Behavioral inhibition and obsessive-compulsive disorder

The psychosocial and educational burden of obsessive-compulsive disorder in youth

BACKGROUND

Pediatric OCD is associated with functional impairment in multiple environments. However, relatively little is known about the impact of comorbid conditions, as well as OCD severity on psychosocial functioning in this population. Furthermore, most studies did not include a control sample, nor examined differences between children and adolescents. The goal of this investigation was to assess psychosocial functioning and its associations with age, symptom severity, and comorbid conditions in a large well characterized sample of pediatric OCD probands, and controls.

METHODS

Participants included 117 pediatric OCD probands and 147 controls, that underwent a careful diagnostic process, and completed several questionnaires and interviews.

RESULTS

Results revealed significant psychosocial impairments across multiple domains/settings, some of which were affected by symptom severity as well as by conduct related comorbidities and to a lesser extent affective disorders. In addition, different aspects of psychosocial impairments were found between children and adolescents.

CONCLUSION

This study provides high resolution information regarding the types and extent of psychosocial dysfunction in youth with OCD, as well as its relationship with clinical and diagnostic correlates. It is recommended that evaluation and management of OCD in youth in research and clinical settings regularly include qualitative and semi-quantitative assessment of function across these domains.

Mouse movement measures enhance the stop-signal task in adult ADHD assessment

The accurate detection of attention-deficit/hyperactivity disorder (ADHD) symptoms, such as inattentiveness and behavioral disinhibition, is crucial for delivering timely assistance and treatment. ADHD is commonly diagnosed and studied with specialized questionnaires and behavioral tests such as the stop-signal task. However, in cases of late-onset or mild forms of ADHD, behavioral measures often fail to gauge the deficiencies well-highlighted by questionnaires. To improve the sensitivity of behavioral tests, we propose a novel version of the stop-signal task (SST), which integrates mouse cursor tracking. In two studies, we investigated whether introducing mouse movement measures to the stop-signal task improves associations with questionnaire-based measures, as compared to the traditional (keypress-based) version of SST. We also scrutinized the influence of different parameters of stop-signal tasks, such as the method of stop-signal delay setting or definition of response inhibition failure, on these associations. Our results show that a) SSRT has weak association with impulsivity, while mouse movement measures have strong and significant association with impulsivity; b) machine learning models trained on the mouse movement data from "known" participants using nested cross-validation procedure can accurately predict impulsivity ratings of "unknown" participants; c) mouse movement features such as maximum acceleration and maximum velocity are among the most important predictors for impulsivity; d) using preset stop-signal delays prompts behavior that is more indicative of impulsivity.

Abnormalities within and beyond the cortico-striato-thalamo-cortical circuitry in medication-free patients with OCD revealed by the fractional amplitude of low-frequency fluctuations and resting-state functional connectivity

Neuroimaging studies of obsessive-compulsive disorder (OCD) often focus on the cortico-striato-thalamo-cortical (CSTC) circuitry, but recent studies have found abnormal spontaneous brain activity in regions outside the CSTC circuitry in patients with OCD using resting-state functional magnetic resonance imaging. Researchers have not clearly determined whether changes in spontaneous brain activity within and beyond the CSTC circuitry coexist in medication-free patients with OCD. To address this question, we recruited 64 medication-free patients with OCD and 60 matched healthy controls (HCs) to investigate their spontaneous brain activity by measuring the fractional amplitude of low-frequency fluctuation (fALFF) and resting-state functional connectivity. Patients with OCD showed increased fALFF values in the left dorsolateral prefrontal cortex (DLPFC) and decreased fALFF values in the right rolandic operculum compared with HCs. Furthermore, patients with OCD exhibited significantly increased functional connectivity between the left DLPFC and the left cerebellum and reduced negative functional connectivity between the right rolandic operculum and the left precuneus. These findings provided new insights into the pathophysiological model of OCD, which may include CSTC circuitry and regions outside this circuitry.

