ANXIETY ACROSS THE MENSTRUAL CYCLE Anxiety Symptoms and Precautionary Behaviour ...

236 Pages·2015·1.69 MB·English

Running head: ANXIETY ACROSS THE MENSTRUAL CYCLE

Anxiety Symptoms and Precautionary Behaviour across the Menstrual Cycle: The Role of
Hormones
Emily Fawcett
Lakehead University
Department of Psychology

A dissertation submitted in partial fulfillment of the requirements of the degree of
Doctor of Philosophy in Clinical Psychology
December 14, 2015

Supervisor: Dr. Dwight Mazmanian
Second Reader: Dr. Kirsten Oinonen
Supervisory Committee Member: Dr. Michel Bédard
Internal Examiner: Dr. Amanda Maranzan
External Examiner: Dr. Jennifer Gordon

© Emily J. Fawcett 2015
Abstract
The present study examined the influence of hormones on obsessive-compulsive disorder (OCD)
symptoms and related phenomena across the menstrual cycle. After exclusions, 223 participants
(51 free-cycling women, 100 hormonal contraceptive users, and 72 men), completed
questionnaires on disgust sensitivity, OCD symptoms, responsibility beliefs, risk-taking, and
anxiety two weeks apart using a within-subjects design (follicular and luteal phases for free-
cycling women). Laboratory participants (n = 178) also completed an emotion discrimination
task, had 2D:4D measured, and a subset of women provided saliva samples (n = 56). Contrary to
the compensatory prophylaxis hypothesis, subclinical OCD contamination symptoms, disgust
sensitivity, and related phenomena did not increase with progesterone levels. However, changes
in salivary progesterone levels across the cycle were positively correlated with changes in
anxiety and negatively correlated with risk-taking. Sexual activity and level of contamination
fears were significant moderators of behavior change across the cycle. Non-sexually active
(versus sexually active) women and women with high (versus low) contamination fears showed
an increase in OCD symptoms from the follicular to the luteal phases. Women with PMS (versus
those without) showed increased OCD symptoms, disgust-sensitivity and responsibility beliefs at
both phases of the menstrual cycle. Finally, women were more sensitive to detecting facial
expressions of disgust than men. Greater disgust sensitivity detection was also associated with
higher 2D:4D, and use of oral contraceptives with either high progesterone dosage or low
androgenicity. The current findings suggest that perhaps not all women experience an increase in
precautionary behaviour across the menstrual cycle, but that there may be subgroups of women
who are more susceptible to behavioural changes as a result of fluctuating hormone levels.
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Acknowledgements

I would like to acknowledge my supervisor, Dr. Dwight Mazmanian, for his support and
guidance throughout every single step of my academic journey. To my second reader, Dr.
Oinonen, your feedback has been instrumental to my progress over the years. To the rest of my
committee, I appreciate your precious time and valued feedback. I would also like to
acknowledge the generous support I have received throughout my degree, including Ontario
Graduate Scholarships and a doctoral fellowship from the Social Sciences and Humanities
Research Council (SSHRC).
While this journey has had its fair share of ups and downs, the support of friends, fellow
colleagues, and family have made the overall ride enjoyable. To my husband, Jonathan, thank
you for supporting me in my every pursuit, no matter the time or distance required. Without you
I would have never made it to where I am today and I can’t wait to see where our next adventure
takes us. I would also like to especially thank my mother, Dawn, who has been a continuous
champion of my academic pursuits and has supported me immensely throughout the years.

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Table of Contents
Abstract……………………………………………………………………………………............ii
Acknowledgements………………………………………………………………………………iii
List of Tables………………………………………………..........................................................ix
List of Figures……………………………………………………………………………….....…xi
Introduction…………………………………………………………………………...……...........1
Mood across reproductive events……………………………………………….……....…1
Menarche…………………………………………………………………….….....2
The menstrual cycle………………………………………………………….…....2
Hormonal contraceptives…………………………………….…………………....6
The postpartum period…………………………………………………….………9
Menopause……………………………………………………………………….10
Hormones and mood……………………………...………………………………….…..11
Hormonal theories of reproductive mood change………………………………..12
Anxiety across reproductive events………………………………………………….…..15
Menarche……………………………………………………………………..…..15
Premenstrual exacerbation…………………………………………………….…15
Pregnancy and the postpartum…………………………………………………...16
Menopause……………………………………………………………………….17
Obsessive-compulsive disorder and reproductive events…………………………….….18
Menarche……………………………………………………….…………….…..20
The menstrual cycle……………………………………………………………...20
Pregnancy and the postpartum………………………………………….………..20
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Subclinical OCD symptoms during pregnancy and the postpartum.. …................22
Menopause……………………………………………………………………….24
Evolutionary models of OCD……………………………………………………………24
Cognitive theory of OCD………………………………………………………………...26
Disgust sensitivity………………………………………………………….…….29
The role of disgust in OCD symptomatology…………………………………....32
Sex differences in disgust: The potential role of progesterone……………….….36
The role of hormones in facial preference and emotion recognition………….....42
Moderators of behaviour change across the menstrual cycle…………………....49
The present study…………………………………………………………………….......51
Primary Hypotheses……………………………………………………………………...53
Supplementary Hypotheses……………………..………………………………………..55
Exploratory Hypothesis……………………………………………………………….....55
Method……………………………………………………………………….…………………..56
Participants……………………………………………………………………..………...56
Exclusions………………………………………………………………………..57
Materials……………………………………………………………………….……...…68
Online Screening Questionnaire………………...……………………………….68
Phase Questionnaires ……………………………………………………………69
The Padua Inventory-Washington State University Revision (PI-WSUR)…..….69

