2005 Personality, Anxiety and Functional Dysphonia

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Personality, anxiety and functional dysphonia

Ulrike Willinger a,*, Harald N. Aschauer b

a University Ear, Nose and Throat Clinic, Medical University of Vienna, Waehringer Guertel 18-20,

A-1090 Vienna, Austriab Department of General Psychiatry, University Hospital for Psychiatry, Vienna, Austria

Received 30 November 2004; accepted 14 June 2005Available online 8 August 2005

Abstract

Psychological factors are considered for the predisposition and perpetuation of functional dysphonia. Inthe present study 61 patients with functional dysphonia were compared with 61 healthy controls, matchedby age, sex, and occupation with respect to Cloninger s personality model, mood, and anxiety.

The patients with functional dysphonia presented significantly higher scores than the healthy controlswith respect to harm avoidance (HA); depressive symptoms; symptoms of unspecific and general anxiety;symptoms of specific anxiety concerning health, illness, and extraversion versus introversion. Nosignificant differences were found in novelty seeking (NS), reward dependence (RD), persistence(PE), or in state-anxiety and anxiety of social situations. These results were found considering univariateand multivariate analyses and confirm the relationship of psychological factors such as personality traits,mood, and anxiety on one hand and conversion disorder in general and functional dysphonia in particularon the other hand. This important relationship should be considered in the diagnostic and therapeuticinterventions of functional dysphonia. 2005 Elsevier Ltd. All rights reserved.

Keywords: Functional dysphonia; Conversion disorder; Symptoms of depression; Symptoms of anxiety; Personality

0191-8869/$ - see front matter 2005 Elsevier Ltd. All rights reserved.doi:10.1016/j.paid.2005.06.011

* Corresponding author. Tel.: +43 1 40400 3335; fax: +43 1 40400 3332.E-mail address: [email protected] (U. Willinger).

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Personality and Individual Differences 39 (2005) 14411449
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1. Introduction

Functional dysphonia is described by complaints of vocal weakness and discomfort in the

throat (Aronson, 1990) and complaints of voice change such as hoarseness, huskiness, and jerk-iness in the absence of a structural or neurological abnormality of the larynx (Scott, Deary, Mac-kenzie, & Wilson, 1997; Wilson, Deary, Scott, & MacKenzie, 1995).

In the diagnostic and statistical manual of mental disorders (DSM-IV) of theAmerican Psy-chiatric Association (1994)functional dysphonia is diagnosed as somatoform disorders, conver-sion disorder with motor symptom or deficit (300.11).

Psychological factors are considered for the predisposition and perpetuation of functional dys-phonia:House and Andrews (1987)pointed out that a third of 71 patients with functional dyspho-nia received diagnoses of mood, anxiety, or adjustment disorders. In a previous analysis of thepresent data base we found that patients with functional dysphonia showed significantly higher

scores than the healthy controls with respect to depressive symptoms, symptoms of unspecificand general anxiety, and symptoms of specific anxiety concerning health and somatic complains(Willinger, Volkl-Kernstock, & Aschauer, 2005). According toAndersson and Schalen (1998)it isgenerally accepted that functional dysphonia is a result of psychosocial stress. They stated thatfunctional dysphonia may be interpreted as a somatic reaction to emotional problems, althoughthe pathogenetic mechanisms are still far from being well understood. Many of the patients intheir study seem to have poor abilities to cope with social stress; they expressed such featuresas helplessness and an inability to manage their life situation, assert themselves, and hold theirown. The patients also had a poor social network and low professional status, and they com-plained of an inability to express themselves verbally. The authors proposed that functional dys-phonia should be considered as a disorder of a particular aspect of communicationa disturbed

capacity for emotional verbal expression.Mans (1993) considered the voice symptom as a creative achievement of the patient to cope

with an internal conflict by using the ego function of speaking in the social context. So, functionaldysphonics display a remarkable sensitivity and variability towards psychosocial factors and anoften immediate connection with the underlying psychic conflict constellation (Mans, 1994).House and Andrews (1987)stated that a significantly high proportion of patients with functionaldysphonia had experienced a difficulty or event that involved conflict over speaking out. There-fore, in the present study we were interested in the expression of symptoms of specific anxiety con-cerning illness and social situations.