The serotonin transporter promoter polymorphism moderates the continuity of behavioral inhibition in early childhood

Persistently elevated behavioral inhibition (BI) in children is a marker of vulnerability to psychopathology. However, little research has considered the joint influences of caregiver and child factors that may moderate the continuity of BI in early childhood, particularly genetic variants that may serve as markers of biological plasticity, such as the serotonin transporter linked polymorphic region (5-HTTLPR). We explored this issue in 371 preschoolers and their caregivers, examining whether parent characteristics (i.e., overinvolvement or anxiety disorder) and child 5-HTTLPR influenced the continuity of BI between ages 3 and 5. Measures were observational ratings of child BI, observational and questionnaire measures of parenting, and parent interviews for anxiety disorder history, and children were genotyped for the 5-HTTLPR. Parent factors did not moderate the association between age 3 and age 5 BI; however, child BI at age 3 interacted with children's 5-HTTLPR variants to predict age 5 BI, such that children with at least one copy of the short allele exhibited less continuity of BI over time relative to children without this putative plasticity variant. Findings are consistent with previous work indicating the 5-HTTLPR short variant increases plasticity to contextual influences, thereby serving to decrease the continuity of BI in early childhood.

Aetiological overlap between obsessive-compulsive related and anxiety disorder symptoms: multivariate twin study

BACKGROUND

The aetiological boundary between obsessive-compulsive related disorders (OCRDs) including obsessive-compulsive disorder (OCD) and anxiety disorders is unclear and continues to generate debate.

AIMS

To determine the genetic overlap and the pattern of causal relationships among OCRDs and anxiety disorders.

METHOD

Multivariate twin modelling methods and a new regression analysis to infer causation were used, involving 2495 male and female twins.

RESULTS

The amount of common genetic liability observed for OCD symptoms was higher when considering anxiety disorders and OCRDs in the model v. modelling OCRD symptoms alone. OCD symptoms emerged as risk factors for the presence of generalised anxiety, panic and hoarding symptoms, whereas social phobia appeared as a risk factor for OCD symptoms.

CONCLUSIONS

OCD represents a complex phenotype that includes important shared features with anxiety disorders and OCRDs. The novel patterns of risk identified between OCD and anxiety disorder may help to explain their frequent co-occurrence.

Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns

Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the existence of two partially distinct temperamental profiles. We used the Temperament and Character Inventory (TCI-R) and the Positive and Negative Emotionality (PNE) scale to compare two groups of patients with OCD (n=227) or AD (n=827). The latter group included patients with social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. Most temperament, character and emotionality measures showed no significant differences between both groups. In the personality measures results, only the self-directedness score (TCI-R) was significantly lower in OCD patients but this difference was not significant when the comparison was adjusted for the depressive scale score and age. Only lower PNE positive affects scores were obtained in OCD patients in the adjusted comparisons. These findings suggest that OCD and AD are not really distinguishable from the point of view of associated personality traits.

Environmental effects on compulsive tail chasing in dogs

Obsessive Compulsive Disorder (OCD) is a neuropsychiatric disorder observed both in humans and animals. Examples of Canine Compulsive Disorder (CD) include excessive tail chasing (TC), light/shadow chasing and flank sucking. We performed a questionnaire survey to investigate the characteristics of compulsive (TC) and its possible associations with environmental correlates and personality in a pet population of 368 dogs from four dog breeds. We observed an early onset of TC at 3–6 months of age and a large variation in TC frequency in all breeds, with an overrepresentation of milder cases. Almost half of the TC dogs showed lowered responsiveness during bouts and displayed also other types of compulsions more often than the controls. Interestingly, dogs that received dietary supplements, especially vitamins and minerals, expressed less TC compared to dogs that did not receive any supplements. Neutered females had less TC, suggesting an influence of ovarian hormones on TC. Tail chasers were shyer and had separated earlier from their mothers than the controls. Finally, our genetic study did not find an association between TC and CDH2, a locus previously associated with the canine flank sucking compulsion. In conclusion, the early-onset and the variable nature of the repetitive behaviour, which is affected by environmental factors such as micronutrients, neutering and maternal care, share several similar components between canine and human compulsions and supports canine TC as a model for human OCD.

