Skip to main content Accessibility help

Population-based, multi-generational family clustering study of social anxiety disorder and avoidant personality disorder

  • K. Isomura (a1), M. Boman (a2), C. Rück (a1), E. Serlachius (a1), H. Larsson (a2), P. Lichtenstein (a2) and D. Mataix-Cols (a1)...



We aimed to provide unbiased estimates of familial risk and heritability of social anxiety disorder (SAD) and avoidant personality disorder (AVPD).


We identified 18 399 individuals diagnosed with SAD and 2673 with AVPD in the Swedish National Patient Register between 1997 and 2009. Risks (odds ratios; OR) for SAD in all biological and non-biological relatives of probands, compared to relatives of unaffected individuals were calculated. We also estimated the risks for AVPD in relatives of probands with SAD.


The risk for SAD among relatives of SAD probands increased proportionally to the degree of genetic relatedness. The risks for first-degree relatives [OR 4.74, 95% confidence interval (CI) 4.28–5.25] were significantly higher than for second-degree and third-degree relatives. Second-degree relatives (OR 2.30, 95% CI 2.01–2.63) had significantly higher risk than third-degree relatives (OR 1.72, 95% CI 1.52–1.94). Relatives at similar genetic distances had similar risks for SAD, despite different degrees of shared environment. Heritability was estimated to be approximately 56%. There were no significant sex differences in the familial patterns. The risk of AVPD in relatives of SAD probands was significantly elevated, even after excluding individuals with both diagnoses (first-degree OR 3.54, second-degree OR 2.20, third-degree OR 1.62). Non-biological relatives (spouses/partners) also had elevated risks for both SAD (OR 4.01) and AVPD (OR 3.85).


SAD clusters in families primarily due to genetic factors. SAD and AVPD are aetiologically related and may represent different expressions of the same vulnerability. The strong marital concordance observed in SAD/AVPD may indicate assortative mating but the exact mechanisms and implications require further investigation.


Corresponding author

* Address for correspondence: Professor D. Mataix-Cols, Ph.D., Department of Clinical Neuroscience, Karolinska Institutet, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), floor 8 SE-11330 Stockholm, Sweden. (Email:


