Anxiety and Early development and

Depression
Multifactorial Studies
Class objectives
• Study and reflect on some of the findings from research on the
multiple relationships behind depression and anxiety
• Consider not only the correlational relationships, but the complex
inter-relationships that can be established: interactional models
Interactio Genetic and
nal
Environmental context
(family) epigenetic
variables

“Neurological
correlates”

Relational patterns and

psychic structure
neurophysiological
(personality)
changes
BEHAVIORAL
expressions

Cognitive and affective

variants
Example of complex systems
• “Since the human cerebral cortex is only diffusely structured by a
genetic plan, and since the eventual differentiation of the cortex is
highly reactive to the individual’s active coping and “meaning
making” in a particular environment, it is very likely that both
abnormal and resilient outcomes following the experience of
significant adversity would encompass a diverse range of neural,
synaptic, and associative networks that are the physiological
underpinnings of many possible individual psychological
organizations” (Ciccetti, et al 2006, p.27).
Towards childhood development:
problems with linearity
• Frecuentently used as a representation of growth
• A simple, progressive advancement
• Temporality as linear, real vs temporality and psychological
 Age
Prenatal///0 years Infancy Adolescence Adulthood Elderly

Pathologic expression
Biologic
predisposition Negative
Risk factors experiences

Regresive mobility Expected

development

Protective
factors Positive
expereinces

Resiliency
Snowball effect:
• Nivel genético:
• “Genes often exert different functional
roles in divergent cell types at varying
developmental periods (Alberts et al.,
1994; Lewin, 2004). Consequently,
defects in such genes may trigger a
cascade of change that is not confined
to a particular neural structure,
functional system, or behavioral
domain.”
Some neurophysiological
correlates
• Three systems:
• The prefrontal cortex (PFC), particularly as it relates to
other regulatory systems; the hypothalamus-pituitary-
adrenal (HPA) system; and the vagal (Xth cranial) nerve
complex (VC) of the autonomic nervous system (ANS)
• Mediated by the neurochemically specific pathways (e.g.,
norepinephrine, dopamine, acetylcholine, serotonin) that
project from the brain stem
• Stress responses
Some gender factors related to
anxiety and depression
• Depression occurs with anxiety
• Although depression and anxiety can be clearly differentiated at biological,
cognitive, behavioral, and affective levels, the extent to which they overlap
and co- occur suggests that the combination represents a unique but
common form of depression, particularly in females.
• In women, it’s more likely
• more anxiety, more somatic symptoms, hypersomnia, weight gain, increased
appetite, fatigue, psychomotor retardation, and body image disturbance
• Higher rates of crying, sadness, and negative self-concept have been noted for
school-age and adolescent girls.
Interactive modeling
• Stress diathesis model
Emotional
expressiveness
differences
• Men or women:
• dysphoric males often expressed their
unhappiness directly and without
hesitation, by acting on the world in an
aggressive, hostile manner.
• Dysphoric symptoms in female
adolescents, in contrast, were
characterized by introspection, absence
of open hostility, and a mostly hidden
preoccupation with self.
 Genes and predisposition
• Predisposition vs expression
• Hormones and their correlation to mood fluctuations
• Estradiol: A positive association between estradiol and later depressive affect has been shown even after
the course of a year
• Fluctuations, research is not conclusive, must be studied in relation to other hormones (oxytocin, for
example).
• Early puberty – depression
• Early puberty results from a complex mix of biological, social, and contextual factors. Genes, as well
as environmental influence like nutrition, exercise, and weight, play a role.
• Depression in mothers may induce early puberty in daughters (Ellis & Garber, 2000), as well as the
presence of unrelated adult male father figures
• Passed on? “suited to a harsh, unpredictable, and threatening environment with few resources—an
environment in which intense defensive responses, fearful avoidance of threats, and early, increased
sexual activity will be likely to result in maximal survival and more offspring born in the next
generation.
Concurrent neurophysiological
mechanisms
• Cortisol levels differ, higher and more promiment in women, and
more likely to be maintained, especially related to social rejection (vs.
Achievement in men)
 Environmental
• Depression in parents (not just genetic)
• Depressed parents are, on average, less reciprocal, attuned, and engaged in
interactions with their children as early as infancy. In addition to the sadness that marks
depression, depressed parents express a greater range and less control of other
negative emotions such as anxiety, guilt, irritability, and hostility than control
• Often model helpless, passive styles of coping. They tend to use discipline methods that
are either ineffectual, coercive, or guilt-inducing
• Girls accompany (communion) depression:
• They also express more sadness, worry, and withdrawal than sons, as well as responsibility for the
mother’s depression
• Females are more likely than males to experience or be affected by the stresses of others in addition
to their parents, which also would create vulnerability to depression.
• Depression  Divorce:
• Marital discord and divorce lead to both internalizing
problems (depression, anxiety), for which females generally
are at higher risk, and externalizing problems (aggression,
antisocial behavior), for which males generally are at higher
risk.
• Other psicosocial difficulties
• Relationship with family
• “conflict with the mother that was associated with submissive
coping was related to concurrent depression and predicted
increases in these symptoms 1 year later for adolescent
daughters but not sons”
• Other relationships
• Women have been shown to be
more invested in relationships
(Friends and romantic) than men,
which would then result in being
more affected by disruptions in
relationships
“Cultural reinforcement of the feminine ideal or stereotype
promotes behaviors that are dependent, relationship-driven,
emotional, helpless, passive, and self- sacrificing. These
behaviors are hypothesized to create risk for depression.”
“loss of voice” and low self-worth in adolescence,
more common to females than males and implicated in
depression, is restricted to a subset of girls who endorse a
feminine orientation.
Cyranowski et al. proposed that female gender socialization and
increased levels of hormones such as oxytocin (which is associated
with reproduction and care- giving) at puberty can intensify the
need for affiliation in girls. This, in turn, can contribute to a difficult
adolescent transition and a depressogenic diathesis.

