Early predictors of adult anxiety disorders

Department of Psychology, Harvard University, Cambridge, MA 02138, USA.
Biological Psychiatry (Impact Factor: 10.26). 01/2000; 46(11):1536-41. DOI: 10.1016/S0006-3223(99)00137-7
Source: PubMed


This paper considers the influence of temperamental factors on the development of anxious symptoms in children and adolescents. About 20 percent of healthy children are born with a temperamental bias that predisposes them to be highly reactive to unfamiliar stimulation as infants and to be fearful of or avoidant to unfamiliar events and people as young children. Experiences act on this initial temperamental bias and, by adolescence, about one-third of this group is likely to show signs of serious social anxiety. These children are also likely to have one or more biological features, including a sympathetically more reactive cardiovascular system, asymmetry of cortical activation in EEG favoring a more active right frontal area, more power in the EEG in the higher frequency range, and a narrower facial skeleton. The data imply that this temperamental bias should be conceptualized as constraining the probability of developing a consistently fearless and spontaneous profile rather than as determining an anxious or introverted phenotype.

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    • "In another study (Caspi, Moffitt, Newman, & Silva, 1996), undercontrolled 3-year-olds were more likely at 21 years to meet diagnostic criteria for antisocial personality disorder and to be involved in crime, whereas inhibited 3-year-olds were more likely at 21 years to meet diagnostic criteria for depression. Further about one-third of children born with a temperamental bias that predisposes them to be highly reactive to unfamiliar stimulation as infants and to be fearful or avoidant of unfamiliar events and people as young children show signs of serious social anxiety by adolescence (Kagan & Snidman, 1999). Preliminary data on a brief parent education program for the reduction of inhibited temperament in preschool children show promise that it may be possible to modify early risk for anxiety disorders (Rapee, 2002). "
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    ABSTRACT: Identifying risk factors of psychopathology has been an important research challenge. Prior studies examining the impact of childhood temperament on adult disorder have largely focused on undercontrolled and inhibited presentations, with little study of overcontrolled traits such as obsessive-compulsive personality traits (OCPTs). We compared rates of childhood OCPTs in adults with OCD (without OCPD) (n=28) to adults with OCPD (without OCD) (n=27), adults with both OCD and OCPD (n=28), and healthy controls (HC) (n= 28), using the Childhood Retrospective Perfectionism Questionnaire, a validated measure of perfectionism, inflexibility, and drive for order. Adults with OCPD (both with and without comorbid OCD) reported higher rates of all three childhood OCPTs relative to HC. Individuals with OCD (without OCPD) reported higher rates of inflexibility and drive for order relative to HC, suggesting that these traits may presage the development of OCD, independent of OCPD. Childhood OCPTs were associated with particular OCD symptom dimensions in adulthood (contamination/cleaning, doubt/checking, and symmetry/ordering), independent of OCD onset age and OCPD diagnosis. Longitudinal prospective studies evaluating OCPTs in children are needed to better understand the progression of these traits from childhood to adulthood and their ability to predict future psychopathology.
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    • "Harm avoidance, a temperamental trait defined by shyness , fatigability, anticipatory worry, and behavioral inhibition , has been linked to the development of internalizing behavior problems. Longitudinal studies indicate that early temperamental inhibition and harm avoidance are associated with later internalizing problems, such as anxiety (Kagan and Snidman 1999; Prior et al. 2000). Research also shows an association between harm avoidance and disruptive behavior disorders, but only when comorbid with internalizing disorders (Rettew et al. 2004). "
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    • "Though infrequently discussed, existing literature suggests that developmental decreases in fearfulness during childhood are not uncommon. Stability estimates for stranger fear and inhibition typically fall in the low to moderate range, with a relatively high proportion of children moving from inhibited to noninhibited classifications (Perez-Edgar & Fox, 2005; Kagan & Snidman, 1999; Sroufe, 1977). Kagan (1994) has suggested that different types of fear may exist within infants who are classified as inhibited early in life which may be uniquely related (or unrelated) to risk for disorder and may account for individual differences in developmental change. "
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    ABSTRACT: Despite implications that stranger fear is an important aspect of developing behavioral inhibition, a known risk factor for anxiety, normative and atypical developmental trajectories of stranger fear across infancy and toddlerhood remain understudied. We used a large, longitudinal data set (N = 1285) including multi-trait, multi-method assessments of temperament to examine the normative course of development for stranger fear and to explore the possibility that individual differences exist in trajectories of stranger fear development between 6 and 36 months of age. A latent class growth analysis suggested four different trajectories of stranger fear during this period. Stable, high levels of stranger fear over time were associated with poorer RSA suppression at 6 months of age. Rates of concordance in trajectory-based class membership for identical (monozygotic) and fraternal (dizygotic) twins, along with associations between atypical stranger fear development and greater anxiety-related maternal characteristics, suggested that individual differences in developmental trajectories of stranger fear may be heritable. Importantly, trajectories of stranger fear during infancy and toddlerhood were linked to individual differences in behavioral inhibition, with chronically high levels of stranger fear and sharp increases in stranger fear over time related to greater levels of inhibition than other developmental trajectories.
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