Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-13T08:29:01.977Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  13 May 2009

X. Caseras ,
V. Giampietro ,
A. Lamas ,
M. Brammer ,
O. Vilarroya ,
S. Carmona ,
M. Rovira ,
R. Torrubia  and
D. Mataix-Cols
X. Caseras*
Affiliation:
Department of Psychiatry and Legal Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Catalonia, Spain King's College London, Institute of Psychiatry, London, UK
V. Giampietro
Affiliation:
King's College London, Institute of Psychiatry, London, UK
A. Lamas
Affiliation:
Department of Psychiatry and Legal Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Catalonia, Spain
M. Brammer
Affiliation:
King's College London, Institute of Psychiatry, London, UK
O. Vilarroya
Affiliation:
Department of Psychiatry and Legal Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Catalonia, Spain
S. Carmona
Affiliation:
Department of Psychiatry and Legal Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Catalonia, Spain
M. Rovira
Affiliation:
CRC Corporació Sanitària, Barcelona, Catalonia, Spain
R. Torrubia
Affiliation:
Department of Psychiatry and Legal Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Catalonia, Spain
D. Mataix-Cols
Affiliation:
King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: X. Caseras, Ph.D., Institute of Psychiatry, Box PO69, De Crespigny Park, LondonSE5 8AF, UK. (Email: x.caseras@iop.kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Most neuroimaging studies of specific phobia have investigated the animal subtype. The blood-injection-injury (BII) subtype is characterized by a unique biphasic psychophysiological response, which could suggest a distinct neural substrate, but direct comparisons between phobia types are lacking.

Method

This study compared the neural responses during the presentation of phobia-specific stimuli in 12 BII phobics, 14 spider (SP) phobics and 14 healthy controls using functional magnetic resonance imaging (fMRI).

Results

Subjective ratings showed that the experimental paradigm produced the desired symptom-specific effects. As in many previous studies, when viewing spider-related stimuli, SP phobics showed increased activation in dorsal anterior cingulate and anterior insula, compared to BII phobics and healthy controls. However, when viewing images of blood-injection-injuries, participants with BII phobia mainly showed increased activation in the thalamus and visual/attention areas (occipito-temporo-parietal cortex), compared with the other two groups. The degree of provoked anxiety and disgust by phobia-relevant images was strongly associated with activation in several common regions across the two phobia groups (thalamus, cerebellum, occipito-temporal regions) but only correlated with activation in the dorsal anterior cingulate gyrus and the anterior insula in the SP phobics.

Conclusions

These results suggest partially distinct neurobiological substrates of animal and BII phobias and support their current classification as two distinct subtypes in the DSM-IV-TR. Further research is needed to better understand the precise neurobiological mechanisms in BII phobia and particularly the fainting response.

