BEHAVIORAL INHIBITION AS A PRECURSOR TO ANXIETY DISORDER: WHAT IS THE NATURE OF THE RISK CONFERRED?

Abstract
Behavioral Inhibition (BI) represents the temperamental tendency to exhibit fearfulness, reticence, and withdrawal in the face of novel events or situations. It has been hypothesized to represent a temperamental precursor to anxiety disorder. We assessed BI and psychopathology in young children of parents with panic disorder alone (N=22), panic disorder plus major depression (N=129), major depression alone (N=49) or neither mood nor major anxiety disorders (N=84). BI was assessed using standardized laboratory observations at ages 2-6 years. Psychopathology was assessed by structured diagnostic interviews with mothers (Kiddie-SADS-E for DSM- III-R) about the children at ages 5 or older. We found that BI was significantly associated with both parental panic disorder and parental depression and that BI was highest among the children whose parents had both disorders. Moreover, we found that children with BI were specifically at risk for social anxiety (DSM-III-R avoidant disorder or social phobia) compared with non-BI children. Rates of other anxiety disorders did not differ between children with and without BI. We discuss the implications of these findings and of studies by other groups for determining the nature of the risk conferred by childhood BI, and make suggestions for future research directions.

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Bibliografía del artículo

1. Kagan J, Reznick JS, Snidman N: Biological bases of childhood shyness. Science 1988; 240:167-171
2. Asendorpf JB: Development of inhibition during childhood: evidence for situational specificity and a two-factor model. Dev Psychol 1990; 26:721-730
3. Asendorpf J: The malleability of behavioral inhibition: A study of individual developmental functions. Dev Psychol 1994; 30:912-919
4. Broberg A, Lamb M, Hwang P: Inhibition: Its stability and correlates in sixteen- to forty-month-old children. Child Dev 1990; 61:1153-1163
5. Fordham K, Stevenson-Hinde J: Shyness, friendship quality, and adjustment during middle childhood. J Child Psychol Psychiat 1999; 40:757-768
6. Scarpa A, Raine A, Venables P, Mednick S: The stability of inhibited/uninhibited temperament from ages 3 to 11 years in Mauritian children. J Abnorm Child Psychol 1995; 23:607-618
7. Stevenson-Hinde J, Shouldice A: 4.5 to 7 years: fearful behaviour, fears and worries. J Child Psychol Psychiat 1995; 36:1027-1038
8. Plomin R, Daniels D: Genetics and shyness., in Shyness: perspectives on research and treatment. Edited by Jones W, Cheek J, Briggs S. New York, NY, Plenum, 1986
9. Plomin R, Emde R, Braungart J, Campos J, Corley R, Fulker D, Kagan J, Reznick J, Robinson J, Zahn-Waxler C, DeFries J: Genetic change and continuity from fourteen to twenty months: the MacArthur Longitudinal Twin Study. Child Dev 1993; 64:1354-1376
10. Matheny AP: Children's behavioral inhibition over age and across situations: Genetic similarity for a trait during change. J Pers 1989; 57:215-235
11. Emde RN, Plomin R, Robinson J, Corley R, DeFries J, Fulker DW, Reznick JS, Campos J, Kagan J, Zahn-Waxler C: Temperament, emotion, and cognition at fourteen months: The MacArthur Longitudinal Twin Study. Child Dev. 1992; 63:1437-1455
12. DiLalla LF, Kagan J, Reznick JS: Genetic etiology of behavioral inhibition among 2-year-old children. Infant Behav Dev 1994; 17:405-412
13. Robinson JL, Kagan J, Reznick JS, Corley R: The heritability of inhibited and uninhibited behavior: A twin study. Dev. Psychol. 1992; 28:1030-1037
14. Insel TR, Ninan PT, Aloi J, Jimerson DC, Skolnick P, Paul SM: A benzodiazepine receptor-mediated model of anxiety: Studies in non-human primates and clinical implications. Arch Gen Psychiatry 1984; 41:741-750
15. Gorman J, Liebowitz M, Fyer A, Stein J: A neuroanatomical hypothesis for panic disorder. Am J Psychiatry 1989; 146:148-161
16. Rosenbaum JF, Biederman J, Gersten M, Hirshfeld DR, Meminger SR, Herman JB, Kagan J, Reznick JS, Snidman N: Behavioral inhibition in children of parents with panic disorder and agoraphobia: a controlled study. Arch Gen Psychiatry 1988; 45:463-470
17. Rosenbaum JF, Biederman J, Hirshfeld DR, Faraone SV, Bolduc EA, Kagan J, Snidman N, Reznick JS: Further evidence of an association between behavioral inhibition and anxiety disorders: results from a family study of children from a non- clinical sample. J Psychiat Res 1991; 25:49-65
18. Biederman J, Rosenbaum J, Hirshfeld D, Faraone S, Bolduc E, Gersten M, Meminger S, Kagan J, Snidman N, Reznick J: Psychiatric correlates of behavioral inhibition in young children of parents with and without psychiatric disorders. Arch Gen Psychiatry 1990; 47:21-26
19. Biederman J, Rosenbaum JF, Bolduc-Murphy EA, Faraone SV, Chaloff J, Hirschfeld DR, Kagan J: A 3-year follow-up of children with and without behavioral inhibition. J Am Acad Child Adolesc Psychiatry 1993; 32:814-821
