Childhood trauma in adults with social anxiety disorder and panic disorder: a cross-national study

Abstract

Objectives: The influence of childhood trauma as a specific environmental factor on the development of adult psychopathology is far from being elucidated. As part of a collaborative project between research groups from South Africa (SA) and Sweden focusing on genetic and environmental factors contributing to anxiety disorders, this study specifically investigated rates of childhood trauma in South African and Swedish patients respectively, and whether, in the sample as a whole, different traumatic experiences in childhood are predictive of social anxiety (SAD) or panic disorder (PD) in adulthood. Method: Participants with SAD or PD (85 from SA, 135 from Sweden) completed the Childhood Trauma Questionnaire (CTQ). Logistic regression was performed with data from the two countries separately, and from the sample as a whole, with primary diagnoses as dependent variables, gender, age, and country as covariates, and the CTQ subscale totals as independent variables. The study also investigated the internal consistency (Cronbach alpha) of the CTQ subscales. Results: SA patients showed higher levels of childhood trauma than Swedish patients. When data from both countries were combined, SAD patients reported higher rates of childhood emotional abuse compared to those with PD. Moreover, emotional abuse in childhood was found to play a predictive role in SAD/PD in adulthood in the Swedish and the combined samples, and the same trend was found in the SA sample. The psychometric qualities of the CTQ subscales were adequate, with the exception of the physical neglect subscale. Conclusion: Our findings suggest that anxiety disorder patients may differ across countries in terms of childhood trauma. Certain forms of childhood abuse may contribute specific vulnerability to different types of psychopathology. Longitudinal studies should focus on the potential sequential development of SAD/PD among individuals with childhood emotional abuse.

The cortisol response to social stress in social anxiety disorder

“…Similarly, van der Vegt et al (2010) examined awakening cortisol levels in anxiety disorders, and stressed the effects of early childhood adversity on cortisol reactivity in these conditions. This is in keeping with the notion that emotional abuse (EA), more so than physical or sexual abuse, may be associated with the pathophysiology of SAD (Asher and Coie, 1990;Lochner et al, 2010). More recently, a study has found that different forms of CT are associated with different CSR (Kuhlman et al, 2015).…”

“…This finding was driven by a negative association between emotional abuse scores and cortisol AUC G in the SAD group, which strongly contrasted the marked positive relationship between emotional abuse scores and AUC G in the control group. Past research has shown that individuals with SAD report higher rates of CT, and in particular EA, compared to healthy individuals (Asher and Coie, 1990;Lochner et al, 2010). The present findings suggest that EA in SAD patients is associated with an altered cortisol stress response, in particular total cortisol exposure in response to a social challenge as reflected in the AUC G .…”

“…Separate models were examined for AUC G (AUC with respect to ground) and AUC I (AUC with respect to increase) (Pruessner et al, 2003). Based on (1) the high rates of emotional abuse reported by patients with SAD (Asher and Coie, 1990;Lochner et al, 2010) and (2) recent evidence suggesting that different forms of childhood adversity are associated with different cortisol stress responses (Kuhlman et al, 2015), we performed one set of analyses based on total CTQ scores and another based on childhood EA scores only.…”

A latent class analysis of trauma based on a nationally representative sample of US adolescents

“…Second, previous research has also found anxiety disorders to be associated with emotional traumas, that is, those traumas that do not stem from a physical act, e.g. being assaulted or being in an accident [44]. However, within this study, those in the high risk group, who were at the highest risk of the anxiety disorders examined, reported a wide variety of physical based traumas, ranging from being mugged to witnessing fights at home.…”

Use of Archived Neonatal Bloodspots for Examining Associations between Prenatal Exposure to Potentially Traumatic or Stressful Life Events, Maternal Herpesvirus Infection and Lifetime History of Generalized Anxiety Disorder in Offspring

“…While much research has focused on the role that early life trauma plays in the development of anxiety disorders among children (Stein et al, 1996;Pynoos et al, 1999;Heim and Nemeroff, 2001;Hovens et al, 2010Hovens et al, , 2012Hovens et al, , 2015Lochner et al, 2010;Klauke et al, 2011;Kuo et al, 2011;Zikic et al, 2015), a growing body of studies suggest that the adverse effects of traumatic events as well as other stressors on the development of anxiety disorders in children may begin before birth (Yehuda et al, 2001;Najman et al, 2010;Rice et al, 2010;Davis and Sandman, 2012;Betts et al, 2014;Park et al, 2014). Researchers have hypothesized that excess exposure to maternal stress hormones during gestation plays a key role in fetal programming of offspring anxiety disorders via causing permanent alterations to hypothalamic-pituitary-adrenal (HPA) axis function and/or via contributing to epigenetic modifications that adversely shape offspring stress reactivity (Weaver et al, 2004;Skinner et al, 2008;Glover et al, 2010;Davis et al, 2011;Radtke et al, 2011;Perroud et al, 2014).…”