According toNichol, Morrison, and Rammage (1993)personality factors may predispose the

patient to dysphonia.Gerritsma (1991)reported that 41% of 82 aphonic and dysphonic patientshad significantly high scores on a neuroticism scale.Kinzel, Biebl, and Rauchegger (1988)foundalexithymic traits (inability to differentiate emotions sufficiently or to express them adequately inwords, lack of fantasies, impoverished imagination, inability to cope with aggressions in an ade-quate way) in patients with functional dysphonia.House and Andrews (1987)however, suggestthat functional dysphonia is usually not found in markedly abnormal personalities.

The results as to the influence of personality traits on functional dysphonia seemed to be con-tradictory. However, in the present study we were interested in the impact of the Unified Bioso-cial Personality Model (Cloninger, 1987a; Cloninger, Svrakic, & Przybeck, 1993) on functionaldysphonia as a conversion disorder (a subtype of somatoform disorder), because this kind of

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personality model was investigated in patients with somatization disorder (another subtype ofsomatoform disorder) and higher scores of one dimension of the model (novelty seeking) werefound in those patients (Battaglia, Bertella, Bajo, Politi, & Bellodi, 1998).Battaglia et al. (1998)

stated that although somatization disorder is considered to be a prototype of a somatoform dis-order, differences requiring further research may well exist between patients with somatization dis-order and individuals with other clinical presentations of somatoform disorder.

The Unified Biosocial Personality Model is a neurobiologically based operant learning modelto guide the rational development of descriptors for temperament that was developed by Clonin-ger (Cloninger, 1987a; Cloninger et al., 1993). He hypothesized the four independent multifaceted,higher-order temperament dimensions novelty seeking (NS), harm avoidance (HA), rewarddependence (RD), and persistence (PE). These four dimensions of personality seemed to beinfluenced by basic emotional dispositions, several studies showed different associations betweenmood disorders and anxiety on the one hand and NS, HA and RD on the other in psychiatric out-

patients in general (Brown, Svrakic, Przybeck, & Cloninger, 1992), and especially in patients withsocial phobia (Kim & Hoover, 1996) and alcohol dependence (Meszaros et al., 1996) but also innon-psychiatric subjects (Krebs, Weyers, & Janke, 1998; Stewart, Ebmeier, & Deary, 2005). Per-sonality dimensions such as NS and RD seemed to covariate only minimally with current moodand seemed to be independent of mood state and feelings, HA and the subscales of HA seemed tobe influenced by depression and anxiety (Brown et al., 1992), significantly higher scores in HA andsignificantly lower scores in PE were found in patients with social phobia compared to healthycontrols (Kim & Hoover, 1996). Therefore, the third aim of the present study was to analyze mul-tivariate differences between the patients with functional dysphonia and the healthy controls withrespect to personality, mood and anxiety.

In detail, the following three research questions were considered:

(1) Are there significant univariate differences between patients with functional dysphonia andhealthy controls with respect to specific anxiety concerning illness and social situations?

(2) Are there significant univariate differences between patients with functional dysphonia andhealthy controls with respect to the four dimensions of Cloningers personality model?

(3) Are there significant multivariate differences between patients with functional dysphonia andhealthy controls with respect to the four dimensions of Cloningers personality model, moodand anxiety?

