Frontal theta power linked to neuroticism and avoidance

Frontal localisation of a theory-based anxiety disorder biomarker - Goal conflict specific rhythmicity

PURPOSE

Anxiety disorders are a major global issue. Diagnosis via symptoms, not biological causes, delivers poor treatment outcomes. Our frontal EEG biomarker, Goal Conflict Specific Rhythmicity (GCSR; 4-12 Hz), developed from our long-standing detailed neuropsychological theory of anxiety processes, is reduced by all chemical types of selective anxiolytic and is high in cases across a range of currently diagnosed anxiety disorders.

METHODS

We assessed frontal sources of GCSR, recording scalp EEG at either low resolution (Experiment 1, 32 channels, University of Otago, ♀:33, ♂:16) or high resolution (Experiment 2, 128 channels, University of Auckland, ♀:10, ♂:8) in healthy participants performing a Stop Signal Task to generate GCSR as previously.

PRINCIPAL RESULTS

sLORETA demonstrated GCSR sources consistently in the right inferior frontal gyrus and, more strongly but less consistently, medial frontal gyrus. Variation was consistent with that of stopping in the same Stop Signal Task, depending on task demands.

MAJOR CONCLUSIONS

The sources of GCSR are consistent with our theory that hippocampal output receives goal information, detects conflict, and returns a negative biasing signal to the areas encoding goals in the current task. They match the variation in the control of stopping when response urgency changes. GCSR appears to index a biological type of anxiety unlike any current diagnosis and should help improve accuracy of diagnosis - anchored to actions of selective anxiolytic drugs. This task-related frontal "theta" rhythmicity provides proof-of-concept for further development of our theory of the neuropsychology of anxiety in direct human tests.

Examination of associations between psychopathy and neural reinforcement sensitivity theory constructs

We investigated psychopathy from the neurobiological perspective of reinforcement sensitivity theory (RST). In contrast to previous semantically derived self-report scales, we operationalised RST systems neurally with evoked electroencephalography (EEG). Participants were from a community sample weighted towards externalising psychopathology. We compared the Carver & White Behavioural Inhibition System (BIS)/Behavioural Approach System (BAS) scales with EEG responses associated with RST's systems of goal conflict (aka 'behavioural inhibition'), repulsion/outcome conflict (aka 'fight/flight/freeze') and attraction (aka 'approach'). Bivariate correlations and multiple regression analysis yielded results generally consistent with past literature for associations between psychopathy and the self-report BIS/BAS scales. There were some differences from self-report associations with neural measures of RST. With EEG measures, (1) no meaningful associations were observed between any psychopathy scales and the attraction system; (2) affective-interpersonal traits of psychopathy were negatively associated with goal conflict; (3) disinhibition-behavioural traits of psychopathy were negatively associated with goal conflict but, unexpectedly, positively associated with outcome conflict. These results indicate frontal-temporal-limbic circuit dysfunction in psychopathy as specific domains were linked to neural deficits in goal conflict processing, but there was no evidence for deficits in attraction-related processes.

Is lack of goal-conflict-specific rhythmicity a biomarker for treatment resistance in generalised anxiety but not social anxiety or major depression?

BACKGROUND

Anxiety and depression cause major detriment to the patient, family, and society - particularly in treatment-resistant (TR) cases, which are highly prevalent. TR prevalence may be due to current diagnoses being based not on biological measures but on symptom lists that suffer from clinical subjectivity, variation in symptom presentation, and comorbidity.

AIMS

Goal-conflict-specific rhythmicity (GCSR) measured using the Stop-Signal Task (SST) may provide the first neural biomarker for an anxiety process and disorder. This GCSR has been validated with selective drugs for anxiety. So, we proposed that GCSR could differ between TR and non-TR individuals and do so differently between those diagnoses normally sensitive to selective anxiolytics and those not.

METHODS

We recorded electroencephalograms (EEG) from 20 TR participants (4 GAD, 5 SAD and 11 MDD) and 24 non-TR participants (4 GAD, 5 SAD and 15 Comorbid GAD/MDD (GMD)) while they performed the SST.

RESULTS

There was significant positive GCSR in all groups except the GAD-TR group. GAD-TR lacked GCSR in the low-frequency range. However, TR had little effect in SAD or MDD/GMD populations with apparent increases not decreases.

