Testing the diathesis-stress model: 5-HTTLPR, childhood emotional maltreatment, and vulnerability to social anxiety disorder


  • Declaration of interest: Disclosure of external financial support in the past 5 years: Hans Joergen Grabe: German Research Foundation; Federal Ministry of Education and Research Germany; speakers honoraria from Bristol-Myers Squibb, Eli Lilly, Novartis, Eisai, Wyeth, Pfizer, Boehringer Ingelheim, Servier and travel funds from Janssen-Cilag, Eli Lilly, Novartis, AstraZeneca and SALUS-Institute for Trend-Research and Therapy Evaluation in Mental Health. Ulrich John: Research grants by the European Union, the Federal Ministry of Education and Research (Germany), The Federal Ministry of Health (Germany), the Federal States of Germany, the German Cancer Aid, the German Research Foundation, the Social Ministry of the State of Mecklenburg-West Pomerania (Germany).

  • How to Cite this Article: Reinelt E, Stopsack M, Aldinger M, John U, Grabe HJ, Barnow S. 2013. Testing the Diathesis-Stress Model: 5-HTTLPR, Childhood Emotional Maltreatment, and Vulnerability to Social Anxiety Disorder. Am J Med Genet Part B 162B:253–261.


Regarding the development of social anxiety disorder (SAD), a diathesis-stress paradigm including biological vulnerabilities and environmental stressors can be assumed. However, studies dealing with the etiology of SAD did not integrate both aspects so far. We examined a particular diathesis-stress model for SAD in which we included a functional polymorphism of the serotonin transporter (5-HTTLPR) as a genetic vulnerability factor and childhood emotional maltreatment (CEM) as an environmental stressor. Current analyses were based on individuals who participated in the Study of Health in Pomerania. Psychiatric disorders were assessed with diagnostic interviews according to DSM-IV criteria. The triallelic genotype of 5-HTTLPR was determined. Statistical analyses were performed in 78 individuals with SAD and 1,035 without an axis I disorder. Logistic regression analysis revealed that the experience of CEM (odds ratio [OR] 4.56; 95% confidence interval [CI] 2.65–7.84), the l/l genotype of 5-HTTLPR (OR 2.13; 95% CI 1.31–3.48), female gender (OR 3.03; 95% CI 1.80–5.08) and younger age (OR 1.04; 95% CI 1.02–1.06) increased the odds for SAD. The data suggest that CEM, the l/l genotype of 5-HTTLPR, female gender and younger age are risk factors for SAD. This is in favor of the tested diathesis-stress model. © 2013 Wiley Periodicals, Inc.