The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia

Human-Wildlife Interaction-A Social Survey

With the results of a survey presented in this paper, we provide insight into public attitudes towards dealing with wildlife. Based on 1569 data sets derived from participating stakeholders, we inquired about the individual experience the participants had made with wild animals, and asked about their personal engagement, attitude towards management, and emotions involved and tried to evaluate basic contextual knowledge. As a result, we discovered a positive effect showing that a strong opinion about dealing with wildlife is associated with increasing contextual knowledge. People that are experienced in and engaged in wildlife conservation expressed significantly stronger positive emotions in this context. We conclude that education is essential in dealing with wildlife responsibly and that positive emotions are a main trigger for such engagement. The results of the survey underline that a combination of contextual knowledge and a positive attitude towards wildlife leads to a higher awareness of possible conflicts between humans and wildlife. Furthermore, these criteria are crucial when developing strategies that strive for a sustainable coexistence.

The social learning of threat and safety in the family: Parent-to-child transmission of social fears via verbal information

Parental verbal threat (vs. safety) information regarding the social world may impact a child's fear responses, evident in subjective, behavioral, cognitive, and physiological indices of fear. In this study, primary caregivers provided standardized verbal threat or safety information to their child (N = 68, M = 5.27 years; 34 girls) regarding two strangers in the lab. Following this manipulation, children reported fear beliefs for each stranger. Physiological and behavioral reactions were recorded as children engaged with the two strangers (who were blind to their characterization) in a social interaction task. Child attention to the strangers was measured in a visual search task. Parents also reported their own, and their child's, social anxiety symptoms. Children reported more fear for the stranger paired with threat information, but no significant differences were found in observed child fear, attention, or heart rate. Higher social anxiety symptoms on the side of the parents and the children exacerbated the effect of parental verbal threat on observed fear. Our findings reveal a causal influence of parental verbal threat information only for child-reported fear and highlight the need to further refine the conditions under which acquired fear beliefs persist and generalize to behavior/physiology or get overruled by nonaversive real-life encounters.

Development and Preliminary Italian Validation of the Emergency Response and Psychological Adjustment Scale

Evaluating the personal adaptation response to the emergency situations is very important for the prevention of mental distress, for the activation of network and community synergies and for the planning and implementation of appropriate psycho-social interventions. So far there are no short tools for the overall assessment of cognitive, emotional and behavioral responses of psychological adaptation to the emergency in the psychometric panorama. The Emergency Response and Psychological Adjustment Scale (ERPAS) was administered to a sample of 1,088 participants, while the concurrent validity was tested through a second administration to 600 participants along with the GSE (Generalized Self-Efficacy Scale) and the BDI-II (Beck Depression Inventory-II). Confirmatory factor analysis bore out a five-factor solution (including 18 items) with good fit indices of adaptation to data, χ²/df = 1.440, RMSEA = 0.028, RMSEA 90% CI = 0.018–0.038, GFI = 0.996, AGFI = 0.959, CFI = 0.982, and NFI = 0.944. Evidence of convergent validity was provided by the significant correlations with variables such as cognitive and somatic depression, and perceived general self-efficacy. The analyses also showed a strong invariance across gender. The ERPAS tool prefigures application during the assessment in multiple emergency contexts (e.g. earthquakes, floods, pandemics, terrorist attacks, war events, major accidents, major fires). This validation study of the ERPAS has shown that this version is a reliable and valid measurement for assessing people's modes of personal response (cognitive, emotional, behavioral) in emergency contexts.

Something Scary is Out There II: the Interplay of Childhood Experiences, Relict Sexual Dinichism, and Cross-cultural Differences in Spatial Fears

Children’s nighttime fear is hypothesized as a cognitive relict reflecting a long history of natural selection for anticipating the direction of nighttime predatory attacks on the presumed human ancestor, Australopithecus afarensis, whose small-bodied females nesting in trees would have anticipated predatory attacks from below. Heavier males nesting on the ground would have anticipated nighttime predatory attacks from their sides. Previous research on preschool children and adults supports this cognitive-relict hypothesis by showing developmental consistencies in their remembrances of the location of a “scary thing” relative to their beds. The current study expands this research by investigating whether nighttime fear in childhood, including the effect of parental threats to behave, influenced adult spatial fears in different biotic and abiotic situations. A 25-item questionnaire employing ordinal scales was given to 474 foreign-born Vietnamese and ethnic Chinese adults living in the USA. Univariate analyses of adult remembrances of childhood indicated that females were more fearful of something scary below their beds than males. To examine the influence of childhood nighttime fear on adult fears, exploratory factor analyses supported three factors: (1) indeterminate agents, indicated something scary under the bed, the difficulty locating unspecific threats, and the brief appearances of large apparitions; (2) environmental uncertainty, indicated by potential encounters with unseen animate threats; (3) predictable animals, as the relative comfort of viewing animals in zoo exhibits. Using structural equation modeling, the results suggest that childhood nighttime fear influenced only the latent variable, indeterminate agents, in both groups via the mediating variable, parental threats.

Clarifying Problems in Behavioural Control: Interface, Lateness and Consciousness

The target paper highlights a number of unresolved issues that, I believe, continue to impede the construction of a viable model of behavioural control in personality psychology; namely, (a) the relationship between controlled and automatic processing (the ‘interface’ problem’) and (b) the time it takes for controlled processes, including consciousness, to be generated (the ‘lateness’ problem). The diversity of views expressed in the commentatories indicates that these are, indeed, real and unresolved problems. This response is structured around the following key questions. (1) How long–term goal planning interfaces with the automatic machinery of behaviour? (2) The extent of the impact of the ‘lateness’ of controlled (including conscious) processes for building models of behavioural control? (3) How best to characterise the personality traits associated with the FFFS, BIS and BAS? (4) How does the BIS control mismatch detection, the generation of error signals, and response inhibition and switching? (5) Is consciousness really a necessary explanatory construct in models of behavioural control? (6) Might neural ‘crosstalk’ of encapsulated action–goal response systems point to the functional significance of consciousness? (7) What are the implications of issues raised in the target paper for lexical and social–cognitive approaches to personality? I conclude by re–iterating the importance of the problems of ‘lateness’ and ‘interface’ for the construction of a viable model of behavioural control sufficient for the fostering of theoretical integration within personality psychology as well as affording the building of conceptual bridges with general psychology. Copyright © 2010 John Wiley & Sons, Ltd.

