Perceived criticism predicts severity of anxiety symptoms after behavioral treatment in patients with obsessive-compulsive disorder and panic disorder with agoraphobia.

In prospective research, psychiatric patients' perceived criticism (PC) from family members has been linked to higher rates of relapse and worse treatment outcome. Researchers have disagreed about whether PC contributes to poor treatment outcomes or whether it merely reflects the severity of a patient's disturbance. In this study, structural equation modeling was used to conduct a cross-lagged panel analysis of the relationship between PC and anxiety symptom severity assessed before and after treatment in anxiety-disordered patients. PC was found to be unrelated to concurrent symptom severity. Furthermore, pretreatment PC significantly predicted posttreatment symptom severity over and above the effect of pretreatment symptom severity, whereas pretreatment symptom severity failed to significantly predict posttreatment PC. Thus, these results are consistent with (although not proof of) the hypothesis that PC detracts from patients' ability to respond to treatment, and inconsistent with the hypothesis that PC is a reflection of a patient's symptom severity. Copyright 2003 Wiley Periodicals, Inc. J Clin Psychol 59: 411-421, 2003.