Serotonin transporter genotype moderates the link between children's reports of overprotective parenting and their behavioral inhibition

The goal of the current study was to examine environmental and genetic correlates of children's levels of behavioral inhibition (BI). Participants were 100 mother child pairs drawn from the community who were part of a larger study of the intergenerational transmission of depression. Results indicated that higher levels of maternal overprotection, as reported by the child, were associated with elevations in BI among children carrying two copies of the lower expressing 5-HTTLPR alleles (S or L(G)), but not among those carrying only one copy or those homozygous for the L(A) allele. In addition, this interaction was specific for the social component of BI, not the nonsocial component. This relation was maintained even after statistically controlling for children's and mother's psychopathology. Together, these findings add to emerging research demonstrating that G × E interactions predict variation in BI during childhood.

Childhood history of behavioral inhibition and comorbidity status in 256 adults with social phobia

BACKGROUND

Behavioral inhibition (BI), a heritable temperament, predisposes one to an increased risk of social phobia. Recent investigations have reported that BI may also be a precursor to anxiety as well as depressive and alcohol-related disorders, which are frequently comorbid with social phobia. In the present study, we explored the relationship between BI and psychiatric disorders in 256 adults with a primary diagnosis of social phobia.

METHODS

BI severity was retrospectively assessed with the Retrospective Self-Report of Inhibition (RSRI). The severity of social phobia and the presence of comorbid diagnoses were evaluated with the Liebowitz Social Anxiety Scale (LSAS) and the Mini-International Neuropsychiatric Interview, respectively.

RESULTS

The RSRI score was significantly and positively correlated with both the LSAS score and the occurrence of a major depressive disorder. No significant association was found with other anxiety and substance-related disorders.

LIMITATION

The assessment of BI was retrospective and self-reported.

CONCLUSION

A childhood history of BI was associated with an increased risk of depressive comorbidity in social phobia.

Deficient proactive interference of eyeblink conditioning in Wistar-Kyoto rats

Wistar-Kyoto (WKY) rats exhibit behavioral inhibition and model anxiety vulnerability. Although WKY rats exhibit faster active avoidance acquisition, simple associative learning or the influence of proactive interference (PI) has not been adequately assessed in this strain. Therefore, we assessed eyeblink conditioning and PI in WKY and outbred Sprague-Dawley (SD) rats. Rats were pre-exposed to either the experimental context, the conditioned stimulus (CS), the unconditional stimulus (US), or the CS & US in an explicitly unpaired (EUP) manner, to examine latent inhibition (LI), US pre-exposure effect, or learned irrelevance (LIRR), respectively. Immediately following pre-exposures, rats were trained in a delay-type paradigm (500 ms CS coterminating with a 10-ms US) for one session. During training SD rats exhibited LI and inhibition from US pre-exposures without evidence of LIRR. PI was less evident in WKY rats; LI was absent in WKY rats. Even in the context of reduced PI to CS-alone and US-alone pre-exposures, LIRR was not apparent in WKY rats. The more normal acquisition rates exhibited by WKY rats, under conditions which degrade performance in SD rats, increases the overall likelihood for WKY rats to acquire defensive responses. Enhanced acquisition of defensive responses is a means by which anxiety vulnerability (e.g., behavioral inhibition) is translated to anxiety psychopathology.

Should OCD be classified as an anxiety disorder in DSM-V?

In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform disorders"). Ongoing advances in our understanding of OCD and other anxiety disorders have raised the question of whether OCD should continue to be classified with the anxiety disorders in DSM-V. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Evidence is reviewed for retaining OCD in the category of anxiety disorders, and for moving OCD to a separate category of obsessive-compulsive (OC)-spectrum disorders, if such a category is included in DSM-V. Our preliminary recommendation is that OCD be retained in the category of anxiety disorders but that this category also includes OC-spectrum disorders along with OCD. If this change is made, the name of this category should be changed to reflect this proposed change.