Depressogenic self-schemas are associated with smaller regional grey matter volume in never-depressed preadolescents

Self-referential processing (i.e., self-schemas that guide processing of self-descriptive information) emerges early in youth, with deeper encoding of negative self-descriptors and/or shallower encoding of positive self-descriptors causally linked to depression. However, the relationship between depressogenic self-schemas and brain structure is unclear. We investigated associations between self-schemas and regional grey matter volume (GMV) in 84 never-depressed preadolescents oversampled for depression risk based on maternal depression history. Self-schemas were assessed using a Self-Referent Encoding Task (SRET) and regional GMV was indexed via voxel-based morphometry analysis of structural magnetic resonance imaging data. Youths' positive self-schemas were associated with greater regional GMV within the ventrolateral prefrontal cortex (vlPFC) and posterior cingulate cortex (PCC), while negative self-schemas were associated with smaller regional GMV within vlPFC and PCC, areas important to emotion regulation and self-referential processing. These associations remained significant after controlling for youths' concurrent depressive symptoms. Exploratory mediation analysis suggested that adolescents' depressogenic self-schemas may mediate associations between GMV and depressive symptoms. Our findings suggest that the observed GMV variations within vlPFC and PCC may serve as neurobiological markers of depressogenic self-schemas during preadolescence.

Social Phobia and Its Impact on Quality of Life Among Regular Undergraduate Students of Mettu University, Mettu, Ethiopia

Background

Social anxiety disorder is a serious and disabling mental health problem that begins before or during adolescence, with the potential to significantly interfere with an individual’s daily functioning and overall quality of life.

Objective

The aims of this study were to assess the prevalence, severity, and quality of life towards social anxiety disorder among students of Mettu University, Ethiopia.

Subjects and Methods

A cross-sectional study was conducted among a stratified sample of 523 undergraduate students to identify the prevalence, correlates of social anxiety disorder, and impacts on quality life. All participants completed the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and World Health Organization Quality of Life-Brief Form, Turkish Version (WHOQOL-BREF-TR). Of 523 students, 26% were screened positive for social anxiety disorder. About 69.4% and 17.4% of the students had mild and moderate symptoms of social anxiety disorder, respectively. WHOQOL BREF-TR scores showed that students with social phobia had significantly lower quality of life quality than those without social phobia. Being criticized by others or fear of parties was the most commonly feared situations. Talking to strangers was the most commonly avoided situations. Being females, current tobacco use, and family history of psychiatric illness were factors significantly associated with social phobia symptoms using logistic regression analysis.

Conclusion

The current study shows high prevalence of social phobia among the university students and its significant negative effects on quality of life which require prompt identification and treatment.

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Neural Activity During Self-referential Processing in Children at Risk for Depression

BACKGROUND

According to cognitive theories of depression, more negative and less positive self-schemas are thought to play a causal role in the disorder. Existing evidence speaks to the neural substrates of self-referential processes in both healthy and depressed individuals, but little is known about how the brain relates to self-referential processing in the context of depression risk in children. We therefore studied the neural substrates of self-referential processing in never-depressed preadolescent children at high and low risk for depression based on maternal depression history.

METHODS

A total of 87 never-depressed 10-12-year-old children (29 with maternal depression) completed a self-referential encoding task during a functional magnetic resonance imaging session, in which they were presented a series of positive and negative trait adjectives and endorsed whether each word was self-descriptive. Small volume correction analyses were conducted within 7 regions of interest that are important for self-referential and emotion-related processes.

RESULTS

Analyses of small volume correction indicated that high-risk children showed greater activation in the ventrolateral prefrontal cortex and ventromedial prefrontal cortex during the positive-word self-referential encoding task condition than low-risk children. Ventrolateral prefrontal cortex activation mediated the association between maternal depression and child depressive symptoms only when children had lower positive self-schemas, indicating that more positive self-schemas may protect at-risk children from developing depressive symptoms.

CONCLUSIONS

Cortical midline and prefrontal regions are important to self-, emotion-, and regulation-related processes. Heightened activation within these regions in never-depressed high-risk children indicates that these neurobiological substrates may mediate early vulnerability to depression in the context of cognitive processes relevant to self-concepts.

The genetic and environmental structure of fear and anxiety in juvenile twins

Fear and anxiety are conceptualized as responses to acute or potential threat, respectively. Adult twin studies found substantial interplay between genetic and environmental factors influencing fear disorders (phobias) and anxiety disorders. Research in children, however, has largely examined these factors independently. Thus, there exists a substantial knowledge gap regarding the underlying etiologic structure of these closely-related constructs during development. Symptom counts for five fear (criticism, the unknown, death, animal, medical) and four anxiety (generalized, panic, separation, social) dimensions were obtained for 373 twin pairs ages 9-14. Multivariate twin modeling was performed to elucidate the genetic and environmental influences distributed amongst these dimensions. The best fitting model contained one genetic, two familial environmental, and two unique environmental factors shared between fear and anxiety symptoms plus dimension-specific genetic and unique environmental factors. Although several environmental factors were shared between fear and anxiety dimensions, one latent factor accounted for genetic influences across both domains. While adult studies find somewhat distinct etiological differences between anxiety and phobic disorders, the current results suggest that their relative genetic and environmental influences are not as clearly demarcated in children. These etiological distinctions are more nuanced, likely contributing to the highly diffuse symptom patterns seen during development.

The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety

Parenting behavior and practices contribute to the intergenerational relationship between parent and child anxiety, with parental control being a consistent predictor of child anxiety. Parental experiential avoidance refers to how a parent copes with their internal world in the context of parenting. Little is known about how this relatively new parenting concept relates to child anxiety. The current study tested the indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance; the indirect effect of parent anxiety on parental control through parental experiential avoidance; and the moderating effect of parental experiential avoidance on the relationship between parental control and child anxiety. Using a cross-sectional design, parents (N = 85) from a community sample of 8–12-year-old children self-reported on a survey measuring parent anxiety, child anxiety, parental control, and parental experiential avoidance. A hierarchical regression indicated that parental experiential avoidance significantly predicted child anxiety and accounted for further variance in child anxiety, over, and above parental control. There was an indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance. Parental experiential avoidance moderated the relationship between parental control and child anxiety, such that the relationship was only significant at high levels of parental experiential avoidance. The current study provides support for the role of parental experiential avoidance in an intergenerational understanding of anxiety. Future research should replicate the study with a clinical sample. Theoretical and practice implications are considered.

Heart rate variability as candidate endophenotype of social anxiety: A two-generation family study

BACKGROUND

Social anxiety disorder (SAD) is the extreme fear and avoidance of one or more social situations. The goal of the current study was to investigate whether heart rate variability (HRV) during resting state and a social performance task (SPT) is a candidate endophenotype of SAD.

METHODS

In this two-generation family study, patients with SAD with their partner and children, and their siblings with partner and children took part in a SPT (total n = 121, 9 families, 3-30 persons per family, age range: 8-61 years, 17 patients with SAD). In this task, participants had to watch and evaluate the speech of a female peer, and had to give a similar speech. HRV was measured during two resting state phases, and during anticipation, speech and recovery phases of the SPT. We tested two criteria for endophenotypes: co-segregation with SAD within families and heritability.

RESULTS

HRV did not co-segregate with SAD within families. Root mean square of successive differences during the first resting phase and recovery, and high frequency power during all phases of the task were heritable.

LIMITATIONS

It should be noted that few participants were diagnosed with SAD. Results during the speech should be interpreted with caution, because the duration was short and there was a lot of movement.