CONCLUSIONS

Overall, these results suggest that GAD may occur in two forms: one resulting from excessive GCSR and so being drug sensitive, and the other resulting from some other mechanism and so being TR. In SAD and MDD groups, heightened GCSR could be a consequence rather than the cause, driven by mechanisms that are normally more sensitive to non-selective panicolytic antidepressants.

Midfrontal conflict theta and parietal P300 are linked to a latent factor of DSM externalising disorders

Psychiatric illnesses form spectra rather than categories, with symptoms varying continuously across individuals, i.e., there is no clear break between health and disorder. Dimensional measures of behaviour and brain activity are promising targets for studying biological mechanisms that are common across disorders. Here, we assessed the extent to which neural measures of the sensitivity of the three biological systems in the reinforcement sensitivity theory (RST) could account for individual differences in a latent general factor estimated from symptom counts across externalising disorders (EXTs). RST explanatory power was pitted against reduced P300, a reliable indicator of externalising per previous research. We assessed 206 participants for DSM-5 EXTs (antisocial personality disorder, conduct disorder, attention-deficit/hyperactivity disorder, intermittent explosive disorder symptoms, alcohol use disorder, and cannabis use disorder). Of the final sample, 49% met diagnostic criteria for at least one of the EXTs. Electroencephalographic measures of the sensitivities of the behavioural activation system (BAS), the fight/flight/freeze system, and the behavioural inhibition system (BIS), as well as P300 were extracted from the gold bar-lemon and stop-signal tasks. As predicted, we found that low neural BIS sensitivity and low P300 were uniquely and negatively associated with our latent factor of externalising. Contrary to prediction, neural BAS/"dopamine" sensitivity was not associated with externalising. Our results provide empirical support for low BIS sensitivity and P300 as neural mechanisms common to disorders within the externalising spectrum; but, given the low N involved, future studies should seek to assess the replicability of our findings and, in particular, the differential involvement of the three RST systems.

Heart and brain traumatic stress biomarker analysis with and without machine learning: A scoping review

The enigma of post-traumatic stress disorder (PTSD) is embedded in a complex array of physiological responses to stressful situations that result in disruptions in arousal and cognitions that characterise the psychological disorder. Deciphering these physiological patterns is complex, which has seen the use of machine learning (ML) grow in popularity. However, it is unclear to what extent ML has been used with physiological data, specifically, the electroencephalogram (EEG) and electrocardiogram (ECG) to further understand the physiological responses associated with PTSD. To better understand the use of EEG and ECG biomarkers, with and without ML, a scoping review was undertaken. A total of 124 papers based on adult samples were identified comprising 19 ML studies involving EEG and ECG. A further 21 studies using EEG data, and 84 studies employing ECG meeting all other criteria but not employing ML were included for comparison. Identified studies indicate classical ML methodologies currently dominate EEG and ECG biomarkers research, with derived biomarkers holding clinically relevant diagnostic implications for PTSD. Discussion of the emerging trends, algorithms used and their success is provided, along with areas for future research.

Reactive Risk-Taking: Anxiety Regulation Via Approach Motivation Increases Risk-Taking Behavior

Experimental research and real-world events demonstrate a puzzling phenomenon-anxiety, which primarily inspires caution, sometimes precedes bouts of risk-taking. We conducted three studies to test whether this phenomenon is due to the regulation of anxiety via reactive approach motivation (RAM), which leaves people less sensitive to negative outcomes and thus more likely to take risks. In Study 1 (N = 231), an achievement anxiety threat caused increased risk-taking on the Behavioral Analogue Risk Task (BART) among trait approach-motivated participants. Using electroencephalogram in Study 2 (N = 97), an economic anxiety threat increased behavioral inhibition system-specific theta activity, a neural correlate of anxiety, which was associated with an increase in risk-taking on the BART among trait approach-motivated participants. In a preregistered Study 3 (N = 432), we replicated the findings of Study 1. These results offer preliminary support for the reactive risk-taking hypothesis.