Keywords

AnxietyfearfMRIspecific phobia
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 1 , January 2010 , pp. 125 - 134
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Brammer, M, Bullmore, ET, Simmons, A, Williams, SCR, Grasby, PM, Howard, RJ, Woodruff, PWR, Rabe-Hesketh, S (1997). Generic brain activation mapping in functional magnetic resonance imaging: a nonparametric approach. Magnetic Resonance Imaging 15, 763–770.CrossRefGoogle ScholarPubMed
Bullmore, ET, Brammer, M, Rabe-Hesketh, S, Curtis, V, Morris, R, Williams, SCR, Sharma, T, McGuire, PK (1999 a). Methods for the diagnosis and treatment of stimulus correlated motion in generic brain activation studies using fMRI. Human Brain Mapping 7, 38–48.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Bullmore, ET, Long, C, Suckling, J, Fadili, J, Calvert, GA, Zelaya, F, Carpenter, TA, Brammer, MJ (2001). Coloured noise and computational inference in neurophysiological (fMRI) time series analysis: resampling methods in time and wavelet domains. Human Brain Mapping 12, 61–78.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Bullmore, ET, Suckling, J, Overmeyer, S, Rabe-Hesketh, S, Taylor, E, Brammer, MJ (1999 b). Global, voxel and cluster tests, by theory and permutation, for a difference between two groups of structural MR images of the brain. IEEE Transactions on Medical Imaging 18, 32–42.Google Scholar
Dilger, S, Straube, T, Mentzel, HJ, Fitzek, C, Reichenbach, JR, Hecht, H, Krieschel, S, Gutberlet, I, Miltner, WHR (2003). Brain activation to phobia-related pictures in spider phobic humans: an event-related functional magnetic resonance imaging study. Neuroscience Letters 348, 29–32.CrossRefGoogle ScholarPubMed
Etkin, A, Wager, TD (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry 164, 1476–1488.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-I/P, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute: New York, NY.Google Scholar
Fredrikson, M, Fischer, H, Wik, G (1997). Cerebral blood flow during anxiety provocation. Journal of Clinical Psychiatry 58 (Suppl. 16), 16–21.Google ScholarPubMed
Fredrikson, M, Wik, G, Annas, P, Ericson, K, Stone-Elander, S (1995). Functional neuroanatomy of visually elicited simple phobic fear: additional data and theoretical analysis. Psychophysiology 32, 43–48.CrossRefGoogle ScholarPubMed
Friman, O, Borga, M, Lundberg, P, Knutsson, H (2003). Adaptive analysis of fMRI data. Neuroimage 19, 837–845.Google Scholar
Graham, DT, Kabler, JD, Lunsford, L (1961). Vasovagal fainting: diphasic response. Psychosomatic Medicine 23, 493–507.Google Scholar
Goossens, L, Schruers, K, Peeters, R, Griez, E, Sunaert, S (2007 a). Visual presentation of phobic stimuli: amygdala activation via an extrageniculostriate pathway? Psychiatry Research 155, 113–120.Google Scholar
Goossens, L, Sunaert, S, Peeters, R, Griez, EJL, Schruers, KRJ (2007 b). Amygdala hyperfunction in phobic fear normalizes after exposure. Biological Psychiatry 62, 1119–1125.Google Scholar
Hermann, A, Schäfer, A, Walter, B, Stark, R, Vaitl, D, Schienle, A (2007). Diminished medial prefrontal cortex activity in blood-injection-injury phobia. Biological Psychology 75, 124–130.Google Scholar
Kleinknecht, RA, Thorndike, RM (1990). The Mutilation Questionnaire as a predictor of blood/injury fear and fainting. Behaviour Research and Therapy 28, 429–437.Google Scholar
Kupfer, DJ, First, MB, Regier, DA, eds (2002). A Research Agenda for DSM-V. American Psychiatric Association: Washington, DC.Google Scholar
LeDoux, J (2003). The emotional brain, fear, and the amygdala. Cellular and Molecular Neurobiology 23, 727–738.CrossRefGoogle ScholarPubMed
Paulus, MP, Stein, MB (2006). An insular view of anxiety. Biological Psychiatry 60, 383–387.CrossRefGoogle ScholarPubMed
Rauch, SL, Savage, CR, Alpert, NM, Miguel, EC, Baer, L, Breiter, HC, Fischman, AJ, Manzo, PA, Moretti, C, Jenike, MA (1995). A positron emission tomographic study of simple phobic symptom provocation. Archives of General Psychiatry 52, 20–28.Google Scholar
Schienle, A, Schäfer, A, Stark, R, Walter, B, Kirsch, P, Vailt, D (2003). Disgust processing in phobia of blood-injection-injury. An fMRI study. Journal of Psychophysiology 17, 87–93.CrossRefGoogle Scholar
Straube, T, Glauer, M, Dilger, S, Mentzel, HJ, Miltner, WHR (2006 a). Effects of cognitive-behavioral therapy on brain activation in specific phobia. Neuroimage 29, 125–135.CrossRefGoogle ScholarPubMed
Straube, T, Mentzel, HJ, Miltner, WHR (2006 b). Neural mechanisms of automatic and direct processing of phobogenic stimuli in specific phobia. Biological Psychiatry 59, 162–170.Google Scholar
Szymanski, J, O'Donohue, W (1995). Fear of Spiders Questionnaire. Journal of Behaviour Therapy and Experimental Psychiatry 26, 31–34.Google Scholar
Thirion, B, Pinel, P, Meriaux, S, Roche, A, Dehaene, S, Poline, JB (2007). Analysis of a large fMRI cohort: statistical and methodological issues for group analysis. Neuroimage 35, 105–120.CrossRefGoogle Scholar
Thyer, BA, Himle, J, Curtis, GC (1985). Blood-injury-illness phobia: a review. Journal of Clinical Psychology 41, 451–459.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Supplementary material: File

Caseras supplementary material

Tables.doc

Download Caseras supplementary material(File)
File 50.7 KB