CONCLUSIONS

HRV during resting state and the SPT is a possible endophenotype, but not of SAD. As other studies have shown that HRV is related to different internalizing disorders, HRV might reflect a transdiagnostic genetic vulnerability for internalizing disorders. Future research should investigate which factors influence the development of psychopathology in persons with decreased HRV.

Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalised anxiety and social anxiety disorders

OBJECTIVE

In this maintenance treatment study, we sought to evaluate the effect on anxiety ratings, safety and tolerability of 3 months of weekly ketamine in 20 patients with treatment-refractory DSM IV generalised anxiety disorder (GAD) and/or social anxiety disorder (SAD), and subsequent assessment of remission post-treatment.

METHODS

This was an uncontrolled open-label study in 20 patients who had been responders in an ascending dose ketamine study. The study was undertaken in a university clinic. Patients received one or two weekly ketamine doses of 1 mg/kg injected subcutaneously for 3 months. Data were collected from December 2015-June 2017.

RESULTS

There were 10 women (50%) and 10 men (50%); 15 patients (75%) met criteria for GAD and 18 (90%) for SAD. One hour after dosing, Fear Questionnaire ratings decreased by ~50%, as did Hamilton Anxiety ratings. Clinician Administered Dissociative States Scale mean scores declined over time, from 20 points at week 1 to 8.8 points at week 14. Compared with pre-dose values, mean systolic and diastolic blood pressure increased by ~10 mm Hg at 30 min. The most common adverse events were nausea, dizziness and blurred vision. Of the 20 patients, 18 reported improved social functioning and/or work functioning during maintenance treatment.

CONCLUSIONS

Weekly ketamine dosing was safe and well tolerated, and post-dose dissociative symptoms tended to reduce after repeated dosing. Patients reported marked improvements in functionality and in their personal lives. Maintenance ketamine may be a therapeutic alternative for patients with treatment refractory GAD/SAD.

TRIAL REGISTRATION

http://www.anzctr.org.au/ACTRN12615000617561.

Delta-beta correlation as a candidate endophenotype of social anxiety: A two-generation family study

BACKGROUND

Social anxiety disorder (SAD) is characterized by an extreme and intense fear and avoidance of social situations. In this two-generation family study we examined delta-beta correlation during a social performance task as candidate endophenotype of SAD.

METHODS

Nine families with a target participant (diagnosed with SAD), their spouse and children, as well as target's siblings with spouse and children performed a social performance task in which they gave a speech in front of a camera. EEG was measured during resting state, anticipation, and recovery. Our analyses focused on two criteria for endophenotypes: co-segregation within families and heritability.

RESULTS

Co-segregation analyses revealed increased negative delta-low beta correlation during anticipation in participants with (sub)clinical SAD compared to participants without (sub)clinical SAD. Heritability analyses revealed that delta-low beta and delta-high beta correlation during anticipation were heritable. Delta-beta correlation did not differ between participants with and without (sub)clinical SAD during resting state or recovery, nor between participants with and without SAD during all phases of the task.

LIMITATIONS

It should be noted that participants were seen only once, they all performed the EEG tasks in the same order, and some participants were too anxious to give a speech.

CONCLUSIONS

Delta-low beta correlation during anticipation of giving a speech might be a candidate endophenotype of SAD, possibly reflecting increased crosstalk between cortical and subcortical regions. If validated as endophenotype, delta-beta correlation during anticipation could be useful in studying the genetic basis, as well as improving treatment and early detection of persons at risk for developing SAD.

The role of marriage in criminal recidivism: a longitudinal and co-relative analysis

AIMS

Marriage is associated with a reduced rate of criminal recidivism, but the underlying mechanisms have only partly been elucidated. We seek to clarify the nature of the association between marriage and recidivism and how that relationship may be moderated as a function of gender, deviance of spouse, a history of violence and familial risk.

METHOD

We utilise a longitudinal cohort design consisting of Swedish men (n = 239 328) and women (n = 72 280), born between 1958 and 1986, who were convicted of at least one crime before age 20 and were not married prior to age 20. The analyses used Cox regression with marriage as a time-dependent covariate. We also perform co-relative analyses in sibling and first cousin pairs.

RESULTS

Marriage after a first crime substantially reduces risk of recidivism in both males (hazard ratio (HR) with key covariates and 95% confidence intervals 0.55, 0.53-0.57) and females (HR = 0.38, 0.34-0.42), although the effect is stronger in females. Marriage to a deviant spouse increases recidivism rates in males. In males, a history of violent criminality and high familial risk, respectively, decrease and increase sensitivity to the protective effect of marriage on recidivism. Consistent with a causal effect of marriage on recidivism, marriage was associated with a decline in risk for criminal relapse comparable with that in the population in both male-male sibling pairs (raw HR = 0.53, 0.45-0.62) and cousin pairs (HR = 0.55, 0.47, 0.65) concordant for prior convictions.

CONCLUSIONS

The protective effect of marriage on risk for criminal recidivism is likely largely causal and is of importance in both males and females. Those at high familial risk for criminal behaviour are more sensitive to the protective effects of marriage.

Behavioral and EEG responses to social evaluation: A two-generation family study on social anxiety

Social anxiety disorder is an invalidating psychiatric disorder characterized by extreme fear and avoidance of one or more social situations in which patients might experience scrutiny by others. The goal of this two-generation family study was to delineate behavioral and electrocortical endophenotypes of social anxiety disorder related to social evaluation. Nine families of patients with social anxiety disorder (their spouse and children, and siblings of these patients with spouse and children) performed a social judgment paradigm in which they believed to be evaluated by peers. For each peer, participants indicated their expectation about the evaluative outcome, after which they received social acceptance or rejection feedback. Task behavior, as well as the feedback-related EEG brain potentials (N1, FRN, P3) and theta power were tested as candidate endophenotypes based on two criteria: co-segregation with social anxiety disorder within families and heritability. Results indicated that reaction time for indicating acceptance-expectations might be a candidate behavioral endophenotype of social anxiety disorder, possibly reflecting increased uncertainty or self-focused attention and vigilance during the social judgment paradigm. N1 in response to expected rejection feedback and P3 in response to acceptance feedback might be candidate electrocortical endophenotypes of social anxiety disorder, although the heritability analyses did not remain significant after correcting for multiple tests. Increased N1 possibly reflects hypervigilance to socially threatening stimuli, and increased P3 might reflect that positive feedback is more important for, and/or less expected by, participants with social anxiety disorder. Finally, increased feedback-related negativity and theta power in response to unexpected rejection feedback compared to the other conditions co-segregated with social anxiety disorder, but these EEG measures were not heritable. The candidate endophenotypes might play a new and promising role in future research on genetic mechanisms, early detection and/or prevention of social anxiety disorder.

