Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T13:46:51.189Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  12 September 2014

K. Isomura ,
M. Boman ,
C. Rück ,
E. Serlachius ,
H. Larsson ,
P. Lichtenstein  and
D. Mataix-Cols
K. Isomura
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
M. Boman
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
C. Rück
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
E. Serlachius
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
D. Mataix-Cols*
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: Professor D. Mataix-Cols, Ph.D., Department of Clinical Neuroscience, Karolinska Institutet, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), floor 8 SE-11330 Stockholm, Sweden. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Anxiety disordersassortative matingavoidant personality disorderfamily studygenetic epidemiologyheritabilitysocial anxiety disordersocial phobia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 8 , June 2015 , pp. 1581 - 1589
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Berkson, J (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics 2, 47–53.CrossRefGoogle ScholarPubMed
Bögels, SM, Alden, L, Beidel, DC, Clark, LA, Pine, DS, Stein, MB, Voncken, M (2010). Social anxiety disorder: questions and answers for the DSM-V. Depression and Anxiety 27, 168–189.CrossRefGoogle ScholarPubMed
Chavira, DA, Shipon-Blum, E, Hitchcock, C, Cohan, S, Stein, MB (2007). Selective mutism and social anxiety disorder: all in the family? Journal of the American Academy of Child and Adolescent Psychiatry 46, 1464–1472.CrossRefGoogle ScholarPubMed
Chavira, DA, Stein, MB (2005). Childhood social anxiety disorder: from understanding to treatment. Child and Adolescent Psychiatric Clinics of North America 14, 797–818, ix.CrossRefGoogle ScholarPubMed
Coelho, HF, Cooper, PJ, Murray, L (2007). A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample. Journal of Affective Disorders 100, 103–113.CrossRefGoogle Scholar
Dierker, LC, Merikangas, KR, Szatmari, P (1999). Influence of parental concordance for psychiatric disorders on psychopathology in offspring. Journal of the American Academy of Child and Adolescent Psychiatry 38, 280–288.CrossRefGoogle ScholarPubMed
Falconer, DS (1960). Quantitative Genetics. Oliver and Boyd: Edinburgh.Google Scholar
Frisell, T, Lichtenstein, P, Långström, N (2011). Violent crime runs in families: a total population study of 12.5 million individuals. Psychological Medicine 41, 97–105.CrossRefGoogle ScholarPubMed
Fyer, AJ, Mannuzza, S, Chapman, TF, Liebowitz, MR, Klein, DF (1993). A direct interview family study of social phobia. Archives of General Psychiatry 50, 286–293.CrossRefGoogle ScholarPubMed
Jaffee, SR, Price, TS (2007). Gene-environment correlations: a review of the evidence and implications for prevention of mental illness. Molecular Psychiatry 12, 432–442.CrossRefGoogle ScholarPubMed
Kendler, KS, Jacobson, KC, Myers, J, Prescott, CA (2002). Sex differences in genetic and environmental risk factors for irrational fears and phobias. Psychological Medicine 32, 209–217.CrossRefGoogle ScholarPubMed
Kendler, KS, Karkowski, LM, Prescott, CA (1999). Fears and phobias: reliability and heritability. Psychological Medicine 29, 539–553.CrossRefGoogle ScholarPubMed
Kendler, KS, Myers, J, Prescott, CA, Neale, MC (2001). The genetic epidemiology of irrational fears and phobias in men. Archives of General Psychiatry 58, 257–265.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of General Psychiatry 49, 273–281.CrossRefGoogle ScholarPubMed
Lichtenstein, P, Yip, BH, Björk, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234–239.CrossRefGoogle ScholarPubMed
Lieb, R, Wittchen, HU, Höfler, M, Fuetsch, M, Stein, MB, Merikangas, KR (2000). Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study. Archives of General Psychiatry 57, 859–866.CrossRefGoogle ScholarPubMed
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450.CrossRefGoogle ScholarPubMed