2. Methods

2.1. Subjects

Sixty-one patients with complaints of vocal weakness and discomfort in the throat were consec-utively recruited and examined at the Department of Phoniatrics and Logopedics of the Univer-sity Ear, Nose and Throat Clinic of Vienna. All patients received laryngoscopic and phonicexaminations for exclusion of organic impairment and fulfilled the DSM-IV (American Psychiat-ric Association, 1994) criteria of conversion disorder, mainly characterized by one or more symp-toms or deficits affecting voluntary motor or sensory function without neurological or general

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medical condition, which are causing clinically significant distress or impairment in social, occu-pational, or other important areas of functioning or warrants of medical evaluation and are notintentionally produced or feigned. Sixty-one controls without voice pathology and without former

ENT, phoniatric, speech or psychiatric treatment were recruited mainly at schools and kindergar-tens and through a circle of acquaintances of students and were matched for age, sex, and occu-pation. Both samples consisted of 48 (79%) female and 13 (21%) male patients. Consistent withthe literature (American Psychiatric Association, 1994), sex distribution showed a significantmajority of female patients (v2 = 20.082; df = 1; p 6 0.0001). The mean age of the patients andthe controls when they entered the study was 36 years (SD = 13 years). About half of the patientsample and the control sample had a voice-demanding occupation28% were teachers, 7% kin-dergarten teachers and 12% salespeopleand reported dependence on the voice in their profes-sional life. All of the patients and controls participated voluntarily and without financialreward after informed consent was obtained. Selection procedure for the samples of patients

and controls has been described in detail in a previous paper (Willinger et al., 2005).

2.2. Measures

Anamnestic data regarding sociodemographic particulars; information about former treat-ments, including ENT, phoniatric (e.g. surgery of larynx), speech, and psychiatric treatments; de-tails of onset; and course of functional dysphonia (e.g. duration, remissions) were evaluatedaccording to a standardized interview.

The Unified Biosocial Personality Model, which is operationalized by the four temperamen-tal dimensions novelty seeking (NS), harm avoidance (HA), reward dependence (RD), andpersistence (PE), was measured by the German version (Aschauer et al., 1994) of the self-

administered Tridimensional Personality Questionnaire (TPQ) (Cloninger, 1987b). NS is de-fined by being quick-tempered, exploratory, excitable, curious, enthusiastic, exuberant, easilybored, impulsive, and disorderly. HA is covered by being cautious, careful, tense, fearful, appre-hensive, nervous, timid, doubtful, discouraged, passive, insecure, negativistic, or pessimistic evenin situations that do not worry other people. RD is defined by being tender-hearted, warm andloving, dedicated, sensitive, dependent, and sociable. PE is represented by being industrious,hard-working, persistent, and stable despite frustration and fatigue. The German version revealedCronbachs alpha coefficients between 0.57 and 0.65, stability over time (3 months) between 0.62and 0.79. External validity showed that 68% of patients with schizophrenia and healthy controlswere classified correctly by NS and HA (Aschauer et al., 1994).

Depressive symptoms were measured by the German version (Hautzinger, Bailer, Worall, &Keller, 1995) of the self-rated Beck Depression Inventory (Beck & Steer, 1987).Information about the symptoms of unspecific and generalized anxiety (e.g. I feel insecure,

I feel anxious, I feel nervous, I am jittery) was obtained by means of the German version(Laux, Glanzmann, Schaffner, & Spielberger, 1981) of the self-ratable State-Trait-Anxiety Inven-tory (Spielberger, Gorusch, & Lushene, 1970), which enables anxiety to be quantified both as atime- and situation-related state (X1) and as a comparatively stable personality trait (X2).

Information about the symptoms of specific anxiety concerning health and social interactionswas assessed by the three different scales somatic complaints (FPI-8), health concern (FPI-9),and extraversion versus introversion (FPI-11) of the self-ratable Freiburg Personality Inven-



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tory (Fahrenberg, Hampel, & Selg, 1994). Somatic complaints ranges from having many so-matic complaints and being psychosomatically disturbed to having few somatic complaints andnot being psychosomatically disturbed (e.g. I often have a headache, I sometimes have an

accelerated heart rate, I am often constipated, I often have chest pain or discomfort).Health concern ranges from being afraid of illness, being conscious about health, and treat-

ing oneself with care not to be worried about health, being unconcerned about health, and feelingrobust (e.g. I am informed on the most widespread diseases and their first signs; If I have adisease, I would like to consult a second doctor; I consult a doctor regularly, also without seri-ous complaints, only for caution; I avoid eating unwashed fruits).