African-American representation in family and twin studies of mood and anxiety disorders: A systematic review

PURPOSE

Mood and anxiety disorders are common and disabling psychiatric disorders with known heritable risk factors. But the extent to which their heritability and familial risks can be generalized across ethnic/racial groups is still largely unknown, but remains of considerable scientific and clinical interest. The main objective in this review was to evaluate African-American (AA) representation in family and twin studies of major mood and anxiety disorders.

METHOD

We conducted key word-driven computerized searches in MEDLINE and PsycINFO and manual searches from reference lists of selected articles. Search parameters included family or twin studies, mood or anxiety disorders, and familial aggregation or heritability. US-based studies published from 1980 to 2015 were included.

RESULTS

The final selection yielded 209 studies, of which 88 did not report race/ethnicity or only reported Caucasian/white race. Of the remaining 121 studies, 66% did not include AAs, 24% included 1-10% AA, 8% included greater than 10% AA and 2 studies were exclusively AA. These trends were similar across study type, disorder and time periods spanning 35 years.

LIMITATIONS

Small samples, including the large number of studies without race/ethnicity reports, limited detailed analyses of change across time by disorder and study type. Adoption studies were not included in this review.

CONCLUSIONS

Underrepresentation of AAs in family and twin studies of affective disorders is substantial and can limit generalizability of established heritability and familial risk estimates across clinical and research settings. Additional twin and family studies focusing on AAs can be of benefit in closing this gap.

Mechanisms of comorbidity, continuity, and discontinuity in anxiety-related disorders

We discuss comorbidity, continuity, and discontinuity of anxiety-related disorders from the perspective of a two-dimensional neuropsychology of fear (threat avoidance) and anxiety (threat approach). Pharmacological dissection of the “neurotic” disorders justifies both a categorical division between fear and anxiety and a subdivision of each mapped to a hierarchy of neural modules that process different immediacies of threat. It is critical that each module can generate normal responses, symptoms of another syndrome, or syndromal responses. We discuss the resultant possibilities for comorbid dysfunction of these modules both with each other and with some disorders not usually classified as anxiety related. The simplest case is symptomatic fear/anxiety comorbidity, where dysfunction in one module results in excess activity in a second, otherwise normal, module to generate symptoms and apparent comorbidity. More complex is syndromal fear/anxiety comorbidity, where more than one module is concurrently dysfunctional. Yet more complex are syndromal comorbidities of anxiety that go beyond the two dimensional fear/anxiety systems: depression, substance use disorder, and attention-deficit/hyperactivity disorder. Our account of attention-deficit/hyperactivity disorder–anxiety comorbidity entails discussion of the neuropsychology of externalizing disorders to account for the lack of anxiety comorbidity in some of these. Finally, we link the neuropsychology of disorder to personality variation, and to the development of a biomarker of variation in the anxiety system among individuals that, if extreme, may provide a means of unambiguously identifying the first of a range of anxiety syndromes.

The Cognitive-Behavioral Treatment of Social Phobia

Mary is a 35-year-old, married, Caucasian female who presented for treatment with complaints of anxiety and panic when in the following situations: writing in front of others, one-to-one situations atwork, and going to the doctor. When in these situations, she feared that she would exhibit symptoms of anxiety and would thus be humiliated and embarrassed. Because of this fear, she had avoided these situations formany years or otherwise endured themwith great anxiety. Marywas diagnosedwith social phobia and was seen for 31 sessions of individual, cognitive-behavioral therapy. Treatment involved self-monitoring, cognitive restructuring, muscle relaxation, breathing retraining, and graduated exposure. At termination, Mary no longermet criteria for social phobia and demonstrated improvements in many areas including lowered subjective experience of anxiety, decreased avoidance, and decreased physiology associated with anxiety. This case is presented as an example of the use of cognitive-behavioral principles in the treatment of social phobia.

Genetics of anxiety: would the genome recognize the DSM?

The nosology of anxiety disorders has undergone substantial evolution over the past several decades. The modern classification of these disorders dates to the publication of Diagnostic and Statistical Manual-III (DSM-III) in 1980, but the validity of the current diagnostic categories has been the subject of controversy. Genetic research can help clarify the boundaries of diagnostic categories by examining the etiologic relationships among them. The question posed in the title of this article asks to what degree the DSM-IV definitions of the anxiety disorders are supported by the evolving body of research on the genetic basis of pathologic anxiety. With DSM-V on the horizon, there is a renewed imperative to examine the structure of these disorders. In this article, we address this issue by, first, providing a brief update about the current status of genetic research on anxiety disorders and then considering whether the evidence suggests that genetic influences conform to or transcend DSM definitions. Finally, we discuss future directions for the genetic dissection of anxiety disorders.

Family Aggregation and Risk Factors in Phobic Disorders over Three-Generations in a Nation-Wide Study

Objective

This nation-wide register-based study investigated how often phobic disorders (PHO) and co-morbid disorders occur in affected families compared to control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors.

Method

A total of N = 746 child and adolescent psychiatric participants born between 1969 and 1986 and registered in the Danish Psychiatric Central Research Register (DPCRR) with a diagnosis of a mental disorder before the age of 18, and developed PHO at some point during their life-time until a maximum age of 40 years were included. In addition, N = 2229 controls without any diagnosis of mental disorders before age 18 and that were matched for age, sex, and residential region were included. Diagnoses of mental disorders were also obtained from the first- degree relatives as a part of the Danish Three Generation Study (3GS). A family load component was obtained by using various mixed regression models.

Results

PHO occurred significantly more often in case than in control families, in particular, in mothers and siblings. Substance use disorders (SUD), Depressive disorders (DEP), anxiety disorders (ANX) and personality disorders (PERS) in the family were significantly associated with specific phobia in the case-probands. After controlling for various mental disorders comorbid to PHO it was found that some of the family transmission could be caused by various other mental disorders in family members rather than the PHO itself. Female sex and more recent year of birth were further risk factors while region of residence was not related to the manifestation of PHO. Case-relatives did not develop PHO earlier than control relatives. After adjusting for various additional explanatory variables, the family load explained only 0.0013% of the variance in the manifestation of PHO in the case-probands

Discussion

These findings, based on a very large and representative dataset, provide evidence for the family aggregation and further risk factors in PHO. In contrast to anxiety disorders and other major mental disorders the family load of PHO in this nation-wide study was rather low.

Social phobia and quality of life in morbidly obese patients before and after bariatric surgery

BACKGROUND

Morbidly obesity is characterized by physical and psychological comorbidities which are associated with reduced quality of life. Bariatric surgery has been linked to a reduction of psychopathology other than to a reduction of weight and improvement in physical functioning. Aim of the present study was to compare psychological features of two groups of morbidly obese patients, before and after bariatric surgery, assessing social phobia and quality of life.

METHODS

A total of 46 morbidly obese patients were enrolled in the study. Of them, 20 were waiting for bilio-pancreatic diversion (group A), while 26 had already undergone surgical procedure (group B). Psychometric evaluation assessed social phobia, fear for the body-shape and quality of life, using appropriate psychometric tests.

