Newman Michelle G, Shin Ki Eun, Zuellig Andrea R
Department of Psychology, The Pennsylvania State University, University Park, United States.
Department of Psychology, The Pennsylvania State University, University Park, United States.
J Affect Disord. 2016 Dec;206:94-102. doi: 10.1016/j.jad.2016.07.008. Epub 2016 Jul 5.
There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.
Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.
Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.
These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.
关于区分广泛性焦虑症（GAD）和惊恐障碍（PD）的特定风险因素尚不清楚。
本研究调查了是否可以通过发育病因因素的差异来区分GAD和PD，这些因素包括童年时期父母丧亡/分离、心理障碍以及与父母的依恋关系。
20名患有成人广泛性焦虑症（GAD）的患者、20名患有成人惊恐障碍（PD）的患者、11名患有成人共病GAD和PD的患者以及21名成年非焦虑对照者完成了诊断访谈，以评估成年期和童年期的精神障碍症状。参与者还报告了与父母的依恋关系、丧亡和分离情况。
童年期诊断的GAD和PD能够将临床组与对照组区分开来，而且临床组之间也能相互区分，这表明同型连续性比异型连续性更有可能出现。与对照组相比，特定恐惧症与所有三个临床组都有关联，而童年期抑郁症、社交恐惧症和创伤后应激障碍（PTSD）则与成人GAD有独特关联。与父母的依恋关系也能将临床组与对照组区分开来。然而，相对于PD而言，反映母亲不安全回避型依恋的分量表得分较高（例如，对童年早期经历没有记忆以及平衡/原谅当前心境）对GAD更具预测性。在父母丧亡或分离方面，各小组之间没有差异。
这些结果支持基于发育风险因素对GAD和PD进行区分。讨论了对未来研究的建议以及这些发现对理解GAD和PD的病因及症状学的意义。