Maes, HH, Neale, MC, Kendler, KS, Hewitt, JK, Silberg, JL, Foley, DL, Meyer, JM, Rutter, M, Simonoff, E, Pickles, A, Eaves, LJ (1998). Assortative mating for major psychiatric diagnoses in two population-based samples. Psychological Medicine 28, 1389–1401.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Boman, M, Monzani, B, Ruck, C, Serlachius, E, Langstrom, N, Lichtenstein, P (2013). Population-based, multigenerational family clustering study of obsessive-compulsive disorder. JAMA Psychiatry 70, 709–717.CrossRefGoogle ScholarPubMed
Merikangas, KR, Lieb, R, Wittchen, HU, Avenevoli, S (2003). Family and high-risk studies of social anxiety disorder. Acta Psychiatrica Scandinavica 108 (Suppl. 417), 28–37.CrossRefGoogle Scholar
Merikangas, KR, Prusoff, BA, Weissman, MM (1988). Parental concordance for affective disorders: psychopathology in offspring. Journal of Affective Disorders 15, 279–290.CrossRefGoogle ScholarPubMed
Mosing, MA, Gordon, SD, Medland, SE, Statham, DJ, Nelson, EC, Heath, AC, Martin, NG, Wray, NR (2009). Genetic and environmental influences on the co-morbidity between depression, panic disorder, agoraphobia, and social phobia: a twin study. Depression and Anxiety 26, 1004–1011.CrossRefGoogle ScholarPubMed
Nelson, EC, Grant, JD, Bucholz, KK, Glowinski, A, Madden, PAF, Reich, W, Heath, AC (2000). Social phobia in a population-based female adolescent twin sample: co-morbidity and associated suicide-related symptoms. Psychological Medicine 30, 797–804.CrossRefGoogle Scholar
Plomin, R (2011). Commentary: why are children in the same family so different? Non-shared environment three decades later. International Journal of Epidemiology 40, 582–592.CrossRefGoogle ScholarPubMed
Reich, J, Yates, W (1988). Family history of psychiatric disorders in social phobia. Comprehensive Psychiatry 29, 72–75.CrossRefGoogle ScholarPubMed
Reichborn-Kjennerud, T, Czajkowski, N, Torgersen, S, Neale, MC, Ørstavik, RE, Tambs, K, Kendler, KS (2007). The relationship between avoidant personality disorder and social phobia: a population-based twin study. American Journal of Psychiatry 164, 1722–1728.CrossRefGoogle ScholarPubMed
SAS/STAT® (2004). SAS/STAT Software . SAS Institute Inc.: Cary, NC.Google Scholar
Stein, MB, Chartier, MJ, Hazen, AL, Kozak, MV, Tancer, ME, Lander, S, Furer, P, Chubaty, D, Walker, JR (1998). A direct-interview family study of generalized social phobia. American Journal of Psychiatry 155, 90–97.CrossRefGoogle ScholarPubMed
Stein, MB, Jang, KL, Livesley, WJ (2002). Heritability of social anxiety-related concerns and personality characteristics: a twin study. Journal of Nervous and Mental Disease 190, 219–24.CrossRefGoogle ScholarPubMed
Stein, MB, Stein, DJ (2008). Social anxiety disorder. Lancet 371, 1115–1125.CrossRefGoogle ScholarPubMed
Statistics Sweden (1994). Facts about the Swedish Family. Demographic reports 1994. Statistics Sweden: Stockholm.Google Scholar
Tidemalm, D, Runeson, B, Waern, M, Frisell, T, Carlström, E, Lichtenstein, P, Långström, N (2011). Familial clustering of suicide risk: a total population study of 11.4 million individuals. Psychological Medicine 41, 2527–2534.CrossRefGoogle Scholar
Tillfors, M, Furmark, T, Ekselius, L, Fredrikson, M (2001). Social phobia and avoidant personality disorder as related to parental history of social anxiety: a general population study. Behaviour Research and Therapy 39, 289–298.CrossRefGoogle ScholarPubMed
Warren, SL, Schmitz, S, Emde, RN (1999). Behavioral genetic analyses of self-reported anxiety at 7 years of age. Journal of the American Academy of Child and Adolescent Psychiatry 38, 1403–1408.CrossRefGoogle ScholarPubMed
Weinstock, LS (1999). Gender differences in the presentation and management of social anxiety disorder. Journal of Clinical Psychiatry 60 (Suppl. 9), 9–13.Google ScholarPubMed
Xu, Y, Schneier, F, Heimberg, RG, Princisvalle, K, Liebowitz, MR, Wang, S, Blanco, C (2012). Gender differences in social anxiety disorder: results from the national epidemiologic sample on alcohol and related conditions. Journal of Anxiety Disorders 26, 12–19.CrossRefGoogle ScholarPubMed
Supplementary material: File

Isomura Supplementary Material

Supplementary Material

Download Isomura Supplementary Material(File)
File 29.4 KB