RESULTS

The percentage of patients showing social phobia was significantly higher compared to a sample of healthy controls (p=0.004), both in group A (p=0.003) and in group B (p=0.029). No differences in percentage of patients affected by social phobia were found between groups. A significantly higher percentage of patients affected by distress about the body (p<0.0001) was found in group A with respect to group B. A reduction of quality of life was found in both groups.

CONCLUSIONS

The present study shows a high prevalence of social phobia in a population of morbidly obese patients, both before and after surgery. A general reduction of quality of life was also observed, with a partial improvement after surgery. Future studies are needed to clarify the relationship between social phobia and quality of life in surgically-treated morbidly obese patients.

Genetics of anxiety disorders: Genetic epidemiological and molecular studies in humans

This review provides a broad overview of the state of research in the genetics of anxiety disorders (AD). Genetic epidemiological studies report a moderate level of familial aggregation (odds ratio: 4-6) and heritability estimates are about 30-50%. Twin studies suggest that the genetic architecture of AD is not isomorphic with their classifications, sharing risk factors with each other. So far, linkage and association studies of AD have produced inconclusive results. Genome-wide association studies of AD can provide an unbiased survey of common genetic variations across the entire genome. Given the shared causes of AD that transcend our current diagnostic classifications, clustering anxiety phenotypes into broader groups may be a powerful approach to identifying susceptibility locus for AD. Using such a shared genetic risk factor, meta-analyses of genome-wide association studies of AD conducted by large consortia are needed. Environmental factors also make a substantial contribution to the cause of AD. Although candidate gene studies of gene by environmental (G × E) interaction have appeared recently, no genome-wide search for G × E interactions have been performed. Epigenetic modification of DNA appears to have important effects on gene expression mediating environmental influences on disease risk. Given that G × E can be linked to an epigenetic modification, a combination analysis of genome-wide G × E interaction and methylation could be an alternative method to find risk variants for AD. This genetic research will enable us to utilize more effective strategies for the prevention and treatment of AD in the near future.

Population-based, multi-generational family clustering study of social anxiety disorder and avoidant personality disorder

BACKGROUND

We aimed to provide unbiased estimates of familial risk and heritability of social anxiety disorder (SAD) and avoidant personality disorder (AVPD).

METHOD

We identified 18 399 individuals diagnosed with SAD and 2673 with AVPD in the Swedish National Patient Register between 1997 and 2009. Risks (odds ratios; OR) for SAD in all biological and non-biological relatives of probands, compared to relatives of unaffected individuals were calculated. We also estimated the risks for AVPD in relatives of probands with SAD.

RESULTS

The risk for SAD among relatives of SAD probands increased proportionally to the degree of genetic relatedness. The risks for first-degree relatives [OR 4.74, 95% confidence interval (CI) 4.28-5.25] were significantly higher than for second-degree and third-degree relatives. Second-degree relatives (OR 2.30, 95% CI 2.01-2.63) had significantly higher risk than third-degree relatives (OR 1.72, 95% CI 1.52-1.94). Relatives at similar genetic distances had similar risks for SAD, despite different degrees of shared environment. Heritability was estimated to be approximately 56%. There were no significant sex differences in the familial patterns. The risk of AVPD in relatives of SAD probands was significantly elevated, even after excluding individuals with both diagnoses (first-degree OR 3.54, second-degree OR 2.20, third-degree OR 1.62). Non-biological relatives (spouses/partners) also had elevated risks for both SAD (OR 4.01) and AVPD (OR 3.85).

CONCLUSIONS

SAD clusters in families primarily due to genetic factors. SAD and AVPD are aetiologically related and may represent different expressions of the same vulnerability. The strong marital concordance observed in SAD/AVPD may indicate assortative mating but the exact mechanisms and implications require further investigation.

Affective modulation of the startle response among children at high and low risk for anxiety disorders

BACKGROUND

Identifying early markers of risk for anxiety disorders in children may aid in understanding underlying mechanisms and informing prevention efforts. Affective modulation of the startle response indexes sensitivity to pleasant and unpleasant environmental contexts and has been shown to relate to anxiety, yet the extent to which abnormalities in affect-modulated startle reflect vulnerability for anxiety disorders in children has yet to be examined. The current study assessed the effects of parental psychopathology on affective modulation of startle in offspring.

METHOD

Nine-year-old children (n = 144) with no history of anxiety or depressive disorders completed a passive picture viewing task in which eye-blink startle responses were measured during the presentation of pleasant, neutral, and unpleasant images.

RESULTS

Maternal anxiety was associated with distinct patterns of affective modulation of startle in offspring, such that children with maternal histories of anxiety showed potentiation of the startle response while viewing unpleasant images, but not attenuation during pleasant images, whereas children with no maternal history of anxiety exhibited attenuation of the startle response during pleasant images, but did not exhibit unpleasant potentiation - even when controlling for child symptoms of anxiety and depression. No effects of maternal depression or paternal psychopathology were observed.

CONCLUSIONS

These findings suggest that both enhanced startle responses in unpleasant conditions and failure to inhibit startle responses in pleasant conditions may reflect early emerging vulnerabilities that contribute to the later development of anxiety disorders.

The structure of genetic and environmental risk factors for fears and phobias

BACKGROUND

Although prior genetic studies of interview-assessed fears and phobias have shown that genetic factors predispose individuals to fears and phobias, they have been restricted to the DSM-III to DSM-IV aggregated subtypes of phobias rather than to individual fearful and phobic stimuli.

METHOD

We examined the lifetime history of fears and/or phobias in response to 21 individual phobic stimuli in 4067 personally interviewed twins from same-sex pairs from the Virginia Adult Twin Study of Psychiatric and Substance Abuse Disorders (VATSPSUD). We performed multivariate statistical analyses using Mx and Mplus.

RESULTS

The best-fitting model for the 21 phobic stimuli included four genetic factors (agora-social-acrophobia, animal phobia, blood-injection-illness phobia and claustrophobia) and three environmental factors (agora-social-hospital phobia, animal phobia, and situational phobia).

CONCLUSIONS

This study provides the first view of the architecture of genetic and environmental risk factors for phobic disorders and their subtypes. The genetic factors of the phobias support the DSM-IV and DSM-5 constructs of animal and blood-injection-injury phobias but do not support the separation of agoraphobia from social phobia. The results also do not show a coherent genetic factor for the DSM-IV and DSM-5 situational phobia. Finally, the patterns of co-morbidity across individual fears and phobias produced by genetic and environmental influences differ appreciably.

Sex differences in anxiety and depression clinical perspectives

Sex differences are prominent in mood and anxiety disorders and may provide a window into mechanisms of onset and maintenance of affective disturbances in both men and women. With the plethora of sex differences in brain structure, function, and stress responsivity, as well as differences in exposure to reproductive hormones, social expectations and experiences, the challenge is to understand which sex differences are relevant to affective illness. This review will focus on clinical aspects of sex differences in affective disorders including the emergence of sex differences across developmental stages and the impact of reproductive events. Biological, cultural, and experiential factors that may underlie sex differences in the phenomenology of mood and anxiety disorders are discussed.

