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Marco Battaglia, MD; Paola Pesenti-Gritti, MSc; Sarah E. Medland, PhD; Anna Ogliari, MD; Kristian Tambs, PhD; Chiara A. M. Spatola, MSc

Arch Gen Psychiatry. 2009;66(1):64-71.

Context  Childhood separation anxiety disorder can predate panic disorder, which usually begins in early adulthood. Both disorders are associated with heightened sensitivity to inhaled CO₂ and can be influenced by childhood parental loss.

Objectives  To find the sources of covariation between childhood separation anxiety disorder, hypersensitivity to CO₂, and panic disorder in adulthood and to measure the effect of childhood parental loss on such covariation.

Design  Multivariate twin study.

Participants  Seven hundred twelve young adults from the Norwegian Institute of Public Health Twin Panel, a general population cohort.

Main Outcome Measures  Personal direct assessment of lifetime panic disorder through structured psychiatric interviews, history of childhood parental loss, and separation anxiety disorder symptoms. Subjective anxiety response to a 35% CO₂/65% O₂ inhaled mixture compared with compressed air (placebo).

Results  Our best-fitting solution yielded a common pathway model, implying that covariation between separation anxiety in childhood, hypersensitivity to CO₂, and panic disorder in adulthood can be explained by a single latent intervening variable influencing all phenotypes. The latent variable governing the 3 phenotypes' covariation was in turn largely (89%) influenced by genetic factors and childhood parental loss (treated as an identified element of risk acting at a family-wide level), which accounted for the remaining 11% of covariance. Residual variance was explained by 1 specific genetic variance component for separation anxiety disorder and variable-specific unique environmental variance components.

Conclusions  Shared genetic determinants appear to be the major underlying cause of the developmental continuity of childhood separation anxiety disorder into adult panic disorder and the association of both disorders with heightened sensitivity to CO₂. Inasmuch as childhood parental loss is a truly environmental risk factor, it can account for a significant additional proportion of the covariation of these 3 developmentally related phenotypes.

Author Affiliations: Department of Psychology, Vita-Salute San Raffaele University; and Department of Clinical Neurosciences, San Raffaele Institute, National Institute of Neuroscience, Milan, Italy (Drs Battaglia and Ogliari, and Mss Pesenti-Gritti and Spatola); Department of Child Psychiatry, Eugenio Medea Scientific Institute, Bosisio Parini, Italy (Dr Battaglia); Genetic Epidemiology Unit, The Queensland Institute of Medical Research, Brisbane, Australia (Dr Medland); The Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond (Drs Medland and Tambs); and The Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway (Dr Tambs).

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