Childhood behavioral inhibition and attachment: Links to generalized anxiety disorder in young adulthood

Abstract

Generalized anxiety disorder (GAD) is under-treated yet prevalent among young adults. Identifying early risk factors for GAD would contribute to its etiological model and identify potential targets for intervention. Insecure attachment patterns, specifically ambivalent and disorganized, have long been proposed as childhood risk factors for GAD. Similarly, childhood behavioral inhibition has been consistently associated with anxiety disorders in adulthood, including GAD. Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has also been shown to be a crucial component of GAD. Furthermore, maternal anxiety is an important feature of developmental models of anxiety including GAD. Yet, to date, no study has examined, within a comprehensive model, how attachment and behavioral inhibition in childhood, maternal anxiety in adolescence, and IU in emerging adulthood contribute to GAD in adulthood. The present study thus examines these links using a longitudinal design with 62 Canadian participants and their mothers. At age 6, participants' attachment and behavioral inhibition were assessed observationally. Maternal anxiety was measured when participants were 14 years of age. IU and GAD were assessed when participants were 21 and 23 years of age, respectively. Structural equation modeling showed that IU mediates the relationships between behavioral inhibition and GAD, while controlling for maternal anxiety. Ambivalent and disorganized-controlling attachment patterns are also indirectly associated with increased GAD symptoms via greater IU scores. Furthermore, a direct and positive effect of behaviorally disorganized attachment was found on GAD symptoms. This longitudinal study supports integrating attachment, behavioral inhibition, and IU in a model of GAD.

Friendship attachment style, intolerance of uncertainty, and psychological distress among unaccompanied immigrant minors in times of COVID‐19

“…This pattern was corroborated by the quantitative analysis showing a significant positive correlation between intolerance of uncertainty and psychological distress. At the bivariate level, we also found a positive association between insecure friendship attachment style and intolerance of uncertainty, confirming prior studies which reported a similar link between insecure attachment patterns and the inability to tolerate uncertain situations (Wright et al, 2017; Zdebik et al, 2022).…”

“…For instance, a cross-sectional study found that, in an adult community sample, attachment anxiety and avoidance were positively associated with higher intolerance of uncertainty, and that these variables were positively correlated with increased worry (Wright et al, 2017). More recently, a longitudinal study by Zdebik et al (2022) found that ambivalent and disorganized-controlling maternal attachment patterns assessed during childhood were associated with greater levels of anxiety via higher intolerance of uncertainty among young adults. A possible explanation is that, because insecure attachment styles are a consequence of the caregiver's inconsistency in providing support and children's reactions to stressful events are tied to their expectations of the caregiver's behavior, insecure maternal attachment patterns may prevent children from learning how to regulate their distress.…”

“…Although this design was motivated by the unique characteristics of UIMs' living conditions (e.g., high mobility and precariousness, difficulty with recruitment), future studies should adopt a longitudinal design to tackle developmental trajectories and test causal relationships among variables to identify the mechanisms underpinning UIMs' psychological adjustment over time in the context of the COVID health emergency (Bonati et al, 2022). Of importance, longitudinal studies would also allow to test possible mediating processes following the extant literature, for example, whether insecure friendship attachment style leads to higher intolerance of uncertainty which, in turn, predicts greater psychological distress (see Zdebik et al, 2022), a hypothesis that could not be addressed in the present study. Second, our participants were recruited by social workers through a nonrandom sampling procedure, which might have caused a bias in the participants' selection.…”

“…Third, we explored the associations among friendship attachment style, intolerance of uncertainty, and psychological distress. In particular, we analyzed the main and interactive effects of the two above‐mentioned variables on psychological distress based on emerging evidence suggesting that (in)secure attachment styles and intolerance of uncertainty might have a joint effect on psychological adjustment (Wright et al, 2017; Zdebik et al, 2022). Furthermore, we addressed whether and how participants described a relation among these constructs in their subjective perceptions.…”

GAD: Development of Intolerance of Uncertainty Model and Contrast Avoidance Model

“…In a longitudinal study, the predictive effect of childhood behavioral inhibition (BI) and attachment styles on GAD in adulthood were examined [7]. The outcomes demonstrated that IU functions as a mediator in the association between BI and GAD.…”