Blood injury and injection phobia: the neglected one

Blood injury and injection (BII) phobia is a unique phobia associated with a diphasic cardiovascular response. The aim of this survey was to report the prevalence of BII phobia, its heritability, and clinical characteristics among the males and females in the Indian subcontinent. An interview and a survey were conducted using a developed BII phobia 21-item questionnaire among 3261 participant males (n = 1648) and females (n = 1613). Cronbach' alpha (α) of 0.972 of internal consistency was reported. The prevalence of BII phobia and associated fainting in females was slightly more than double in the males with a significant gender related effect. Similar avoidance behaviours involving hospital visits were reported for both males and females. The relative frequency of BII phobia among first and third degree relatives was found to be higher than among second degree relatives. Depression was found highly comorbid with BII phobia while a low rate of obsessive compulsion disorder (OCD) and social anxiety disorder (SAD) was reported. Morbidity associated with BII phobia may increase dramatically when other medical problems coincide with it.

Prevalence and heritability of obsessive-compulsive spectrum and anxiety disorder symptoms: A survey of the Australian Twin Registry

While past twin studies indicate moderate levels of heritability of "obsessive-compulsive related" and anxiety disorder symptoms, no single study has reported such estimates in the same twin population nor examined potential genetic sex differences. We assessed symptoms of obsessive-compulsive disorder, body dysmorphic disorder, hoarding disorder, hypochondriasis, panic disorder, social phobia and generalized anxiety disorder in 2,495 adult twins (1,468 female). Prevalence estimates for the corresponding symptom measures were determined using empirically derived cut-off scores. Twin resemblance was assessed by Pearson correlations and biometrical model-fitting analyses, incorporating sex-specific effects, using OpenMx. Prevalence estimates ranged from 1.6% in the symptoms of generalized anxiety to 16.9% for social phobia. Female twins demonstrated significantly higher prevalence rates across all domains with the exception of obsessive-compulsive symptoms. Additive genetic factors accounted for a moderate proportion of the total liability to each symptom domain. Evidence suggesting qualitative genetic sex differences (i.e., distinct genetic influences between genders) was observed for body dysmorphic concern and panic symptoms, while quantitative differences were observed for hoarding and social phobia symptoms, indicating stronger heritability in females. Novel findings in this study include the observation of probable genetic sex differences in liability towards hoarding symptoms and dysmorphic concern, as well as the lack of such differences in hypochondriasis. The trend towards qualitative sex differences in panic symptoms has some intuitive appeal with regard to biological-experimental models of panic.

A multivariate twin study of the dimensions of religiosity and common psychiatric and substance use disorders

The authors sought to decompose the covariance between seven dimensions of religiosity and two internalizing psychiatric disorders (major depression and phobia) and two externalizing substance use disorders (alcohol dependence and nicotine dependence). Significant negative correlations, accounted for by shared additive genetic effects, were found between alcohol dependence and six of the seven religiosity factors. Additive genetic effects accounted for significant negative correlations between nicotine dependence and one religiosity factor, social religiosity, and between phobia and unvengefulness. Common environmental effects accounted for a significant positive correlation between phobia and the factor God as judge. No statistically significant covariance due to genetic or environmental effects was found for major depression and any of the seven religiosity factors. Overall, although several statistically significant bivariate relationships were found, the estimates of covariance due to additive genetic effects were modest.

The prevalence, clinical correlates and structure of phobic fears in Han Chinese women with recurrent major depression

BACKGROUND

Phobic fears are common in the general population and among individuals with major depression (MD). We know little about the prevalence, clinical correlates, and structure of phobic fears in Chinese women with MD.

METHODS

We assessed 22 phobic fears in 6017 Han Chinese women with MD. We used exploratory factor analysis to examine the structure of these phobic fears. We examined the relationship between individual phobic fears and the severity of MD, neuroticism, comorbid panic disorder, generalized anxiety disorder and dysthymia using logistic regression models.

RESULTS

The frequency of phobic fears ranged from 3.0% (eating in public) to 36.0% (snakes). Phobic fears were significantly associated with more severe MD, high neuroticism, and co-morbid panic disorder, generalized anxiety disorder and dysthymia. Our factor analysis suggested four underlying subgroups of phobic fears which differed in their clinical correlates, severity and patterns of comorbidity.

LIMITATIONS

Data were collected retrospectively through interview and recall bias may have affected the results.

CONCLUSIONS

Phobic fears are correlated with comorbid MD and more severe MD. These phobic fears clearly subdivide into four subgroups that differ meaningfully from each other.

Differential postpartum sensitivity to the anxiety-modulating effects of offspring contact is associated with innate anxiety and brainstem levels of dopamine beta-hydroxylase in female laboratory rats

In female mammals, the postpartum period involves dramatic shifts in many socioemotional behaviors. This includes a suppression of anxiety-related behaviors that requires recent physical contact with offspring. Factors contributing to differences among females in their susceptibility to the anxiety-modulating effect of offspring contact are unknown, but could include their innate anxiety and brain monoaminergic activity. Anxiety behavior was assessed in a large group of nulliparous female rats and the least-anxious and most-anxious tertiles were mated. Anxiety was assessed again postpartum after females were permitted or prevented from contacting their offspring 4 h before testing. Levels of dopamine β-hydroxylase (DBH, norepinephrine synthesizing enzyme) and tryptophan hydroxylase-2 (TPH2, serotonin synthesizing enzyme) were measured in the brainstem and dorsal raphe, respectively. It was found that anxiety-related behavior in the two groups did not differ when dams were permitted contact with offspring before testing. Removal of the offspring before testing, however, differentially affected anxiety based on dams' innate anxiety. Specifically, dams reverted back to their pre-mating levels of anxiety such that offspring removal slightly increased anxiety in the most-anxious females but greatly lowered anxiety in the least-anxious females. This reduction in anxiety in the least-anxious females after litter removal was associated with lower brainstem DBH. There was no relationship between females' anxiety and dorsal raphe TPH2. Thus, a primary effect of recent contact with offspring on anxiety-related behavior in postpartum rats is to shift females away from their innate anxiety to a more moderate level of responding. This effect is particularly true for females with the lowest anxiety, may be mediated by central noradrenergic systems, and has implications for their ability to attend to their offspring.