Right frontal anxiolytic-sensitive EEG 'theta' rhythm in the stop-signal task is a theory-based anxiety disorder biomarker

Psychiatric diagnoses currently rely on a patient’s presenting symptoms or signs, lacking much-needed theory-based biomarkers. Our neuropsychological theory of anxiety, recently supported by human imaging, is founded on a longstanding, reliable, rodent ‘theta’ brain rhythm model of human clinical anxiolytic drug action. We have now developed a human scalp EEG homolog—goal-conflict-specific rhythmicity (GCSR), i.e., EEG rhythmicity specific to a balanced conflict between goals (e.g., approach-avoidance). Critically, GCSR is consistently reduced by different classes of anxiolytic drug and correlates with clinically-relevant trait anxiety scores (STAI-T). Here we show elevated GCSR in student volunteers divided, after testing, on their STAI-T scores into low, medium, and high (typical of clinical anxiety) groups. We then tested anxiety disorder patients (meeting diagnostic criteria) and similar controls recruited separately from the community. The patient group had higher average GCSR than their controls—with a mixture of high and low GCSR that varied with, but cut across, conventional disorder diagnosis. Consequently, GCSR scores should provide the first theoretically-based biomarker that could help diagnose, and so redefine, a psychiatric disorder.

The Role of the Dorsal-Lateral Prefrontal Cortex in Reward Sensitivity During Approach-Avoidance Conflict

Approach-Avoidance conflict (AAC) arises from decisions with embedded positive and negative outcomes, such that approaching leads to reward and punishment and avoiding to neither. Despite its importance, the field lacks a mechanistic understanding of which regions are driving avoidance behavior during conflict. In the current task, we utilized transcranial magnetic stimulation (TMS) and drift-diffusion modeling to investigate the role of one of the most prominent regions relevant to AAC-the dorsolateral prefrontal cortex (dlPFC). The first experiment uses in-task disruption to examine the right dlPFC's (r-dlPFC) causal role in avoidance behavior. The second uses single TMS pulses to probe the excitability of the r-dlPFC, and downstream cortical activations, during avoidance behavior. Disrupting r-dlPFC during conflict decision-making reduced reward sensitivity. Further, r-dlPFC was engaged with a network of regions within the lateral and medial prefrontal, cingulate, and temporal cortices that associate with behavior during conflict. Together, these studies use TMS to demonstrate a role for the dlPFC in reward sensitivity during conflict and elucidate the r-dlPFC's network of cortical regions associated with avoidance behavior. By identifying r-dlPFC's mechanistic role in AAC behavior, contextualized within its conflict-specific downstream neural connectivity, we advance dlPFC as a potential neural target for psychiatric therapeutics.

Neuroticism and Attention Toward Sexual and Non-Sexual Images During an Oddball Task: Evidence from Event-Related Potentials

While previous research has argued that neuroticism is a vulnerability factor for the experience of sexual difficulties, the basic cognitive processes associated with the impact of such a personality trait on the processing of sexually explicit stimuli are less understood. The current study examined the influence of neuroticism on the attentional processes and its neurophysiological correlates during the perception of sexual and non-sexual images. Event-related potentials from 30 women and 28 men were recorded during a modified oddball paradigm in which participants of both sexes visualized stimuli from three different categories (sexual, non-sexual positive, and non-sexual negative), and two arousal levels (high and low arousal). A P1 latency effect was found for female participants, in which high neuroticism was associated with longer latencies for pornographic compared to romantic sexual images. Higher levels of neuroticism were also associated with higher P3 amplitudes for highly arousing images, with both sexual and non-sexual content. Results were interpreted in light of the information processing model of sexual arousal and showed that neuroticism seems to impact both automatic and conscious pathways of processing of sexual stimuli.

Resting-State Theta Oscillations and Reward Sensitivity in Risk Taking

Females demonstrate greater risk aversion than males on a variety of tasks, but the underlying neurobiological basis is still unclear. We studied how theta (4–7 Hz) oscillations at rest related to three different measures of risk taking. Thirty-five participants (15 females) completed the Bomb Risk Elicitation Task (BRET), which allowed us to measure risk taking during an economic game. The Domain-Specific Risk-Taking Scale (DOSPERT) was used to measure self-assessed risk attitudes as well as reward and punishment sensitivities. In addition, the Barratt Impulsiveness Scale (BIS11) was included to quantify impulsiveness. To obtain measures of frontal theta asymmetry and frontal theta power, we used magnetoencephalography (MEG) acquired prior to task completion, while participants were at rest. Frontal theta asymmetry correlated with average risk taking during the game but only in the female sample. By contrast, frontal theta power correlated with risk taking as well as with measures of reward and punishment sensitivity in the joint sample. Importantly, we showed that reward sensitivity mediated a correlation between risk taking and the power of theta oscillations localized to the anterior cingulate cortex. In addition, we observed significant sex differences in source- and sensor-space theta power, risk taking during the game, and reward sensitivity. Our findings suggest that sensitivity to rewards, associated with resting-state theta oscillations in the anterior cingulate cortex, is a trait that potentially contributes to sex differences in risk taking.

