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Although recent diagnostic systems support the distinctiveness of panic disorder (PD) and somatization disorder, a high level of comorbidity of these two diagnoses has been reported, indicating a need for investigations with external validators. One hundred fifty-nine outpatients with DSM-III-R PD and 76 surgical controls were screened for lifetime presence of DSM-III-R somatization disorder, and the risks for some types of psychiatric disorders in their families were computed. In our sample, 23% of women and 5% of men with PD also had DSM-III-R somatization disorder, Women patients with PD plus somatization disorder did not differ from women with PD only in age at onset of panic, agoraphobia, childhood history of separation anxiety, or lifetime diagnoses of other disorders. Familial risks for PD, PD-agoraphobia, and alcohol dependence were significantly higher for families of women with PD and women with PD plus somatization disorder than for controls. The familial risks for antisocial personality (ASP) disorder (a familial indicator for the somatization disorder spectrum of liability, phenomenologically independent from both PD and somatization disorder) were significantly higher for families of women with PD plus somatization disorder than for families of women with PD only or for controls. Application of DSM-IV criteria for somatization disorder substantially decreased the comorbidity with PD. Our data suggest that somatization disorder is not simply a form of PD, and that the two disorders may coexist in the same subject without sharing a common genetic diathesis. Compared with DSM-III-R, DSM-IV criteria for somatization disorder appear to be simpler in structure and of less complicated application. Copyright (C) 1995 by W.B. Saunders Company Z8 0 ZR 0 ZS 0 ZB 13

In a controlled 48 h ambulatory polysomnographic study of never-depressed subjects with DSM-III-R borderline (BDL) personality disorder (PD) we obtained measures of tonic and phasic heart rate variability. Subjects with BDL PD showed a significantly smaller index of tonic heart rate decrease during NREM sleep than normal controls. This is unlikely to be a state-dependent finding and it may derive from relative augmentation of adrenergic function compared to cholinergic function between wakefulness and NREM sleep. Hyperadrenergic states in BDL PD have already been suggested by studies of other biological indicators: a smaller index of tonic heart rate decrease may be a further correlate of core psychobiological dimensions such as impulsivity and affective instability. Z8 0 ZR 0 ZS 0 ZB 5

The sleep parameters of never-depressed borderline subjects and age- and sex-matched normal controls were compared by continuous 48-hr ambulatory electroencephalographic (EEG) monitoring. Borderline subjects had a significantly shorter rapid eye movement latency, normal architecture of rapid eye movements sleep, and had familial risks for mood disorders four times greater than in the families of controls. Reduced latency of rapid eye movement can be a trait indicator of liability to depression, present before the clinical appearance of the disorder, and demonstrable in a putative high-risk population.

Objective: The authors investigated the relation ofage at onset ofpanic disorder to liability to panic disorder and agoraphobia. Method: Two hundred thirty-one outpatients with panic disorder were compared with 13 1 surgical outpatients on demographic variables and familial risk ofpsychiatric disorders. The distribution ofpatients’ ages at onset ofpanic disorder and several covariates were entered in a stepwise survivalanalysis. Results: The patients with panic disorder had a significantly higher rate of childhood separation anxiety disorder and higher familial risks of panic disorder/panic disorder with agoraphobia and alcoholism. A family history ofpanic disorder with agoraphobia and the presence ofchildhood separation anxiety disorder influenced age at onset ofpanic disorder. Conclusions: Age at onset ofpanic disorder may reflect genetic penetrance, and separation anxiety disorder may be an individual predictor of earlier onset ofpanic disorder. (Am JPsychiatry1995; 152:1362-1364)

Direct, blind interviews were used to study the risk for and prevalence of DSM-III-R Axis I and II disorders in 93 first-degree relatives of outpatients with schizotypal personality disorder (SPD) and outpatients with other personality disorders. Risks for SPD (at a slightly loosened diagnostic threshold) and schizoid personality disorder were significantly higher in the families of probands with SPD. Schizophrenia was present only among relatives of probands with SPD, accounting for a morbid risk of 4.1 percent. Neither familial risks for mood and anxiety disorders nor the prevalence of other Axis II disorders significantly differed in the two groups of relatives. It is suggested that SPD is a familial disorder representing a phenotypic expression of liability to schizophrenia. ZR 0 ZS 0 Z8 1 ZB 31