The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls

Caseras, Xavier; Giampietro, Vincent; Lamas, Amilton da Costa; Brammer, Mick; Vilarroya, Óscar; Carmona, Susanna; Rovira, Mariana; Torrubia, Rafael; Mataix‐Cols, David

doi:10.1017/s0033291709005972

Cited by 66 publications

(70 citation statements)

References 23 publications

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“…Identical contrast estimates clearly deviating from zero in all three groups argue against this hypothesis. Lack of activation within the fear circuitry in BII is further supported by previous studies (Caseras et al, 2010a;Hermann et al, 2007;Schienle et al, 2003). It should be noted, however, that those and present findings may be limited to sustained emotional responses in BII phobia, since different results have been obtained for rapid and transient fear reactions (Caseras et al, 2010b).…”

Section: Contrast/regionsupporting

confidence: 88%

“…Based on previous findings (Caseras et al, 2010a;Hermann et al, 2007) we did not assume to detect typical fear circuit activation patterns in dental phobics; instead, modulation of phobogenic responses by orbitofrontal areas was expected. In a first step, we investigated the specificity of neural activations in phobics, comparing them to both a healthy and an analogue phobic control group.…”

Section: Introductionmentioning

confidence: 83%

“…Recent investigations on hemodynamic response patterns during sustained emotional processing in BII phobia (Caseras et al, 2010a;Hermann et al, 2007;Schienle et al, 2003) were not able to replicate the typical neural NeuroImage 56 (2011) 363-372 response pattern of spider phobia (including the amygdala, insula and ACC) for BII phobia when subjects were presented generally disgusting (Schienle et al, 2003) or phobogenic stimuli (Caseras et al, 2010a;Hermann et al, 2007). Instead, studies reported relatively unspecific activation of the thalamus and visual/attention areas (Caseras et al, 2010a), the right cuneus and lingual gyrus (Schienle et al, 2003), and decreased medial PFC activation . Of particular interest are results from Caseras et al (2010a,b) who reported similar response patterns during immediate reactions towards threat, but differences under sustained processing pointing towards the pivotal role of emotional regulation in the differentiation of these phobia subtypes.…”

Section: Introductionmentioning

confidence: 99%

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How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia

et al. 2011

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Specific phobia of the animal subtype has been employed as a model disorder exploring the neurocircuitry of anxiety disorders, but evidence is lacking whether the detected neural response pattern accounts for all animal subtypes, nor across other phobia subtypes. The present study aimed at directly comparing two subtypes of specific phobia: snake phobia (SP) representing the animal, and dental phobia (DP) representing the blood-injection-injury subtype. Using functional magnetic resonance imaging (fMRI), brain activation and skin conductance was measured during phobogenic video stimulation in 12 DP, 12 SP, and 17 healthy controls. For SP, the previously described activation of fear circuitry structures encompassing the insula, anterior cingulate cortex and thalamus could be replicated and was furthermore associated with autonomic arousal. In contrast, DP showed circumscribed activation of the prefrontal and orbitofrontal cortex (PFC/OFC) when directly compared to SP, being dissociated from autonomic arousal. Results provide preliminary evidence for the idea that snake and dental phobia are characterized by distinct underlying neural systems during sustained emotional processing with evaluation processes in DP being controlled by orbitofrontal areas, whereas phobogenic reactions in SP are primarily guided by limbic and paralimbic structures. Findings support the current diagnostic classification conventions, separating distinct subtypes in DSM-IV-TR. They highlight that caution might be warranted though for generalizing findings derived from animal phobia to other phobic and anxiety disorders. If replicated, results could contribute to a better understanding of underlying neurobiological mechanisms of specific phobia and their respective classification.

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Section: Contrast/regionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia

et al. 2011

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“…[20] Conversely, individuals with B-I-I phobia responded to their phobic stimulus with significantly increased activation in the bilateral occipito-parietal cortex and thalamus compared to individuals with spider phobias. [20] While this research suggests neural differences between B-I-I phobia and animal phobia, there is very limited research examining neural differences between other SP types.…”

Section: Resultsmentioning

confidence: 98%

Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V

et al. 2010

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The present review was conducted in order to evaluate the current diagnostic criteria for specific phobia (SP) in light of the empirical evidence gathered since DSM-IV and to propose changes to DSM-V where change is clearly and reliably indicated by the evidence. In response to questions put forth by the DSM-V Anxiety, OC Spectrum, Posttraumatic, and Dissociative Disorder Work Group, four primary areas were determined for this review: the accuracy and utility of the current SP type classification system, the validity of test anxiety as a type of SP, the boundary between agoraphobia and SP, and the reliability and utility of the diagnostic criteria for SP. Developmental issues are addressed within each area. Literature reviews examining academic findings published between 1994 and 2009 were carried out and the results are included herein. The review presents a number of options and preliminary recommendations to be considered for DSM-V. All of these recommendations should be considered tentative as they await the field trials and expert consensus necessary prior to their inclusion in the DSM-V. The present review also reveals a great need for future research in the area of SP and directions for such research is provided.

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“…Unfortunately, results are rather inconclusive and seem to critically depend on experimental designs and procedures. Confrontation with phobia-relevant or generally disgusting images has been associated with diminished medial prefrontal cortex (PFC) activity (Hermann et al, 2007) and relatively unspecific activations in thalamus and occipital cortex in BII phobics (Caseras et al, 2010a, Schienle et al, 2003). Direct comparison between BII and animal phobics revealed that only spider phobics showed activations in key areas for emotional processing, i.e.…”

Section: Introductionmentioning

confidence: 99%

Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia

Brinkmann¹,

Poller

Miltner

et al. 2017

NeuroImage: Clinical

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Blood-injection-injury (BII) phobia differs from other subtypes of specific phobia in that it is associated with elevated disgust-sensitivity as well as specific autonomic and brain responses during processing of phobia-relevant stimuli. To what extent these features play a role already during threat anticipation is unclear. In the current fMRI experiment, 16 female BII phobics and 16 female healthy controls anticipated the presentation of phobia-specific and neutral pictures. On the behavioral level, anxiety dominated the anticipatory period in BII phobics relative to controls, while both anxiety and disgust were elevated during picture presentation. By applying two different models for the analysis of brain responses to anticipation of phobia-specific versus neutral stimuli, we found initial and sustained increases of activation in anterior cingulate cortex (ACC), insula, lateral and medial prefrontal cortex (PFC), thalamus and visual areas, as well as initial activation in the amygdala for BII phobics as compared to healthy controls. These results suggest that BII phobia is characterized by activation of a typical neural defense network during threat anticipation, with anxiety as the predominant emotion.

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The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls

Cited by 66 publications

References 23 publications

How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia

How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia

Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V

Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia

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