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Early life stress and the anxious brain: evidence for a neural mechanism linking childhood emotional maltreatment to anxiety in adulthood
BackgroundChildhood emotional maltreatment (CEM) increases the likelihood of developing an anxiety disorder in adulthood, but the neural processes underlying conferment of this risk have not been established. Here, we test the potential for neuroimaging the adult brain to inform understanding of the mechanism linking CEM to adult anxiety symptoms.MethodOne hundred eighty-two adults (148 females, 34 males) with a normal-to-clinical range of anxiety symptoms underwent structural and functional magnetic resonance imaging while completing an emotion-processing paradigm with facial expressions of fear, anger, and happiness. Participants completed self-report measures of CEM and current anxiety symptoms. Voxelwise mediation analyses on gray-matter volumes and activation to each emotion condition were used to identify candidate brain mechanisms relating CEM to anxiety in adulthood.ResultsDuring processing of fear and anger faces, greater amygdala and less right dorsolateral prefrontal (dlPFC) activation partially mediated the positive relationship between CEM and anxiety symptoms. Greater right posterior insula activation to fear also partially mediated this relationship, as did greater ventral anterior cingulate (ACC) and less dorsal ACC activation to anger. Responses to happy faces in these regions did not mediate the CEM-anxiety relationship. Smaller right dlPFC gray-matter volumes also partially mediated the CEM-anxiety relationship.ConclusionsActivation patterns of the adult brain demonstrate the potential to inform mechanistic accounts of the CEM conferment of anxiety symptoms. Results support the hypothesis that exaggerated limbic activation to negative valence facial emotions links CEM to anxiety symptoms, which may be consequent to a breakdown of cortical regulatory processes
The age of onset of anxiety disorders
Book cover Age of Onset of Mental Disorders pp 125–147Cite as The Age of Onset of Anxiety Disorders Jeroen S. Legerstee, Bram Dierckx, Elisabeth M. W. J. Utens, Frank C. Verhulst, Carola Zieldorff, Gwen C. Dieleman & Jasmijn M. de Lijster Chapter First Online: 12 November 2018 1043 Accesses Abstract Anxiety disorders are highly prevalent and debilitating psychiatric conditions, which often remain unrecognised and untreated. However, left untreated, anxiety disorders often persist and can contribute to the development of other psychiatric disorders. Therefore, early detection and subsequent intervention are important. Information on the age of onset (AOO) of anxiety disorders could be informative for the timing of prevention strategies. The aim of this chapter is to review and quantitatively synthesise previous findings on the AOO of anxiety disorders. We extended data of a previous meta-analysis of our research group (de Lijster et al. 2017) with a literature search of studies published between October 2014 and June 2017. Anxiety disorders in general were found to have their mean onset at 21 years, which is earlier than the average onset of mood disorders and substance use disorders. However, the age period in which anxiety disorders develops is relatively broad. Separation anxiety disorder, specific phobia and social phobia have their onset in childhood and adolescence, whereas agoraphobia, obsessive–compulsive disorder, post-traumatic stress disorder and panic disorder have their onset in early adulthood. Generalised anxiety disorder had the latest mean onset at almost 35 years