Extraversion versus introversion ranges from being extraverted, sociable, impulsive, andenterprising to being introverted, reserved, reflective, and serious (e.g. I am able to entertain abig society, In society or at public events I prefer to be in the background, I am very slowin contracting a new friendship).

Information about anxiety concerning illness and social situations was obtained by means ofthe self-ratable Interaction-Anxiety Questionnaire (Becker, 1997). It consists of six differentsubscales that are summed up to two higher order factors. The first factor, illness-anxiety, iscovered by fear of physical injury, fear of illness, and fear of medical treatment (e.g. Howun-/pleasant is it for you. . .: . . . if you are assuming that someone is following you in the dark-ness, . . . if you are receiving anonymous letters with threats of physical violence, . . . if youhave to go to the hospital for some time, . . . if you are standing in a group of persons andyou notice that one of them has an infectious illness).

The second factor, anxiety of social situations is covered by fear of social scenes, fear oftransgressing social standards, anxiety over self-competence, and fear of social devaluation andinferiority (e.g. How un-/pleasant is it for you. . .: . . . if your boss is watching you while

you are working, . . .

if you should speak in front of many people, . . .

if you remember thatyou once lied to your best friend, . . . if you should complain about bad treatment in an restau-rant, . . . if you realize that other people are laughing about you).

2.3. Statistical analyses

Distribution of sex within the patient sample was analyzed for significance by the chi-squaretest. Univariate group differences between patients and matched controls were tested for signifi-cance by univariate t-tests for paired samples. Discriminant analysis was used for multivariategroup differences between patients and controls regarding those variables of the four personality

traits, mood, and anxiety, which were significantly different between patients and controls in theunivariate analyses of the present and a previous study (Willinger et al., 2005). The cut-off level forstatistical significance was set atp< 0.05, 2-tailed. All statistical analyses were performed by SPSSfor Windows, Version 10.0.

3. Results

Patients with functional dysphonia scored significantly lower in extraversion versus introver-sion (t-value =12.28; df = 56; p 6 0.001) and significantly higher in fear of illness



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(t-value = 2.29; df = 58; p 6 0.026). No significant difference was found in fear of social situa-tions (t-value = 1.58; df = 58; p = 0.119). Moreover, the patients showed significantly higherscores than healthy controls with respect to harm avoidance (t-value = 3.85; df = 58;

p 6 0.001). No significant differences were found in NS (t-value =

1.47; df = 58; p= 0.146),RD (t-value = 0.4; df = 58; p= 0.69) and PE (t-value = 0.79; df = 58; p= 0.432). Numericaldetails of these results and of those previous statistical analyses of the present data (Willingeret al., 2005) which were used for the following discriminant analysis are given inTable 1.

Multivariate group comparisons between the patients and the controls showed significant dif-ferences between the two groups (canonical correlation = 0.5; Wilksk= 0.8; v2 = 28.6; df = 7;

p 6 0.0001). Seventy-three percentage of the patients and controls were classified correctly by per-sonality, mood, and anxiety. The correlations between the discriminant variables and the stan-dardized canonical discriminant function showed high values with respect to the depressivesymptoms (r= 0.8), to specific anxiety concerning somatic complaints (r= 0.7), and HA

(r = 0.6), modest values with respect to specific anxiety concerning illness (r= 0.4) and health(r= 0.4), and low values with respect to general anxiety (r= 0.2) and extraversion versus intro-version (r= 0.008).