Hide All
Berkson, J (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics 2, 4753.
Bögels, SM, Alden, L, Beidel, DC, Clark, LA, Pine, DS, Stein, MB, Voncken, M (2010). Social anxiety disorder: questions and answers for the DSM-V. Depression and Anxiety 27, 168189.
Chavira, DA, Shipon-Blum, E, Hitchcock, C, Cohan, S, Stein, MB (2007). Selective mutism and social anxiety disorder: all in the family? Journal of the American Academy of Child and Adolescent Psychiatry 46, 14641472.
Chavira, DA, Stein, MB (2005). Childhood social anxiety disorder: from understanding to treatment. Child and Adolescent Psychiatric Clinics of North America 14, 797818, ix.
Coelho, HF, Cooper, PJ, Murray, L (2007). A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample. Journal of Affective Disorders 100, 103113.
Dierker, LC, Merikangas, KR, Szatmari, P (1999). Influence of parental concordance for psychiatric disorders on psychopathology in offspring. Journal of the American Academy of Child and Adolescent Psychiatry 38, 280288.
Falconer, DS (1960). Quantitative Genetics. Oliver and Boyd: Edinburgh.
Frisell, T, Lichtenstein, P, Långström, N (2011). Violent crime runs in families: a total population study of 12.5 million individuals. Psychological Medicine 41, 97105.
Fyer, AJ, Mannuzza, S, Chapman, TF, Liebowitz, MR, Klein, DF (1993). A direct interview family study of social phobia. Archives of General Psychiatry 50, 286293.
Jaffee, SR, Price, TS (2007). Gene-environment correlations: a review of the evidence and implications for prevention of mental illness. Molecular Psychiatry 12, 432442.
Kendler, KS, Jacobson, KC, Myers, J, Prescott, CA (2002). Sex differences in genetic and environmental risk factors for irrational fears and phobias. Psychological Medicine 32, 209217.
Kendler, KS, Karkowski, LM, Prescott, CA (1999). Fears and phobias: reliability and heritability. Psychological Medicine 29, 539553.
Kendler, KS, Myers, J, Prescott, CA, Neale, MC (2001). The genetic epidemiology of irrational fears and phobias in men. Archives of General Psychiatry 58, 257265.
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of General Psychiatry 49, 273281.
Lichtenstein, P, Yip, BH, Björk, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.
Lieb, R, Wittchen, HU, Höfler, M, Fuetsch, M, Stein, MB, Merikangas, KR (2000). Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study. Archives of General Psychiatry 57, 859866.
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450.
Maes, HH, Neale, MC, Kendler, KS, Hewitt, JK, Silberg, JL, Foley, DL, Meyer, JM, Rutter, M, Simonoff, E, Pickles, A, Eaves, LJ (1998). Assortative mating for major psychiatric diagnoses in two population-based samples. Psychological Medicine 28, 13891401.
Mataix-Cols, D, Boman, M, Monzani, B, Ruck, C, Serlachius, E, Langstrom, N, Lichtenstein, P (2013). Population-based, multigenerational family clustering study of obsessive-compulsive disorder. JAMA Psychiatry 70, 709717.
Merikangas, KR, Lieb, R, Wittchen, HU, Avenevoli, S (2003). Family and high-risk studies of social anxiety disorder. Acta Psychiatrica Scandinavica 108 (Suppl. 417), 2837.
Merikangas, KR, Prusoff, BA, Weissman, MM (1988). Parental concordance for affective disorders: psychopathology in offspring. Journal of Affective Disorders 15, 279290.
Mosing, MA, Gordon, SD, Medland, SE, Statham, DJ, Nelson, EC, Heath, AC, Martin, NG, Wray, NR (2009). Genetic and environmental influences on the co-morbidity between depression, panic disorder, agoraphobia, and social phobia: a twin study. Depression and Anxiety 26, 10041011.
Nelson, EC, Grant, JD, Bucholz, KK, Glowinski, A, Madden, PAF, Reich, W, Heath, AC (2000). Social phobia in a population-based female adolescent twin sample: co-morbidity and associated suicide-related symptoms. Psychological Medicine 30, 797804.
Plomin, R (2011). Commentary: why are children in the same family so different? Non-shared environment three decades later. International Journal of Epidemiology 40, 582592.
Reich, J, Yates, W (1988). Family history of psychiatric disorders in social phobia. Comprehensive Psychiatry 29, 7275.
Reichborn-Kjennerud, T, Czajkowski, N, Torgersen, S, Neale, MC, Ørstavik, RE, Tambs, K, Kendler, KS (2007). The relationship between avoidant personality disorder and social phobia: a population-based twin study. American Journal of Psychiatry 164, 17221728.
SAS/STAT® (2004). SAS/STAT Software . SAS Institute Inc.: Cary, NC.
Stein, MB, Chartier, MJ, Hazen, AL, Kozak, MV, Tancer, ME, Lander, S, Furer, P, Chubaty, D, Walker, JR (1998). A direct-interview family study of generalized social phobia. American Journal of Psychiatry 155, 9097.
Stein, MB, Jang, KL, Livesley, WJ (2002). Heritability of social anxiety-related concerns and personality characteristics: a twin study. Journal of Nervous and Mental Disease 190, 219–24.
Stein, MB, Stein, DJ (2008). Social anxiety disorder. Lancet 371, 11151125.
Statistics Sweden (1994). Facts about the Swedish Family. Demographic reports 1994. Statistics Sweden: Stockholm.
Tidemalm, D, Runeson, B, Waern, M, Frisell, T, Carlström, E, Lichtenstein, P, Långström, N (2011). Familial clustering of suicide risk: a total population study of 11.4 million individuals. Psychological Medicine 41, 25272534.
Tillfors, M, Furmark, T, Ekselius, L, Fredrikson, M (2001). Social phobia and avoidant personality disorder as related to parental history of social anxiety: a general population study. Behaviour Research and Therapy 39, 289298.
Warren, SL, Schmitz, S, Emde, RN (1999). Behavioral genetic analyses of self-reported anxiety at 7 years of age. Journal of the American Academy of Child and Adolescent Psychiatry 38, 14031408.
Weinstock, LS (1999). Gender differences in the presentation and management of social anxiety disorder. Journal of Clinical Psychiatry 60 (Suppl. 9), 913.
Xu, Y, Schneier, F, Heimberg, RG, Princisvalle, K, Liebowitz, MR, Wang, S, Blanco, C (2012). Gender differences in social anxiety disorder: results from the national epidemiologic sample on alcohol and related conditions. Journal of Anxiety Disorders 26, 1219.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Isomura Supplementary Material
Supplementary Material

 Word (29 KB)
29 KB

Population-based, multi-generational family clustering study of social anxiety disorder and avoidant personality disorder

  • K. Isomura (a1), M. Boman (a2), C. Rück (a1), E. Serlachius (a1), H. Larsson (a2), P. Lichtenstein (a2) and D. Mataix-Cols (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.