Laterality of an EEG anxiety disorder biomarker largely follows handedness

Anxiety disorders are the most common mental disorders impacting people worldwide. Using an auditory Stop Signal Task (SST), we have developed an anxiety disorder biomarker (goal-conflict specific rhythmicity/GCSR) that occurs at the right frontal site F8 in right-handed participants. Here, we compare its laterality in left-handers (n = 26) versus demographically-matched right-handers (n = 26) between the ages of 18-30. We assessed the effects on GCSR power of the handedness of the participants (left or right), blocks of the SST, left-right variation across frontal channels (F7, F3, Fz, F4, F8), and EEG frequency (4-12 Hz). Left-handers differed from right-handers most at the channels furthest from the midline. This difference was largely a mirroring of right hander responses by left handers. With frontal channels coded in reverse order for left handers the original significant differences disappeared. Some differences remained between the groups in the frequency variation across blocks of testing. These and other data suggest that the circuitry engaged by conflict in the SST is different from that directly controlling stopping behaviour. Our results also suggest that where GCSR is used as an anxiety process or disorder biomarker in groups that combine both left and right-handed people, data only from the channel ipsilateral to the dominant hand should be used (F7, or F8, respectively).

Goal-Conflict EEG Theta and Biased Economic Decisions: A Role for a Second Negative Motivation System

Economic decision biases can reflect emotion and emotion dysfunction. Economic paradigms thus provide a solid framework for analysis of brain processes related to emotion and its disorders. Importantly for economic decisions, goal-conflict activates different negative motivational processes than pure loss; generating negative decision biases linked to anxiety and fear, respectively. Previously, right frontal goal-conflict specific EEG rhythmicity (GCSR) was shown to reflect anxiety processing. Here, we assessed GCSR in a forced-choice, economic decision-making task. Ninety participants were tested in three key conditions where gain:loss ratios of left mouse clicks were set to 75:25 (GAIN), 50:50 (CONFLICT) and 25:75 (LOSS). Right clicks produced no monetary consequences and skipped the current trial. The participants were not told the different conditions but could learn about them by associating the background stimulus color with the specific payoff. Goal-conflict was defined as the mathematical contrast of activity in CONFLICT minus the average of that in GAIN and LOSS. Replicating previous findings with somewhat different conditions, right frontal GCSR was detected. Importantly, greater right frontal GCSR significantly predicted a preference for economic safety in CONFLICT but not in GAIN or LOSS; but did not predict trait anxiety or neuroticism. We conclude that goal-conflict has unique neuroeconomics effects on choice biases; and that these reflect anxiety processing that is not effectively captured by trait anxiety or neuroticism.

Changes of EEG band oscillations to tonic cold pain and the behavioral inhibition and fight-flight-freeze systems

Using electroencephalography (EEG) power measures within conventional delta, theta, alpha, beta, and gamma bands, the aims of the current study were to highlight cortical correlates of subjective perception of cold pain (CP) and the associations of these measures with behavioral inhibition system (BIS), fight-flight-freeze system (FFFS), and behavioral approach system personality traits. EEG was recorded in 55 healthy right-handed women under (i) a white noise interruption detection condition (Baseline); (ii) enduring CP induced by the cold cup test. CP and Baseline EEG band power scores within conventional frequency bands served for covariance analyses. We found that: (1) higher Pain scorers had higher EEG beta power changes at left frontal, midline central, posterior temporal leads; (2) higher BIS was associated with greater EEG delta activity changes at parietal scalp regions; (3) higher FFFS was associated with higher EEG delta activity changes at temporal and left-parietal regions, and with lower EEG gamma activity changes at right parietal regions. High FFFS, compared to Low FFFS scorers, also showed a lower gamma power across the midline, posterior temporal, and parietal regions. Results suggest a functional role of higher EEG beta activity in the subjective perception of tonic pain. EEG delta activity underpins conflict resolution system responsible for passive avoidance control of pain, while higher EEG delta and lower EEG gamma activity changes, taken together, underpin active avoidance system responsible for pain escape behavior.

