioral therapies for individuals with anxiety disorders, including panic disorder.


Alonso, P., Menchòn J. M., Jiménez S, Segalàs J., Mataix-Cols, D., Jaurrieta, N., Labad, J., Vallejo, J., Cardoner, N., Pujol, J. (2008). Personality dimensions in obsessive–compulsive disorder: Relation to clinical variables. Psychiatry Research, 157 (1) , 159-168 .[Limk]
 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association. .[Limk]
Armfield, J. M. (2006). Cognitive vulnerability: a model of the etiology of fear. Clinical psychology review26 (6) , 746-768.[Link]
Armstrong, T., Wilbanks, D., Leong, D., & Hsu, K. (2021). Beyond Vernacular: Measurement Solutions to the Lexical Fallacy in Disgust Research. Journal of Anxiety Disorders, 102408.[Link]
Árnadóttir, Á., & Daníelsdóttir, S. A. (2016). The contribution of disgust in contamination fear: The mediating role of harm avoidance and incompleteness, (Doctoral dissertation).
Bal, Z. E., Solmaz, M., Aker, D. A., Akin, E., & Kose, S. (2017). Temperament and character dimensions of personality in patients with generalized anxiety disorder. Psychiatry and Behavioral Sciences, 7 (1) , 10-9.[Link]
Bandelow, B., Broocks, A., Pekrun, G., George, A., Meyer, T., Pralle, L., & Rüther, E. (2000). The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial. Pharmacopsychiatry, 33 (05) , 174-181. [Link]
Barlow, D. H. (Ed.). (2021). Clinical handbook of psychological disorders: A step-by-step treatment manual. Guilford publications. [Link]
Bentler, P. M. (1995). EQS structural equations program manual. Encino, CA: Multivariate software, Vol 6. [Link]
Bijttebier, P., Beck, I., Claes, L., & Vandereycken, W. (2009). Gray's Reinforcement Sensitivity Theory as a framework for research on personality–psychopathology associations. Clinical psychology review, 29 (5) , 421-430.[Link]
Bruno, A., Muscatello, M. R. A., Pandolfo, G., La Ciura, G., Quattrone, D., Scimeca, G., & Zoccali, R. A. (2018). Does personality matter? Temperament and character dimensions in panic subtypes. Archives of Neuropsychiatry55 (4) , 325.[Link]
Cervin, M., Perrin, S., Olsson, E., Claesdotter-Knutsson, E., & Lindvall, M. (2020). Incompleteness, harm avoidance, and disgust: a comparison of youth with OCD, anxiety disorders, and no psychiatric disorder. Journal of anxiety disorders69, 102175. . [Link]
Cloninger, C. R. (1994). Temperament and personality. Current opinion in neurobiology4(2), 266-273.  [Link]
Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of general psychiatry50(12), 975-990. [Link]
De Jong, P. J., & Merckelbach, H. (1998). Blood-injection-injury phobia and fear of spiders: Domain specific individual differences in disgust sensitivity. Personality and Individual Differences. 24, 153–158.[Link]
Eysenck HJ. The biological basis of personality. Springfield: Thomas 1967[Link]
Gray, J. A., & McNaughton, N. (2000). The europsychology of anxiety: an enquiry into the functions of the septohippocampal system. [Link]
Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual differences, 16 (5) , 701-713.[Link]
Izci, F., Gültekin, B. K., Saglam, S., Koc, M. I., Zincir, S. B., & Atmaca, M. (2014). Temperament, character traits, and alexithymia in patients with panic disorder. Neuropsychiatric disease and treatment10, 879.[Link]
 Javelot, H., & Weiner, L. (2021). Panic and pandemic: narrative review of the literature on the links and risks of panic disorder as a consequence of the SARS-CoV-2 pandemic. L'encephale, 47 (1) , 38-42.[Link]
Kampman, O., Viikki, M., & Leinonen, E. (2017). Anxiety disorders and temperament—an update review. Current psychiatry reports, 19 (5) , 27.[Link]
Kampman, O., Viikki, M., Järventausta, K., & Leinonen, E. (2014). Meta analysis of anxiety disorders and temperament. Neuropsychobiology, 69 (3) , 175-186. [Link]
Karsazi, H., & Nasiri, M. (2016). Factor analysis and evaluation of internal structure of disgust sensitivity scale. Journal of Clinical Psychology, 8(4), 49-62. [Limk]
Khalsa, S. S., Feinstein, J. S., Li, W., Feusner, J. D., Adolphs, R., & Hurlemann, R. (2016). Panic anxiety in humans with bilateral amygdala lesions: pharmacological induction via cardiorespiratory interoceptive pathways. Journal of Neuroscience, 36 (12) , 3559-3566.[Link]
Kline, R. B. (2010). Promise and pitfalls of structural equation modeling in gifted research. In B. Thompson & R. F. Subotnik (Eds.) , Methodologies for conducting research on giftedness, 147–169. [Link]
Knowles, K. A., Jessup, S. C., & Olatunji, B. O. (2018). Disgust in anxiety and obsessive-compulsive disorders: recent findings and future directions. Current psychiatry reports, 20 (9) , 1-10.[Link]
Koh, S. H., Lim, K. Y., Cho, S. M., & Chung, Y. K. (2004). The comparison study of temperament and character in subjects with panic disorder. Journal of Korean Neuropsychiatric Association, 43 (6) , 706-711.[Link]
