High Risk Studies of Anxiety Disorders

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Given the early age of onset for anxiety disorders, studies of children of parents with anxiety have become an increasingly important source of information on the premorbid risk factors and early forms of expression of anxiety. Increased rates of anxiety symptoms and disorders among offspring of parents with anxiety disorders have been demonstrated by Turner (1987), Biederman (1991), Sylvester (1988), Last (1991), Warner (1995b), Beidel et al. (1997), Beidel (1988), Capps et al. (1996), Merikangas et al. (1998a), Unnewehr et al. (1998), and Warner et al. (1995a). Table 2 shows that the risk of anxiety disorders among offspring of parents with anxiety disorders compared to those of controls averages 3.5 (range 1.3-13.3), suggesting specificity of parent-child concordance within broad subtypes of anxiety disorders.

However, similar to studies of adults that show common familial and genetic risk factors for anxiety and depression (Kendler et al. 1996; Merikangas 1990; Stavrakaki and Vargo 1986), studies in children have also revealed a lack of specificity of parental anxiety and/or depression (Beidel and Turner 1997; Sylvester et al. 1988; Turner et al. 1987; Warner et al. 1995b).

The high rates of anxiety disorders among offspring of parents with anxiety suggest that there may be underlying psychologic or biologic vulnerability factors for anxiety disorders in general that may already manifest in children prior to puberty. Previous research has shown that children at risk for anxiety dis-

Table 2 Controlled high-risk studies of anxiety

Sample Relative Study Author (YR)

risk

Proband Offspring

Anxiety Comorbid Diagnoses n Age

Proband Offspring

Anxiety Comorbid Diagnoses n Age

Panic

Simple

87

5-

15

9.2

Unnewehr et al. 1998

Panic

MDD

-

91

7-

17

13.3

Sylvester et al. 1987

PaniclMDD

Panic

Early on

145

6-

29

1.3

Warner et al. 1995

set MDD

Agor

AgorlPanic

-

43

8-

24

-

Capps et al. 1996

AgorlOCD

Dysthymia

-

43

7-

12

4.8

Turneret al. 1987

PaniclSocial

Alcohol or

Substance

192

7-

17

2.0

Merikangas et al. 1998

Phobia

Drugs

+Anxiety

Anxiety+Dep

Anxiety

MDD

129

7-

12

4.0

Beidel et al. 1997

Agor, agoraphobia; Dep, depression; Dx, diagnosis; MDD, major depressive disorder; OCD, obsessive-compulsive disorder; Not eval, not evaluated.

Agor, agoraphobia; Dep, depression; Dx, diagnosis; MDD, major depressive disorder; OCD, obsessive-compulsive disorder; Not eval, not evaluated.

orders throughout life are characterized by behavioral inhibition (Rosenbaum et al. 1988), autonomic reactivity (Beidel 1988; Merikangas et al. 1999), somatic symptoms (Reichler et al. 1988; Turner et al. 1987), social fears (Sylvester et al. 1988; Turner et al. 1987), enhanced startle reflex (Merikangas et al. 1999), and respiratory sensitivity (Pine et al. 2000).

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Getting to Know Anxiety

Getting to Know Anxiety

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