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

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.

Childhood attachment and behavioral inhibition: Predicting intolerance of uncertainty in adulthood.

Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has been identified as an important cognitive component of anxiety disorders, yet little is known about its etiology. Links to temperament, particularly behavioral inhibition (BI), and insecure attachment have been proposed in the development of IU, but no prospective empirical investigation has been performed thus far. In the current study, attachment to caregiver and BI of 60 children were assessed at age 6, using observational measures. Mother's anxiety symptoms were assessed when participants were 14 years old. IU was reported by participants when they were 21 years old, as was neuroticism. Two types of insecure attachment (ambivalent and disorganized-controlling) and BI were positively related to IU over a 15-year span, even after controlling for participants' neuroticism and maternal anxiety. Attachment and BI had no significant interacting effect on the development of IU. Maternal anxiety was positively related to child BI and insecure attachment, but not IU. This study is the first to provide empirical support for a link between ambivalent and disorganized-controlling attachment and BI in preschool children to the development of IU in adulthood. Results have etiological and preventative implications not only for anxiety disorders but also for all disorders related to IU.