4. Discussion

Personality factors may predispose patients to dysphonia (Nichol et al., 1993). In the currentstudy we investigated patients with functional dysphonia and their control cohorts by means ofthe Unified Biosocial Personality Model, operationalized by the TPQ. Significant differences

Table 1Means, standard deviations and significance of personality traits, symptoms of anxiety and depression in patients withfunctional dysphonia and healthy controls

Variables Patients (n= 61) Controls (n= 61) SignificanceMean SD Mean SD

Novelty seeking (TPQ)a 15.3 5.2 16.7 5.1 n.s.Harm avoidance (TPQ)a 15.6 6.2 11.7 5.0 s.Reward dependence (TPQ)a 14.0 3.5 13.7 3.6 n.s.Persistence (TPQ)a 4.5 2.1 4.2 1.8 n.s.

Extraversion vs introversion (FPI-R)b 7.8 2.4 11.9 0.7 s.Fear of illness (IAF)a 83.6 13.1 78.3 10.6 s.Fear of social situations (IAF)a 121.6 18.9 116.5 19.6 n.s.

Depressive symptoms (BDI)a,c 9.3 7.4 4.2 4.1 s.State-anxiety (STAI-X1)a,c 38.9 12.3 35.1 9.5 n.s.Trait-anxiety (STAI-X2)a,c 40.7 11.3 35.5 9.6 s.Somatic complaints (FPI-R)a,c 4.3 2.9 2.4 2.0 s.Health concern (FPI-R)a,c 5.8 2.7 4.8 2.7 s.

s.: significant (p< 0.05), n.s.: not significant.a Higher values show higher tendencies in variables.b Higher values show more extraversion, lower values show more introversion.c SeeWillinger et al. (2005).



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were found in one dimension of the TPQ, namely HA. Patients with functional dysphonia tend tobe cautious, careful, tense, fearful, apprehensive, nervous, timid, doubtful, discouraged, passive,insecure, negativistic, and pessimistic even in situations that do not worry other people. In the

other three temperament dimensionsNS, RD, and PEthere were no significant differences. Pa-tients and controls seem to have similar tendencies towards intense excitement to novel stimuli,exploratory activity, reward, succor, and perseverance despite frustration and fatigue. In the lit-erature there are contradictory results regarding personality in functional dysphonia.House andAndrews (1987)identified only 2 patients with personality disorder (histrionic) among 71 patientswith functional dysphonia. Personality disorder may be too strong a criterion to look for; it maybe better to look for characteristic personality traits.White, Deary, and Wilson (1997)stated thatpatients with functional dysphonia showed a greater degree of mild psychiatric disturbance but nosignificant differences in personality traits compared to patients with dysphonia associated withstructural laryngeal abnormality and to ENT outpatient controls; patients with functional dys-

phonia did not show unusual levels of neuroticism, extraversion or hysteroid traits. Otherwise,according toScott et al. (1997)psychological and social factors seem to play an important rolein the initiation and perpetuation of functional dysphonia.Bauer (1991)found that functionaldysphonia often appeared as an unspecific reaction to emotional disturbances. Gerritsma(1991)reported high scores in two scales, neuroticism and neurotic somatization, which measurethe neurotic instability that manifests itself in the expression of psychoneurotic and functionalphysical complaints. According to Roy et al. (1997) the patients with functional dysphoniashowed emotional adjustment problems despite successful voice management. These patients con-sidered themselves as people who to a significantly greater degree than others deny good healthand report a variety of vague somatic symptoms; are pessimistic, dissatisfied, sad, suspicious,interpersonally sensitive, diffusedly anxious, and confused; adhere rigidly to ideas and attitudes;

and tend to engage in denial, withdraw socially, and be insecure and anxious when in contact withothers.

In the current study we found significant differences in anxiety concerning illness. The patientswith functional dysphonia showed significantly higher scores than healthy controls with respect tofear of physical injury, fear of illness, and fear of medical treatment. We did not find any signif-icant differences in fear of social situations, which encompasses fear of social scenes, fear of trans-gressing social standards, fear of inadequate self-competence, and fear of social devaluation andinferiority, but we did find such a difference regarding behavior in social situations: the patientswith functional dysphonia considered themselves to be introverted, reserved, reflective, andserious.

