Behavioral inhibition as a precursor to psychopathology

Understanding the association between temperamental behavioral inhibition (BI) and psychopathology has implications for elucidating etiological factors, identifying early indicators of risk, and informing prevention. We begin by discussing the relations between behavioral inhibition and other widely used temperament/ personality constructs and go on to outline a number of conceptual models of the temperament-psychopathology relationship. We then review data from cross-sectional, follow-up, and family studies that are relevant to these models. The data indicate that behavioral inhibition is associated with the anxiety disorders, particularly social anxiety disorder, and possibly with depressive disorders as well. Of the various conceptual models of temperament and psychopathology, the literature provides the greatest support for behavioral inhibition as being at least partially distinct from anxiety, but predisposing to the development of anxiety disorders in the presence of neurocognitive and environmental moderators. Moreover, behavioral inhibition appears to influence and be influenced by other factors, suggesting that levels of temperamental vulnerability may change over time, consistent with a dynamic vulnerability model. In contrast, behavioral inhibition does not simply appear to be a milder form of, or precursor to, anxiety disorders. We conclude by considering the heterogeneity of behavioral inhibition and its role within broader frameworks for psychopathology.