Behavioral disinhibition 'possible familial risk factor for bipolar disorder'


3 March 2006

Study findings have suggested a familial link between bipolar disorder in parents and behavioral disinhibition in their children.

"Behavioral disinhibition may be a familially transmitted predisposing factor for dysregulatory distress later in life," say Dina Hirshfeld-Becker (Massachusetts General Hospital, Boston, USA) and colleagues.

They found that, compared with the children of parents with panic disorder, depression, or no mental health condition, those born to parents with bipolar disorder were 2.62 times more likely to have behavioral disinhibition.

For their study, the researchers conducted a secondary analysis of data from a pre-existing high-risk study of children at risk for panic disorder and depression (n=278) due to having parents with one or both of the conditions, along with 34 children who had parents with bipolar disorder. Eighty-one children with mentally healthy parents were also included in the analysis.

When aged between 2 and 6 years, the children had been classified as behaviorally inhibited, disinhibited, or neither in laboratory assessments.

The results showed higher rates of behavioral disinhibition among the children born to parents with bipolar disorder than those of parents without bipolar disorder, at 53% versus 34%.

The association between parental bipolar disorder and behavioral disinhibition was particularly strong for the 18 children born to parents with bipolar I disorder, at a rate of 67%.

Hirshfeld-Becker and team note that the differences among the groups were not accounted for by parental panic disorder or major depression, or by parental history of attention deficit hyperactivity disorder, conduct disorder, antisocial personality, or substance use disorders.

Behavioral inhibition showed no association with parental bipolar disorder, the researchers report.

"Our pilot results support the hypothesis that behavioral disinhibition represents an early risk factor for bipolar disorder, in particular, bipolar I disorder," Hirshfeld-Becker et al conclude in the American Journal of Psychiatry.

"Clinically, our findings suggest that young offspring of bipolar patients who exhibit behavioral disinhibition should be monitored closely for the onset of disruptive behavior or mood disorder symptoms.

"They also raise the possibility that these children might be fruitfully targeted for early interventive efforts."


SOURCE:- Am J Psychiatry 2006; 163: 265–271