Disgust Scale-Revised (DIS-R)…………………………….…………………....70

Three Domain Disgust Scale (TDDS)………………………………………...…71

Responsibility Attitude Scale (RAS)…………………………………………….72

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Domain-Specific Risk-Taking scale (DOSPERT)……………………………….73

The Hospital Anxiety and Depression Scale (HADS)……………………….......74

Personality Research Form (PRF) Infrequency and Social Desirability Scales....74

The Karolinska Directed Emotional Faces (KDEF)……………………………..75

Emotion Discrimination Task………………………………………………...….76

Hand Measurements …………………………………………………………..…77

Salivary Progesterone Collection…………………………………………...……78
Procedure……………………………………………………………………….……......78
Planned Data Analyses……………………………………………………………….….81
Primary Hypotheses…………………………………………………………...…81
Supplementary Hypotheses………………………………………………………83
Exploratory Hypothesis………………………………………………………….83
Signal Detection Analysis……..…..………………………………………………..……83
Results…………………………………………………………………………………..…....…..85
Data Screening……………………………………………………………………..…….85
Screening Survey………………………………………………………………………...86
Progesterone Analysis……………………………………………………………………87
Details of Study Measures…..…………………………………………………..……….90
Primary Hypotheses………………………………………………………………….......92
Hypothesis 1……………………………………………………………………...92
Moderators of behaviour change across the menstrual cycle………………...….96
Hypothesis 2…………………………………………………..…………….…..105
Hypothesis 3(a)…………………………….………………………………...…113
Hypothesis 3(b)……………………….…………………………………..…….116
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Supplementary Hypotheses……………………..…………………………………........116
Exploratory Hypothesis ……………………………………………………………......117
Discussion……………………………………………………………………………………....121
Main Hypotheses: Hypothesis 1………………………………………………………..124
Moderators of behaviour change across the menstrual cycle……………….….125
PMS…………………………………………………………………….125
Level of contamination fears……………………………….…………..126
Stage of luteal phase testing………………………….…………………126
Sexual activity…………………………………………………………..127
Hypothesis 2…………………………………………………………………………….130
Hypothesis 3…………………………………………………………………………….134
Neural correlates of Negative Mood Symptoms across the Menstrual Cycle………….138
Limitations and Future Directions………………………………………………….......141
Clinical Implications……………………………………………………………………149
Conclusions……………………………………………………………………………..150
References…………………………………………………………………………..…………..151
Appendices
A. Emotions and Mood Covering Letter A……………………………………..……....191
B. Consent Form A ………………………….................................................................192
C. Background Information Questionnaire …………………………………...…..........194
D. Debriefing Form A…………………………………………………………….…….202
E. Emotions and Mood Covering Letter B…………………………………………......203
F. Consent Form B………………………………………………………………….......204
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G. Phase 1 Questionnaire……………………………………………………………….205
H. Debriefing Form B………………………………………………………………..…223

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List of Tables
Table Description Page
1. Demographic Characteristics of the Overall Sample (N = 332) 58
2. Demographic Characteristics of the Final Sample after Exclusions (N = 223) 62
3. Demographic Characteristics of the Final Sample after Exclusions (N = 223),
Separated by Group 63
4. Women’s Reproductive History (n = 151) 65
5. Types of Hormonal Contraceptives used in Current Hormonal
Contraceptive Users (n = 100) 66
6. Oral Contraceptive Brands along with their Phasicity, Progestin Dose,
and Androgenic Activity in current Oral Contraceptive Users (n = 88) 67
7. Scale Means, Standard Deviations, and Internal Consistencies for the
Final Sample (N = 223) 91
8. Intercorrelations between the Main Four Dependent Variables Averaged
across the two Time Points for all Participants (N = 223) 93
9. Group Means for the Four Main Dependent Variables, Separated by Time
and Group 95
10. Correlations between Progesterone Change Scores and OCD Symptoms,
Disgust Sensitivity, Risk-taking, Responsibility Beliefs, and Anxiety
Change Scores in Free-Cycling Women, including Partial Correlations
(n = 35) 109
11. Correlations between Change in Risk-taking Subscales across the Cycle
and Changes in Progesterone Levels (n = 35) 111
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12. Sensitivity for Detecting Disgust in Facial Expressions Broken Down by
Group (Men, Free-Cycling Women, Hormonal Contraceptive Users) and
Subgroups (OC Progesterone and Androgen Activity) 115
13. Correlations between individual items on the Premenstrual Symptoms
Screening Tool (PSST) and Average OCD Symptoms in all Women
(n = 148) 118

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