Risky economic choices and frontal EEG asymmetry in the context of Reinforcer-Sensitivity-Theory-5

This study investigated individual risky choice behavior in a gambling task and its relation with traits proposed by the Reinforcer-Sensitivity-Theory-5 (RST-5; Corr & McNaughton in Neuroscience and Biobehavioral Reviews, 36(10), 2339-2354, 2012) as well as with frontal EEG asymmetry. As assumed by the RST-5, the results showed independent influences of approach/avoidance and gain/loss sensitivities on participants' behavior in risky choices. Individual approach/avoidance sensitivity was predicted by trait measures of the behavioral approach system (BAS) and the behavioral inhibition system (BIS), while no such correlation was present for gain/loss sensitivity. EEG recordings revealed relatively stronger left-frontal cortical activity for trials with approach motivation compared to conflict and avoidance motivation. On the individual level, relatively stronger left-frontal cortical activity was associated with trait BAS. In addition, activity changes in frontal EEG asymmetry were associated relatively higher behavioral approach sensitivity. We conclude that frontal EEG asymmetry is an especially useful neuronal marker of BAS sensitivity and that the traits proposed by the RST-5 (measured by frontal EEG asymmetry and self-report) can be used to explain individual differences in risky choice behavior.

An improved human anxiety process biomarker: characterization of frequency band, personality and pharmacology

Anxiety disorders are among the most common mental illness in the western world with a major impact on disability. But their diagnosis has lacked objective biomarkers. We previously demonstrated a human anxiety process biomarker, goal-conflict-specific electroencephalography (EEG) rhythmicity (GCSR) in the stop-signal task (SST). Here we have developed and characterized an improved test appropriate for clinical group testing. We modified the SST to produce balanced numbers of trials in clearly separated stop-signal delay groups. As previously, right frontal (F8) GCSR was extracted as the difference in EEG log Fourier power between matching stop and go trials (that is, stop-signal-specific power) of a quadratic contrast of the three delay values (that is, power when stopping and going are in balanced conflict compared with the average of when stopping or going is greater). Separate experiments assessed drug sensitivity (n=34) and personality relations (n=59). GCSR in this new SST was reduced by three chemically distinct anxiolytic drugs (administered double-blind): buspirone (10 mg), triazolam (0.25 mg) and pregabalin (75 mg); had a frequency range (4-12 Hz) consistent with rodent model data; and positively correlated significantly with neuroticism and nonsignificantly with trait anxiety scores. GCSR, measured in our new form of the SST, should be suitable as a biomarker for one specific anxiety process in the testing of clinical groups and novel drugs and in the development of measures suitable for individual diagnosis.

Social exclusion modulates event-related frontal theta and tracks ostracism distress in children

Social exclusion is a potent elicitor of distress. Previous studies have shown that medial frontal theta oscillations are modulated by the experience of social exclusion. Using the Cyberball paradigm, we examined event-related dynamics of theta power in the EEG at medial frontal sites while children aged 8-12 years were exposed to conditions of fair play and social exclusion. Using an event-related design, we found that medial frontal theta oscillations (4-8Hz) increase during both early (i.e., 200-400ms) and late (i.e., 400-800ms) processing of rejection events during social exclusion relative to perceptually identical "not my turn" events during inclusion. Importantly, we show that only for the later time window (400-800ms) slow-wave theta power tracks self-reported ostracism distress. Specifically, greater theta power at medial frontal sites to "rejection" events predicted higher levels of ostracism distress. Alpha and beta oscillations for rejection events were unrelated to ostracism distress at either 200-400ms or 400-800ms time windows. Our findings extend previous studies by showing that medial frontal theta oscillations for rejection events are a neural signature of social exclusion, linked to experienced distress in middle childhood.

