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Interpersonal Stress Regulation and the Development of Anxiety Disorders: An Attachment-Based Developmental Framework

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      Abstract

      Anxiety disorders represent a common but often debilitating form of psychopathology in both children and adults. While there is a growing understanding of the etiology and maintenance of these disorders across various research domains, only recently have integrative accounts been proposed. While classical attachment history has been a traditional core construct in psychological models of anxiety, contemporary attachment theory has the potential to integrate neurobiological and behavioral findings within a multidisciplinary developmental framework. The current paper proposes a modern attachment theory-based developmental model grounded in relevant literature from multiple disciplines including social neuroscience, genetics, neuroendocrinology, and the study of family factors involved in the development of anxiety disorders. Recent accounts of stress regulation have highlighted the interplay between stress, anxiety, and activation of the attachment system. This interplay directly affects the development of social–cognitive and mentalizing capacities that are acquired in the interpersonal context of early attachment relationships. Early attachment experiences are conceptualized as the key organizer of a complex interplay between genetic, environmental, and epigenetic contributions to the development of anxiety disorders – a multifactorial etiology resulting from dysfunctional co-regulation of fear and stress states. These risk-conferring processes are characterized by hyperactivation strategies in the face of anxiety. The cumulative allostatic load and subsequent “wear and tear” effects associated with hyperactivation strategies converge on the neural pathways of anxiety and stress. Attachment experiences further influence the development of anxiety as potential moderators of risk factors, differentially impacting on genetic vulnerability and relevant neurobiological pathways. Implications for further research and potential treatments are outlined.

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      Most cited references 270

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        Epigenetic programming by maternal behavior.

        Here we report that increased pup licking and grooming (LG) and arched-back nursing (ABN) by rat mothers altered the offspring epigenome at a glucocorticoid receptor (GR) gene promoter in the hippocampus. Offspring of mothers that showed high levels of LG and ABN were found to have differences in DNA methylation, as compared to offspring of 'low-LG-ABN' mothers. These differences emerged over the first week of life, were reversed with cross-fostering, persisted into adulthood and were associated with altered histone acetylation and transcription factor (NGFI-A) binding to the GR promoter. Central infusion of a histone deacetylase inhibitor removed the group differences in histone acetylation, DNA methylation, NGFI-A binding, GR expression and hypothalamic-pituitary-adrenal (HPA) responses to stress, suggesting a causal relation among epigenomic state, GR expression and the maternal effect on stress responses in the offspring. Thus we show that an epigenomic state of a gene can be established through behavioral programming, and it is potentially reversible.
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            Author and article information

            Affiliations
            1simpleResearch Department of Clinical, Educational and Health Psychology, University College London London, UK
            2simpleDevelopmental Neuroscience Unit, Anna Freud Centre, University College London London, UK
            3simpleRoyal Holloway, University of London London, UK
            4simpleYale Child Study Center, Yale University New Haven, CT, USA
            5simpleDepartment of Psychology, University of Leuven Leuven, Belgium
            Author notes

            Edited by: Luke R. Johnson, Uniformed Services University of the Health Sciences, USA

            Reviewed by: René Hurlemann, University of Bonn, Germany; Kwang Choi, Uniformed Services University of the Health Sciences, USA

            *Correspondence: Tobias Nolte, Anna Freud Centre, 12 Maresfield Gardens, London NW3 5SU, UK. e-mail: tobias.nolte@ 123456annafreud.org

            Tobias Nolte and Jo Guiney share joint first authorship.

            Journal
            Front Behav Neurosci
            Front. Behav. Neurosci.
            Frontiers in Behavioral Neuroscience
            Frontiers Research Foundation
            1662-5153
            02 July 2011
            21 September 2011
            2011
            : 5
            3177081
            21960962
            10.3389/fnbeh.2011.00055
            Copyright © 2011 Nolte, Guiney, Fonagy, Mayes and Luyten.

            This is an open-access article subject to a non-exclusive license between the authors and Frontiers Media SA, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and other Frontiers conditions are complied with.

            Counts
            Figures: 1, Tables: 0, Equations: 0, References: 310, Pages: 21, Words: 21871
            Categories
            Neuroscience
            Hypothesis and Theory

            Neurosciences

            attachment, anxiety disorders, allostasis, hyperactivation, stress, mentalization, anxiety

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