20. Hirshfeld DR, Rosenbaum JF, Biederman J, Bolduc EA, Faraone SV, Snidman N, Reznick JS, Kagan J: Stable behavioral inhibition and its association with anxiety disorder. J Am Acad Child Adolesc Psychiatry 1992; 31:103-111
21. Spitzer R, WIlliams J, Gibbon M, First M: Structured Clinical Interview for DSM- III-R-Non-Patient Edition (SCID-NP, Version 1.0). Washington, DC, American Psychiatric Press, 1990
22. Hollingshead AB: Four Factor Index of Social Position. New Haven:, Yale University, 1975
23. Orvaschel H, Puig-Antich J: Schedule for Affective Disorder and Schizophrenia for School-Age Children-Epidemiologic 4th version. Ft. Lauderdale, Nova University, Center for Psychological Study, 1987
24. Achenbach TM: Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington, VT, University of Vermont Department of Psychiatry, 1991
25. Achenbach TM: Manual for the child behavior checklist/2-3 and 1992 profile. Burlington, VT, Department of Psychiatry, University of Vermont, 1992
26. Manassis K, Bradley S, Goldberg S, Hood J, Swinson R: Behavioural inhibition, attachment and anxiety in children of mothers with anxiety disorders. Can J Psychiatry 1995; 40:87-92
27. Battaglia M, Bajo S, Strambi LF, Brambilla F, Castronovo C, Vanni G, Bellodi L: Physiological and behavioral responses to minor stressors in offspring of patients with panic disorder. J Psychiat Res 1997; 31:365-376
28. Kochanska G: Patterns of inhibition to the unfamiliar in children of normal and affectively ill mothers. Child Dev 1991; 62:250-263
29. Caspi A, Moffitt TE, Newman DL, Silva PA: Behavioral observations at age 3 years predict adult psychiatric disorders. Arch Gen Psychiatry 1996; 53:1033-1039
30. Reznick JS, Hegeman IM, Kaufman E, Woods SW, Jacobs M: Retrospective and concurrent self-report of behavioral inhibition and their relation to adult mental health. Dev Psychopathol 1992; 4:301-321
31. Merikangas KR, Dierker LC, Szatmari P: Psychopathology among offspring of parents with substance abuse and/or anxiety disorders: a high-risk study. J Child Psychol Psychiat 1998; 39:711-720
32. Merikangas KR, Avenevoli S, Dierker L, Grillon C: Vulnerability factors among children at risk for anxiety disorders. Biol Psychiatry 1999; 46:1523-1535
33. Muris P, Merckelbach H, Wessel I, van de Ven M: Psychopathological correlates of self-reported behavioural inhibition in normal children. Behav Res Ther 1999; 37:575-84
34. Prior M, Smart D, Sanson A, Oberklaid F: Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence? J Am Acad Child Adolesc Psychiatry 2000; 39:461-468
35. Biederman J, Rosenbaum JF, Hirshfeld DR, Faraone SV, Bolduc EA, Gersten M, Meminger SR, Kagan J, Snidman N, Reznick JS: Psychiatric correlates of behavioral inhibition in young children of parents with and without psychiatric disorders. Arch Gen Psychiatry 1990; 47:21-26
36. Biederman J, Rosenbaum JF, Bolduc-Murphy EA, Faraone SV, Chaloff J, Hirshfeld DR, Kagan J: A 3-year follow-up of children with and without behavioral inhibition. J. Am. Acad. Child Adolesc. Psychiatry 1993; 32:814-821
37. Schwartz C, Snidman N, Kagan J: Adolescent social anxiety as an outcome of inhibited temperament in childhood. J Am Acad Child Adolesc Psychiatry 1999; 38:1008-1015
38. Hayward C, Killen J, Kraemer K, Taylor C: Linking self-reported childhood behavioral inhibition to adolescent social phobia. J Am Acad Child Adolesc Psychiatry 1998; 37
39. Cooper PJ, Eke M: Childhood shyness and maternal social phobia: a community study. Br J Psychiatry 1999; 174:439-443
40. Rickman M, Davidson R: Personality and behavior in parents of temperamentally inhibited and uninhibited children. Dev Psychology 1994; 30:346-354
41. Mick M, Telch M: Social anxiety and history of behavioral inhibition in young adults. J Anx Disorders 1998; 12:1-20
42. DeRuiter C, Rijkin H, Garssen B: Comorbidity among the anxiety disorders. J Anxiety Disord 1989; 3:57-68
43. Mannuzza S, Fyer A, Liebowitz M, Klein D: Delineating the boundaries of social phobia: Its relationship to panic disorder and agoraphobia. J Anx Disord 1990; 4:41- 59
44. Turner S, Beidel D: Social phobia: clinical syndrome, diagnosis and comorbidity. Clin Psychol Review 1989; 9:3-18
45. Kessler RC, Stang P, Wittchen HU, Stein M, Walters EE: Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychol Med 1999; 29:555-567
46. Regier DA, Rae DS, Narrow WE, Kaelber CT, Schatzberg AF: Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. Br J Psychiatry 1998; 34(Suppl):24-28
47. Stein MB, Fuetsch M, Muller N, Hofler M, Lieb R, Wittchen HU: Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults. Arch Gen Psychiatry 2001; 58:251-256
48. Rosenbaum J, Biederman J, Hirshfeld D, Bolduc E, Chaloff J: Behavioral inhibition in children: a possible precursor to panic disorder or social phobia. J Clin Psychiatry 1991; 52:11(suppl):5-9
49. Rosenbaum JF, Biederman J, Bolduc-Murphy EA, Faraone SV, Chaloff J, Hirshfeld DR, Kagan J: Behavioral inhibition in childhood: A risk factor for anxiety disorders. Harv Rev Psychiatry 1993; 1:2-16

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