Development of a theoretically-derived human anxiety syndrome biomarker

“Anxiety disorders” are extremely common; and are a major source of health costs and lost work days. Their diagnosis is currently based on clinical symptom check lists and there are no biological markers to diagnose specific syndromal causes. This paper describes: 1) a detailed theory of the brain systems controlling anxiolytic-insensitive threat-avoidance and anxiolytic-sensitive threat-approach — where, in specific brain structures, activity generates specific normal behaviours, hyperactivity generates abnormal behaviours, and hyper-reactivity (hypersensitivity to input) generates specific clinical syndromes; 2) a rodent model of systemic anxiolytic action (rhythmical slow activity), linked to the theory, that over a period of 40 years has shown predictive validity with no false positives or false negatives — and which is likely to assay the sensitivity of endogenous systems that control anxiety; and, 3) derivation from this rodent-based theory of a specific non-invasive biomarker (goal-conflict-specific rhythmicity) for the threat-approach system in humans. This new biomarker should allow division of untreated “anxiety” patients, with superficially similar clusters of symptoms, into distinct high scoring (syndromal) and low scoring groups with different treatment-responses. This would be the first theoretically-derived biomarker for any mental disorder and should: 1) predict treatment efficacy better than current symptom-based diagnoses; 2) provide a human single dose test of novel anxiolytics; 3) provide a starting point for developing biomarkers for other “anxiety” syndromes; and so, 4) greatly improve treatment outcomes and cost-effectiveness.

Functional topography of serotonergic systems supports the Deakin/Graeff hypothesis of anxiety and affective disorders

Over 20 years ago, Deakin and Graeff hypothesized about the role of different serotonergic pathways in controlling the behavioral and physiologic responses to aversive stimuli, and how compromise of these pathways could lead to specific symptoms of anxiety and affective disorders. A growing body of evidence suggests these serotonergic pathways arise from topographically organized subpopulations of serotonergic neurons located in the dorsal and median raphe nuclei. We argue that serotonergic neurons in the dorsal/caudal parts of the dorsal raphe nucleus project to forebrain limbic regions involved in stress/conflict anxiety-related processes, which may be relevant for anxiety and affective disorders. Serotonergic neurons in the "lateral wings" of the dorsal raphe nucleus provide inhibitory control over structures controlling fight-or-flight responses. Dysfunction of this pathway could be relevant for panic disorder. Finally, serotonergic neurons in the median raphe nucleus, and the developmentally and functionally-related interfascicular part of the dorsal raphe nucleus, give rise to forebrain limbic projections that are involved in tolerance and coping with aversive stimuli, which could be important for affective disorders like depression. Elucidating the mechanisms through which stress activates these topographically and functionally distinct serotonergic pathways, and how dysfunction of these pathways leads to symptoms of neuropsychiatric disorders, may lead to the development of novel approaches to both the prevention and treatment of anxiety and affective disorders.

A comparison of phenylketonuria with attention deficit hyperactivity disorder: do markedly different aetiologies deliver common phenotypes?

Phenylketonuria (PKU) is a well-defined metabolic disorder arising from a mutation that disrupts phenylalanine metabolism and so produces a variety of neural changes indirectly. Severe cognitive impairment can be prevented by dietary treatment; however, residual symptoms may be reported. These residual symptoms appear to overlap a more prevalent childhood disorder: Attention Deficit/Hyperactivity Disorder (ADHD). However, the aetiology of ADHD is a vast contrast to PKU: it seems to arise from a complex combination of genes; and it has a substantial environmental component. We ask whether these two disorders result from two vastly different genotypes that converge on a specific core phenotype that includes similar dysfunctions of Gray's (Gray, 1982) Behavioural Inhibition System (BIS), coupled with other disorder-specific dysfunctions. If so, we believe comparison of the commonalities will allow greater understanding of the neuropsychology of both disorders. We review in detail the aetiology, treatment, neural pathology, cognitive deficits and electrophysiological abnormalities of PKU; and compare this with selected directly matching aspects of ADHD. The biochemical and neural pathologies of PKU and ADHD are quite distinct in their causes and detail; but they result in the disorder in the brain of large amino acid levels, dopamine and white matter that are very similar and could explain the overlap of symptoms within and between the PKU and ADHD spectra. The common deficits affect visual function, motor function, attention, working memory, planning, and inhibition. For each of PKU and ADHD separately, a subset of deficits has been attributed to a primary dysfunction of behavioural inhibition. In the case of ADHD (excluding the inattentive subtype) this has been proposed to involve a specific failure of the BIS; and we suggest that this is also true of PKU. This accounts for a substantial proportion of the parallels in the superficial symptoms of both disorders and we see this as linked to prefrontal, rather than more general, dysfunction of the BIS.