Retrospective reports of behavioral inhibition and young adults' current symptoms of social anxiety, depression, and anxious arousal

The primary goal of this study was to investigate the specificity of the social versus nonsocial components of self-reported behavioral inhibition during childhood with young adults' current symptoms of anhedonic depression, social anxiety, and anxious arousal. As hypothesized, the social component of BI demonstrated some specificity for symptoms of social anxiety versus other internalizing disorders. Furthermore, results support the hypothesis that the relationship between BI and depressive symptoms is mediated by levels of social anxiety and anxious arousal.

Specificity and structure of obsessive-compulsive disorder symptoms

Research in obsessive-compulsive disorder (OCD) shows heterogeneous symptoms. No longer satisfied with categorizations of obsessions or compulsions, contemporary symptom measures are multidimensional and assess specific symptoms (e.g., checking, washing) as well as experiences bearing a putative relation to OCD (e.g., hoarding). This two-study correlational design examined three OCD measures in student samples (total N=805). Objectives were to evaluate (a) the measures' joint factor structure; (b) specificity of relations between OCD and symptoms of general distress, panic, and depression; and (c) the pattern of convergent and discriminant relations among OCD scales after accounting for general distress. Results were that both exploratory and confirmatory factor analyses supported a five-factor structure: checking, contamination, rituals, impulses, and hoarding. Scales showed meaningful patterns of relations with general distress, panic, and depression. That is, OCD symptoms correlated moderately with general distress and panic, but related more weakly to depression. Parallel scales measuring the five domains were reliable and showed strong convergence across instruments. After accounting for general distress, discriminant validity was found: Mono-trait correlations between instruments were the highest correlations overall and were substantially higher than hetero-trait values either within or between instruments. We discuss the importance of understanding relations among OCD measures, between OCD and other symptoms, and implications of this type of analysis for defining OCD.

Assessing the development of inflated responsibility beliefs: the Pathways to Inflated Responsibility Beliefs Scale

Inflated responsibility beliefs are hypothesized to be a central feature of obsessive-compulsive disorder (OCD; Rachman, 1998, 2002; Salkovskis, 1985), but the etiology of these beliefs remains untested. Salkovskis and colleagues (1999) proposed 5 primary pathways to the development of inflated responsibility beliefs (e.g., heightened responsibility as a child, exposure to rigid and extreme codes of conduct as a child). The current paper presents 2 studies developing a self-report measure--the Pathways to Inflated Responsibility Beliefs Scale (PIRBS)--of these hypothesized pathways. In the first study, an initial version of the scale is developed and the number of items are reduced. In the second study, the revised scale is shown to provide a reasonable match to the proposed structure and to have good internal consistency, retest reliability, and convergent and divergent validity. These initial data suggest that the PIRBS may be useful for studying the etiology of inflated responsibility beliefs that are hypothesized to be central to the development of OCD. Limitations and future directions are discussed.

Psychometric Properties of the Behavioral Inhibition Scale in Young Adults

Abstract. The Behavioral Inhibition Scale (BIS) is a brief questionnaire for measuring Kagan's (1994) temperamental characteristic of children and adolescents to be unusually shy and to react with fear and withdrawal in situations that are novel and/or unfamiliar. The present study examined the psychometric properties of the BIS in two separate samples of undergraduate students (Ns = 124 and 73). The students of Sample 1 completed the BIS as well as questionnaires for measuring personality traits, anxiety, and other psychopathological symptoms, whereas students of Sample 2 completed the scale as well as a widely used anxiety inventory on two separate occasions, some 4 weeks apart. The results showed that the BIS was reliable in terms of internal consistency and test-retest stability. Further, the scale was predominantly correlated with general levels of anxiety symptoms and not with other psychopathological symptoms. Finally, the BIS was related to other personality factors in a theoretically meaningful way, and essentially seems to reflect a combination of high neuroticism/behavioral inhibition and low extraversion/behavioral approach.