Kumar, V. (2016). To walk alongside: Myth, magic, and mind in The Golden Bough. HAU: Journal of Ethnographic Theory, 6 (2) , 233-254.[Link]
Mahmood Alilou, M., Bakhshipour Roudsari, A., & Nasiri, M. (2018). Structural Relationships Between Behavioral Brain Systems, Disgust Sensitivity, and Obsessive-Compulsive Disorder. Iranian Journal of Psychiatry and Clinical Psychology, 23 (4) , 466-479.[Link]
Marchesi, C., De Panfilis, C., Cantoni, A., Giannelli, M. R., & Maggini, C. (2008). Effect of pharmacological treatment on temperament and character in panic disorder. Psychiatry research, 158 (2) , 147-154.[Link]
Mason, E. C., & Richardson, R. (2012). Treating disgust in anxiety disorders. Clinical Psychology: Science and Practice, 19 (2), 180–194.  [link]
Mochcovitch, M. D., Baczynski, T. P., Silva, A. C. D. O., & Nardi, A. E. (2015). Treatment effect on temperament and character in panic disorder: a prospective randomized double-blind study. MedicalExpress2.[Link]
Mochcovitch, M. D., Nardi, A. E., & Cardoso, A. (2012). Temperament and character dimensions and their relationship to major depression and panic disorder. Revista Brasileira de Psiquiatria, 34 (3) , 342–351.[Link]
Oaten, M., Stevenson, R. J., & Case, T. I. (2009). Disgust as a disease-avoidance mechanism. Psychological bulletin, 135 (2) , 303.[Link]
Ohi, K., Otowa, T., Shimada, M., Sugiyama, S., Tanahashi, S., Kaiya, H.,... & Shioiri, T. (2021). Shared trans-ancestry genetic etiology between panic disorder and anxiety disorders. Psychiatry and clinical neurosciences, 75 (6) , 209-211. [Link]
Okuro, R. T., Freire, R. C., Zin, W. A., Quagliato, L. A., & Nardi, A. E. (2020). Panic disorder respiratory subtype: psychopathology and challenge tests–an update. Brazilian Journal of Psychiatry42, 420-430.[Link]
Ólafsson, R. P., Emmelkamp, P. M., Ólason, D. Þ., & Kristjánsson, Á. (2020). Disgust and contamination concerns: The mediating role of harm avoidance and incompleteness. International Journal of Cognitive Therapy, 13, 251-270. [Link]
 Olatunji, B. O., Armstrong, T., & Elwood, L. (2017). Is disgust proneness associated with anxiety and related disorders? A qualitative review and meta-analysis of group comparison and correlational studies. Perspectives on Psychological Science, 12 (4) , 613-648.[Link]
Olatunji, B. O., Cisler, J., McKay, D., & Phillips, M. L. (2010). Is disgust associated with psychopathology? Emerging research in the anxiety disorders. Psychiatry research, 175 (1-2) , 1-10. [Link]
Olatunji, B. O., Unoka, Z. S., Beran, E., David, B., & Armstrong, T. (2009). Disgust sensitivity and psychopathological symptoms: Distinctions from harm avoidance. Journal of Psychopathology and Behavioral Assessment, 31 (2) , 137.[Link]
Perna, G., & Caldirola, D. (2017). Management of treatment-resistant panic disorder. Current treatment options in psychiatry, 4 (4) , 371-386.[Link]
Perna, G., di Pasquale, D., Grassi, M., Vanni, G., Bellodi, L., & Caldirola, D. (2012). Temperament, Character and Anxiety Sensitivity in Panic Disorder: A High-Risk Study. Psychopathology, 45 (5) , 300-304.[Link]
Rozin, P., & Fallon, A. E. (1987). A perspective on disgust. Psychological review, 94 (1) , 23.[Link]
Scheer, V., Blanco, C., Olfson, M., Lemogne, C., Airagnes, G., Peyre, H., & Hoertel, N. (2020). A comprehensive model of predictors of suicide attempt in individuals with panic disorder: Results from a national 3-year prospective study. General Hospital Psychiatry, 67, 127-135.[Link]
Song, Y. J., Kang, E. H., & Yu, B. H. (2010). Effect of temperament and character on pharmacotherapy in panic disorder patients. Korean Journal of Psychopharmacology, 21 (3) , 144-149.[Link]
Tunnell, N. C., Ritz, T., Wilhelm, F. H., Roth, W. T., & Meuret, A. E. (2021). Habituation or Normalization? Experiential and Respiratory Recovery From Voluntary Hyperventilation in Treated Versus Untreated Patients With Panic Disorder. Behavior Therapy, 52 (1) , 124-135.[Link]
Wiborg, I. M., Falkum, E., Dahl, A. A., & Gullberg, C. (2005). Is harm avoidance an essential feature of patients with panic disorder?. Comprehensive psychiatry, 46 (4) , 311-314.[Link]
Wu, M. H., Wang, W. E., Wang, T. N., Lin, N. C., Lu, M. L., Lui, L. M.,... & Chen, V. C. H. (2021). Asthma and early smoking associated with high risk of panic disorder in adolescents and young adults. Social Psychiatry and Psychiatric Epidemiology, 1-12.[Link]
Zaninotto, L., Solmi, M., Toffanin, T., Veronese, N., Cloninger, C. R., & Correll, C. U. (2016). A meta-analysis of temperament and character dimensions in patients with mood disorders: Comparison to healthy controls and unaffected siblings. Journal of affective disorders194, 84-97.[Link]