Gender intensification
hypothesis
Anxiety
• Anxiety and Fear. Anxiety is object-less) fear.
• Girls have more fears and worries than boys
and experience them more intensively.
• These sex differences in fear and anxiety
are present in the 1st years of life at
clinical levels and continue through
adolescence
• This is the case across all sub-types
(DSM IV even)
Temperament and fear
• Temperament: high vs low reactive
• Effortful control: restraint and the ability to inhibit oneself, is
more characteristic of girls than boys
• Inhibited control in young children is associated with the
later development of anxiety and anxiety disorders.
• Sex differences in reactivity
• Males: low autonomic arousal
• Neural pathway: The amygdala is implicated in startle
response to explicit and contextual cues, ////the bed
nucleus of the stria terminalis is involved in response to
contextual cues
• Boys are allowed and encouraged to explore
their physical environments, which creates
opportunities to master the unfamiliar and to
feel comfortable or safe in a variety of
contexts. In contrast, girls’ exploration is often
curtailed.
• Fearfulness is accepted and sometimes
encouraged in girls, but is less tolerated in
boys. Parents are more tolerant, however, of
anger, assertion, and misbehavior in boys.
Society and culture reinforce these messages.

Environment
• Victimization reaction:
• Girls not only report more anxiety than boys, but
being victimized leads to more negative opinions of
themselves, which, in turn, makes them vulnerable
to increased anxiety.
• Interpersonally aware
• interpersonal sensitivity is linked with social skills
but also with emotional distress.
• Even with correlating higher cortisol (fear of negative evaluation)

More cultural differences

So how do these variables
interact?
• Developmentally
• vulnerability factors more common to girls than
boys may be present in childhood, but lead to
depression only in the face of challenges that
increase in adolescence.
• Anxiety is a precursor to depression, in girls.
A psychological
variable
• Rumination
• Rumination involves worry,
perseveration, and even obsession (at
times) about one’s inner state and may
begin in childhood as anxiety and
worry develop.
Vicious cycle, or
snowball
• Repeated exposure to psychological stress over
time may sensitize children so that later on,
even brief exposures to similar stressors (or
even thoughts and images in the absence of
apparent stress that serve as reminders) could
induce depression.
• Temperamentally anxious children may develop
“affective maps” or “somatic markers” of their
experiences where threat- or stress-related
information becomes particularly salient
• Negative emotional experiences are more often
talked about.
• They also develop scripts of over-involvement in
others’ distress that include themes of empathy and
guilt
 Vicious cycle…
• “Perturbations that occur during brain development can potentiate a
cascade of maturational and structural changes that eventuate in the neural
system proceeding along a trajectory that deviates from that generally taken
during normal neurobiological development (Cicchetti & Tucker, 1994a; Courchesne et al., 1994;
Nowakowski & Hayes, 1999). Early stressors, either physiological or emotional, may alter
the neurodevelopmental processes of networks, in turn generating a cascade
of effects through subsequent developmental periods, conceivably
constraining the child’s flexibility to adapt to new challenging situations with
new strategies rather than with old conceptual and behavioral prototypes
(Cicchetti & Tucker, 1994a; Gunnar, 2000; Sanchez, Ladd, & Plotsky, 2001). Accordingly, early psychological
trauma may eventuate not only in emotional sensitization (Maughan & Cicchetti, 2002;
Rieder & Cicchetti, 1989) but also in pathological sensitization of neurophysiological re-
activity (Pollak, Cicchetti, & Klorman, 1998).