Maternal anxiety disorders prior to conception, psychopathology during pregnancy and early infants' development: a prospective-longitudinal study

Family-genetic studies suggest that anxiety disorders run in families and that mechanisms of familial transmission might act as early as during pregnancy. The aims of the Maternal Anxiety in Relation to Infant Development (MARI) Study are to prospectively investigate the course of pregnancy in women with and without anxiety disorders prior to conception from early pregnancy to postpartum focussing on (a) maternal psychopathology, (b) maternal perinatal health, and (c) offspring outcomes that are supposed to be early indicators/ antecendents for later anxiety disorders. The MARI Study is a prospective-longitudinal study program with seven waves of assessment: T1 (baseline: week 10 to 12 of gestation), T2 (week 22 to 24 of gestation), T3 (week 35 to 37 of gestation), T4 (10 days postpartum), T5 (2 months postpartum), T6 (4 months postpartum), and T7 (16 months postpartum). Overall, N = 306 pregnant women were enrolled during early pregnancy (T1) and allocated to one of the following initial diagnostic groups: no AD: no anxiety nor depressive disorder prior to pregnancy (N = 109), pure D: pure depressive disorder(s) prior to pregnancy (N = 48), pure A: pure anxiety disorder(s) prior to pregnancy (N = 84), and comorbid AD: comorbid anxiety and depressive disorders prior to pregnancy (N = 65). Overall, N = 284 mothers could be retained until T6 (retention rate: 92.8 %) and N = 274 until T7 (retention rate: 89.5 %). Clinical and psychosocial measures were used including a standardized diagnostic interview (CIDI-V) with dimensional scales and standardized observation paradigms (mother-infant-relationship, infant temperament and neuropsychological development). Dimensional anxiety and depression liability indices were developed to reflect the severity of anxiety and depressive disorders prior to pregnancy and to ease longitudinal modelling. Findings from this study will contribute to improved knowledge about the natural course of anxiety disorders during transition to parenthood and associated outcomes that are assumed to be early indicators of later psychopathology in the offspring. Results are expected to provide new insights into mechanisms of familial transmission and clues for targeted prevention and early intervention.

Genetic and environmental risk factors for illicit substance use and use disorders: Joint analysis of self and co-twin ratings

The specificity of genetic and environmental risk factors for illicit substance use and substance use disorders (SUD) was investigated by utilizing self and co-twin reports in 1,791 male twins. There was a high rate of comorbidity between both use of, and SUD from, different classes of illicit substances. For substance use, the model that included one common genetic, one shared environmental, and one individual-specific (i.e., unique) environmental factor, along with substance-specific effects that were attributed entirely to genetic factors fit the data best. For illicit SUD, one common genetic and one common unique environmental risk factor, and substance specific shared environmental and unique environmental risk factors were identified. Risk factors for illicit substance use and SUD are mainly non-specific to substance class. Co-twin rating of illicit substance use and SUD was a reliable source of information, and by taking account of random and systematic measurement error, environmental exposures unique to the individual were of lesser importance than found in earlier studies.

Prevalence, correlates, and comorbidities of four DSM-IV specific phobia subtypes: results from the Korean Epidemiological Catchment Area study

Although several studies have detected differences in clinical features among specific phobias, there is a shortage of detailed national data on the on the DSM-IV SP subtypes, particularly in the Asian population. To examine the prevalence, demographic and other correlates, and co-morbidities of DSM-IV SP subtypes in a nationwide sample of Korean adults. We recruited 6510 participants aged 18-64 years for this study. Lay interviewers used the Composite International Diagnostic Interview to assess participants. We analyzed socio-demographics, health-related correlates and frequencies of comorbid mental disorders among participants with SP and each subtypes compared to unaffected adults. The prevalence of lifetime DSM-IV SP was 3.8%, and animal phobias were the most prevalent type of SP. Blood-injection-injury phobia was negatively associated with education, whereas situational phobia was positively associated with education. The strongest mental disorder comorbidity was associated with situational phobia; there is a higher probability of comorbid mood (OR=5.73, 95% CI=2.09-15.73), anxiety (OR=7.54, 95% CI=2.34-24.28), and somatoform disorders (OR=7.61, 95% CI=1.64-35.22) with this subtype. Blood-injection-injury phobia was highly associated with alcohol dependence (OR=9.02, 95% CI=3.54-23.02). Specific phobias are heterogeneous with respect to socio-demographic characteristics and comorbidity pattern. Implications of the usefulness of current subtype categories should continue to be investigated.

A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears

Evidence from twin studies suggests that genetic factors contribute to the risk of developing a fear or a phobia. The aim of the present study was to review the current literature regarding twin studies describing the genetic basis of specific phobias and their corresponding fears. The analysis included five twin studies on fears and ten twin studies on specific phobias. Heritability estimates of fear subtypes and specific phobia subtypes both varied widely, even within the subtypes. A meta-analysis performed on the twin study results indicated that fears and specific phobias are moderately heritable. The highest mean heritability (±SEM) among fear subtypes was found for animal fear (45%±0.004), and among specific phobias for the blood-injury-injection phobia (33%±0.06). For most phenotypes, variance could be explained solely by additive genetic and unique environmental effects. Given the dearth of independent data on the heritability of specific phobias and fears, additional research is needed.

Intergenerational transmission of risk for social inhibition: the interplay between parental responsiveness and genetic influences

To better understand mechanisms underlying the intergenerational transmission of social anxiety, we used a prospective adoption design to examine the roles of genetic influences (inferred from birth mothers' social phobia) and rearing environment (adoptive mothers' and fathers' responsiveness) on the development of socially inhibited, anxious behaviors in children between 18 and 27 months of age. The sample consisted of 275 adoption-linked families, each including an adopted child, adoptive parents, and a birth mother. Results indicated that children whose birth mothers met criteria for the diagnosis of social phobia showed elevated levels of observed behavioral inhibition in a social situation at 27 months of age if their adoptive mothers provided less emotionally and verbally responsive rearing environments at 18 months of age. Conversely, in the context of higher levels of maternal responsiveness, children of birth mothers with a history of social phobia did not show elevated levels of behavioral inhibition. These findings on maternal responsiveness were replicated in a model predicting parent reports of child social anxiety. The findings are discussed in terms of gene-environment interactions in the intergenerational transmission of social anxiety.

Re-examining the differential familial liability of agoraphobia and panic disorder

BACKGROUND

Controversy surrounds the question of whether agoraphobia (AG) exists as an independent diagnostic entity apart from panic. In favor of this position, AG without panic disorder (PD) in parents was found being unrelated to offsprings' risk for AG or PD, albeit it may enhance the familial transmission of PD (Nocon et al., Depress Anxiety 2008;25:422-434). However, a recent behavioral genetic analysis (Mosing et al., Depress Anxiety 2009;26:1004-1011) found an increased risk for both PD and AG in siblings of those with AG without PD, casting doubt on whether AG exists independently of PD. Convincing evidence for either position notably requires considering also other anxiety disorders to establish the position of AG relative to the panic/anxiety spectrum.

METHODS

Familial transmission of panic attacks (PAs), PD, and AG was examined in a 10-year prospective-longitudinal community study of 3,021 adolescents and young adults including completed direct and indirect information on parental psychopathology. Standardized diagnostic assessments using the Munich-Composite International Diagnostic Interview allowed generating exclusive diagnostic groups independent from diagnostic hierarchy rules.