According toNichol et al. (1993)the . . .

voice of an individual is a very sensitive indicator ofattitudes, emotions, and role assumptions. It is a major component in social interactions. There-fore it is not surprising that impairments of voice function are not uncommon accompaniments ofpsychological conflicts.

According toButcher (1995)functional dysphonia arises mostly in women who tend to assumean above average number of responsibilities; who are frequently caught up in family and interper-sonal relationship difficulties; who find it hard to express their emotions, especially negative feel-ings; and who have difficulties in asserting themselves. Inefficient assertiveness may contribute tofeelings of powerlessness and helplessness which might be associated with emotional disturbanceand conditions of anxiety and depression.



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Multivariate group comparisons between the patients and the controls showed significant dif-ferences between the two groups. Seventy-three percentage of the patients and controls were clas-sified correctly by personality, mood, and anxiety, especially by depressive symptoms, somatic

complaints, and HA. These results emphasized the relationship between personality, mood andanxiety which were found in several studies about associations between mood disorders and anx-iety on the one hand and NS, HA and RD on the other (Brown et al., 1992; Kim & Hoover, 1996;Krebs et al., 1998; Meszaros et al., 1996; Stewart et al., 2005). However, the multivariate and uni-variate results indicate that personality, mood and anxiety should be considered not only in thediagnostic of functional dysphonia but also in the therapeutic interventions.

Summing up: When compared to healthy controls, the patients with functional dysphoniashowed a significantly higher tendency to respond intensely to aversive stimuli and to avoid pun-ishment, novelty, and non-reward. Moreover, the patients presented significantly higher scoresthan the healthy controls with respect to specific anxiety concerning illness and social situations

by reporting higher fear of physical injury, fear of illness, and fear of medical treatment and byconsidering themselves to be introverted, reserved, reflective, and serious. These results werefound considering univariate and multivariate analyses and confirm the relationship of psycholog-ical factors such as personality traits and anxiety on one hand and conversion disorder in generaland functional dysphonia in particular on the other hand. This important relationship should beconsidered in the diagnostic and therapeutic interventions of functional dysphonia.

References

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington,DC: American Psychiatric Association.

Andersson, K., & Schalen, L. (1998). Etiology and treatment of psychogenic voice disorder: results of a follow-up studyof thirty patients. Journal of Voice, 12, 96106.

Aronson, A. E. (1990). Clinical voice disorders (3rd ed.). New York: Thieme Inc.Aschauer, H. N., Meszaros, K., Willinger, U., Fischer, G., Berger, P., Reiter, E., et al. (1994). Tridimensional

Personality Questionnaire: Ergebnisse zu Gutekriterien der deutschen Version des Fragebogens. Neuropsychiatrie, 8,177181.

Battaglia, M., Bertella, S., Bajo, S., Politi, E., & Bellodi, L. (1998). An investigation of the co-occurrence of panic andsomatization disorders through temperamental variables. Psychosomatic Medicine, 60, 726729.

Bauer, H. H. (1991). Zur Definition psychogener Stimmstorungen. Laryngo-Rhino-Otologie, 70, 102104.Beck, A. T., & Steer, R. A. (1987). Beck depression inventorymanual. San Antonio: The Psychological Corporation.Becker, P. (1997). Interaktions-Angst-Fragebogen. Gottingen: Beltz-Verlag.

Brown, S. L., Svrakic, D. M., Przybeck, T. R., & Cloninger, C. R. (1992). The relationship of personality to mood andanxiety states: a dimensional approach.Journal of Psychiatric Research, 26, 197211.

Butcher, P. (1995). Psychological process in psychogenic voice disorder. European Journal of Disordered Communi-cation, 30, 467474.

Cloninger, C. R. (1987a). A systematic method for clinical description and classification of personality variants.Archives of General Psychiatry, 44, 573588.

Cloninger, C. R. (1987b). Tridimensional Personality Questionnaire (TPQ) (version 4). St Louis, MO: WashingtonUniversity Medical School, Department of Psychiatry.

Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character.Archives of General Psychiatry, 50, 975989.



9/9

Fahrenberg, J., Hampel, R., & Selg, H. (1994). Das Freiburger Personlichkeitsinventar (FPI). InRevidierte Fassung undteilweise geanderte Fassung FPI-A1. Handanweisung. GottingenTorontoZurich: Verlag fur Psychologie, Dr. C. J.Hogrefe.

Gerritsma, E. J. (1991). An investigation into some personality characteristics of patients with psychogenic aphonia anddysphonia. Folia Phoniatrica, 43, 1320.Hautzinger, M., Bailer, M., Worall, H., & Keller, F. (1995). Beck-Depressions-Inventar (BDI). BernGottingen

TorontoSeattle: Verlag Hans Huber.House, A., & Andrews, H. (1987). The psychiatric and social characteristics of patients with functional dysphonia.

Journal of Psychosomatic Research, 31, 483490.Kim, S. W., & Hoover, K. M. (1996). Tridimensional personality questionnaire: assessment in patients with social

phobia and a control group. Psychological Reports, 78, 4349.Kinzel, J., Biebl, W., & Rauchegger, H. (1988). Functional aphonia. A conversion symptom as defensive mechanism

against anxiety. Psychotherapy Psychosomatic, 49, 3136.Krebs, H., Weyers, P., & Janke, W. (1998). Validation of the German version of Cloninger s TPQ: replication and

correlations with stress coping, mood measures and drug use. Personality and Individual Differences, 24, 805814.Laux, L., Glanzmann, P., Schaffner, P., & Spielberger, C. D. (1981). Das State-Trait-Angstinventar. Theoretische

Grundlagen und Handanweisung. Weinheim: Beltz Testgesellschaft.Mans, E. J. (1993). The psychosomatic interview in diagnosis of functional voice disorders. Folia Phoniatr Basel, 45,

105111.Mans, E. J. (1994). Psychotherapeutic treatment of patients with functional voice disorders. Folia Phoniatrica

Logopedica, 46, 18.Meszaros, K., Willinger, U., Fischer, G., Schonbeck, G., Aschauer, H. N., & on behalf of The European Fluvoxamine

in Alcoholism Study Group (1996). The tridimensional personality model: influencing variables in a sample ofdetoxified alcohol dependents. Comprehensive Psychiatry, 37, 109114.

Nichol, H., Morrison, M. D., & Rammage, L. A. (1993). Interdisciplinary approach to functional voice disorders: thepsychiatrists role. OtolaryngologyHead and Neck Surgery, 108, 643647.

Roy, N., McGrory, J. J., Tasko, S. M., Bless, D. M., Heisey, D., & Ford, C. N. (1997). Psychological correlates offunctional dysphonia: an investigation using the Minnesota Multiphasic Personality Inventory. Journal of Voice, 11,

443451.Scott, S., Deary, I. J., Mackenzie, K., & Wilson, J. A. (1997). Functional dysphonia: a role for psychologists?Psychology, Health & Medicine, 2, 169180.

Spielberger, C. D., Gorusch, R. L., & Lushene, R. E. (1970).Manual for the state-trait anxiety inventory (STAI). PaloAlto: Consulting Psychologists Press Inc.

Stewart, M. E., Ebmeier, K. P., & Deary, I. J. (2005). Personality correlates of happiness and sadness: EPQ-R and TPQcompared. Personality and Individual Differences, 38, 10851096.

White, A., Deary, I. J., & Wilson, J. A. (1997). Psychiatric disturbance and personality traits in dysphonic patients.European Journal of Disordered Communication, 32, 307314.

Willinger, U., Volkl-Kernstock, S., & Aschauer, H. N. (2005). Marked depression and anxiety in patients withfunctional dysphonia. Psychiatry Research, 134, 8591.

Wilson, J. A., Deary, I. J., Scott, S., & MacKenzie, K. (1995). Functional dysphonia. British Medical Journal, 311,10391040.


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