Brief report
Childhood history of behavioral inhibition and comorbidity status in 256 adults with social phobia

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Abstract

Background

Behavioral inhibition (BI), a heritable temperament, predisposes one to an increased risk of social phobia. Recent investigations have reported that BI may also be a precursor to anxiety as well as depressive and alcohol-related disorders, which are frequently comorbid with social phobia. In the present study, we explored the relationship between BI and psychiatric disorders in 256 adults with a primary diagnosis of social phobia.

Methods

BI severity was retrospectively assessed with the Retrospective Self-Report of Inhibition (RSRI). The severity of social phobia and the presence of comorbid diagnoses were evaluated with the Liebowitz Social Anxiety Scale (LSAS) and the Mini-International Neuropsychiatric Interview, respectively.

Results

The RSRI score was significantly and positively correlated with both the LSAS score and the occurrence of a major depressive disorder. No significant association was found with other anxiety and substance-related disorders.

Limitation

The assessment of BI was retrospective and self-reported.

Conclusion

A childhood history of BI was associated with an increased risk of depressive comorbidity in social phobia.

Introduction

Social phobia is a common anxiety disorder that often imposes persistent functional impairment (Lepine, 2001). Both family-association and prospective studies suggest the existence of a continuity of social anxiety symptomatology from childhood to adulthood (Rosenbaum et al., 1991a, Fyer et al., 1995, Caspi et al., 1996). Indeed, behavioral inhibition to the unfamiliar and novelty (BI), a heritable childhood temperament defined by a tendency to restrict exploration and avoid novelty, has been proposed as a predictive factor of social phobia (Kagan et al., 1988, Hirshfeld et al., 1992, Biederman et al., 2001). However, recent studies have reported that children with BI may also be at risk of having depression, alcohol-related disorders, or other anxiety disorders that frequently occur alongside social phobia (Rosenbaum et al., 1991b, Hirshfeld et al., 1992, Caspi et al., 1996, Magee et al., 1996, Hill et al., 1999, Neal et al., 2002, Coles et al., 2006).

In the present study, we tested the hypothesis that a childhood history of BI increases the severity of social phobia and the risk of suffering from other psychiatric disorders, especially depression, in social phobia. For this, we used data from a French multisite investigation that included 256 adults with social phobia, and we explored the links between the severity of BI and i) the severity of social phobia and ii) the occurrence of lifetime comorbidity associations, especially depression, alcohol-related disorders, and other anxiety disorders.

Section snippets

Study population

Two hundred and seventy adult patients with a primary diagnosis of social phobia were recruited to participate in this study through six French outpatient centers specialized in the management of social phobia. All of the patients fulfilled the DSM-IV criteria for social anxiety disorder in accordance with the Munich-Composite International Diagnostic Interview (Wittchen, 1998). Exclusion criteria for the patients consisted of the presence of psychotic disorder, a history of neurological

Results

Fourteen respondents (5.1%) were excluded due to missing data. The study population consisted of 256 patients (113 men; mean age = 34.0, SD = 9.7) who suffered from social phobia for an average of 20.7 years (SD = 11.4). Generalized social phobia affects 199 of the included patients. With regard to treatment at the moment of the study, 183 patients received serotonin reuptake inhibitors (n = 143), benzodiazepines (n = 112), and/or cognitive–behavioral therapy (n = 25). At the moment of the inclusion,

Discussion

Our findings show that the severity of childhood BI was associated with the severity of social anxiety and the occurrence of lifetime avoidant personality disorder and major depressive disorder in adults with social phobia. No significant association was found between BI and other lifetime comorbidities.

First, we found a significant relationship between BI and avoidant personality disorder in social phobia. This result is concordant with the relationship between the severity of childhood BI and

Role of the funding source

This investigation was carried out through a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique AOM 96-242). The French Ministry of Health had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

The authors report no financial disclosure.

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