RESULTS

Parental PD without AG was associated with an increased risk for PA and PD+AG, but not for PD without AG or AG without PD in offspring. Parental AG without PD was unrelated to the offsprings' risk for PA, exclusive PD or AG, or PD+AG. Findings were largely unaffected by adjustment for other offspring or parental anxiety disorders.

CONCLUSIONS

Findings provide further evidence for the independence of AG apart from the PD spectrum.

A phenotype of early infancy predicts reactivity of the amygdala in male adults

One of the central questions that has occupied those disciplines concerned with human development is the nature of continuities and discontinuities from birth to maturity. The amygdala has a central role in the processing of novelty and emotion in the brain. Although there is considerable variability among individuals in the reactivity of the amygdala to novel and emotional stimuli, the origin of these individual differences is not well understood. Four-month old infants called high reactive (HR) demonstrate a distinctive pattern of vigorous motor activity and crying to specific unfamiliar visual, auditory and olfactory stimuli in the laboratory. Low-reactive infants show the complementary pattern. Here, we demonstrate that the HR infant phenotype predicts greater amygdalar reactivity to novel faces almost two decades later in adults. A prediction of individual differences in brain function at maturity can be made on the basis of a single behavioral assessment made in the laboratory at 4 months of age. This is the earliest known human behavioral phenotype that predicts individual differences in patterns of neural activity at maturity. These temperamental differences rooted in infancy may be relevant to understanding individual differences in vulnerability and resilience to clinical psychiatric disorder. Males who were HR infants showed particularly high levels of reactivity to novel faces in the amygdala that distinguished them as adults from all other sex/temperament subgroups, suggesting that their amygdala is particularly prone to engagement by unfamiliar faces. These findings underline the importance of taking gender into account when studying the developmental neurobiology of human temperament and anxiety disorders. The genetic study of behavioral and biologic intermediate phenotypes (or 'endophenotypes') indexing anxiety-proneness offers an important alternative to examining phenotypes based on clinically defined disorder. As the HR phenotype is characterized by specific patterns of reactivity to elemental visual, olfactory and auditory stimuli, well before complex social behaviors such as shyness or fearful interaction with strangers can be observed, it may be closer to underlying neurobiological mechanisms than behavioral profiles observed later in life. This possibility, together with the fact that environmental factors have less time to impact the 4-month phenotype, suggests that this temperamental profile may be a fruitful target for high-risk genetic studies.

Linkage analysis of alternative anxiety phenotypes in multiply affected panic disorder families

BACKGROUND

The choice of phenotype definitions for genetic studies of panic and phobic disorders is complicated by family, twin, and neurobiological data indicating both distinct and shared risk factors as well as heterogeneity within categories. We have previously reported a genome scan in 120 multiplex panic disorder (PD) families using a phenotype that closely adhered to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., PD definition. Here, we extend this work by carrying out exploratory linkage analyses in this same pedigree set using ten additional literature-based panic and phobia-related phenotypes that take into account aspects of these hypothesized complexities.

METHODS

Multiply affected families (>2 individuals with PD) were recruited from clinical and nonclinical sources, evaluated by a clinician-administered semistructured interview and a subsequent blind consensus best estimate procedure. Each phenotype was analyzed under dominant and recessive models using parametric two-point (homogeneity and heterogeneity), multipoint, and nonparametric methods. Empirically based permutations were used to estimate model-specific and global (across all phenotypes) P-values.

RESULTS

The highest score was a two-point lod (4.27, global P<0.08) on chromosome 13 (D13S793, 76 cM) for the phenotype 'specific or social phobia' under a recessive model and conditions of homogeneity. There was minimal support for linkage to any of the remaining nine phenotypes.

CONCLUSION

Although the interpretation of findings is limited by the sample size and the large number of phenotypes and models analyzed, these data suggest a region on chromosome 13 as a potential site for further exploration in relation to the risk for specific and social phobias.

A twin study of computer anxiety in Turkish adolescents

The present study investigated computer anxiety within a sample of Turkish twins aged 10-18. A total of 185 twin-pairs participated in the study. Of the twins, 64 pairs (34.6 percent) were monozygotic (MZ) and 121 pairs (65.4 percent) were dizygotic (DZ). Of the 121 DZ twins, 54 pairs (44.63 percent) were same-sex twins and 67 pairs (55.37 percent) were opposite-sex twins. Computer anxiety was assessed using Computer Anxiety Rating Scale-Turkish Version (CARS-TV), one of the three main scales of "Measuring Technophobia Instruments" developed by Rosen and Weil. The results of paired t test comparisons showed no significant differences in MZ and same-sex DZ twin-pairs' levels of computer anxiety. On the other hand, a significant difference was found in opposite-sex DZ twin-pairs' level of computer anxiety. Interesting enough, males appeared to be more computer anxious than their female co-twins. In the present study, using Falconer's formula, heritability estimate for computer anxiety was derived from correlations based on MZ and DZ twins' mean scores on CARS-TV. The results showed that 57 percent of the variance in computer anxiety was from genetics and 41.5 percent was from nonshared environmental factors. Shared environmental influence, on the other hand, was very small and negligible. Interpretations of results and potential directions for future research are presented.

Etiology of Social Anxiety Disorder in Children and Youth

Social Anxiety Disorder is a heterogeneous and distressing problem for many children and youth. Unravelling its multiple causes is essential for a full understanding of the condition. This selective review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent-child interactions (attachment, parenting styles). We conclude that genetic influences, behavioural inhibition and parent-child interactions play significant and interactive roles in the development and maintenance of social anxiety disorder. Other influences are also acknowledged, such as peer relationships, social skills deficits and traumatic experience. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.

Clarifying the relationship between religiosity and psychiatric illness: the impact of covariates and the specificity of buffering effects

Previous analyses in a large population-based sample of female twins indicated that three dimensions of religiosity – personal devotion, personal conservatism and institutional conservatism – were, in different ways, significantly related to current depressive symptoms and substance use and lifetime psychiatric and substance use disorders. Furthermore, personal devotion, but neither personal conservatism nor institutional conservatism, buffered the depressogenic effects of stressful life events (SLEs). We here explore further these results, using linear, logistic and Cox regression models. Eight personality and six demographic variables had distinct patterns of association with the three dimensions. Personal devotion was positively associated with years of education, age, and optimism and negatively correlated with neuroticism. Personal conservatism was negatively associated with education, income, age, mastery and positively correlated with neuroticism. Institutional conservatism was negatively correlated with self-esteem and parental education. Covarying for these 14 variables produced little change in their association with psychiatric and substance use outcomes. The impact of the dimensions of religiosity differed as a function of the SLE category. High levels of both personal devotion and institutional conservatism protected against the depressogenic effects of death and personal illness. High levels of personal conservatism were associated with increased sensitivity to relationship problems. These results suggest that the association between religiosity and low risk for symptoms of depression and substance use may be in part causal. The relationship between dimensions of religiosity and response to SLEs is complex but probably of importance in clarifying the nature of the coping process.