Elevated amygdala activity during reappraisal anticipation predicts anxiety in avoidant personality disorder

Abstract

Background Avoidant personality disorder is characterized by pervasive anxiety, fear of criticism, disapproval, and rejection, particularly in anticipation of exposure to social situations. An important but underexplored question concerns whether anxiety in avoidant patients is associated with an impaired ability to engage emotion regulatory strategies in anticipation of and during appraisal of negative social stimuli. Methods We examined the use of an adaptive emotion regulation strategy, cognitive reappraisal, in avoidant patients. In addition to assessing individual differences in state and trait anxiety levels, self-reported affect as well as measures of neural activity were compared between 17 avoidant patients and 21 healthy control participants both in anticipation of and during performance of a reappraisal task. Results Avoidant patients showed greater state and trait-related anxiety relative to healthy participants. In addition, relative to healthy participants, avoidant patients showed pronounced amygdala hyper-reactivity during reappraisal anticipation, and this hyper-reactivity effect was positively associated with increasing self-reported anxiety levels. Limitations Our finding of exaggerated amygdala activity during reappraisal anticipation could reflect anxiety about the impending need to reappraise, anxiety about the certainty of an upcoming negative image, or anxiety relating to anticipated scrutiny of task responses by the experimenters. While we believe that all of these possibilities are consistent with the phenomenology of avoidant personality disorder, future research may clarify this ambiguity. Conclusions These results suggest that amygdala reactivity in anticipation of receiving negative social information may represent a key component of the neural mechanisms underlying the heightened anxiety present in avoidant patients.

Brain structural anomalies in borderline and avoidant personality disorder patients and their associations with disorder-specific symptoms

“…Denny and colleagues (2015) found evidence for amygdala hyper-reactivity in AvPD patients relative to healthy controls when anticipating engaging in explicit emotion regulation via cognitive reappraisal, whereas Koenigsberg and colleagues (2014) did not find evidence of greater amygdala recruitment in AvPD patients relative to healthy controls when repeatedly viewing negative emotional pictures. However, structural differences in AvPD have remained unexplored.…”

“…hippocampus) and those that represent nodes of a network underlying the cognitive control of emotion, including medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC) (Krause-Utz et al, 2014; Ochsner et al, 2012; Schulze et al, 2016). The amygdala is a medial temporal lobe region consistently implicated in processing negative affect in BPD (Krause-Utz et al, 2014), AvPD (Denny et al, 2015), and many other psychiatric illnesses (Denny et al, 2009), as well as in HC given its importance in representing the threat value of a stimulus (LeDoux, 1996; Ochsner et al, 2012). Further, hippocampus, noted for its crucial role in episodic and autobiographical memory consolidation (Squire, 1992), has been shown to differentiate BPD patients from healthy controls in terms of structural volume (Schulze et al, 2016).…”

“…With regard to AvPD patients, to our knowledge there are only two published neuroimaging reports in the literature, both of which were functional neuroimaging studies (Denny et al, 2015; Koenigsberg et al, 2014). Denny and colleagues (2015) found evidence for amygdala hyper-reactivity in AvPD patients relative to healthy controls when anticipating engaging in explicit emotion regulation via cognitive reappraisal, whereas Koenigsberg and colleagues (2014) did not find evidence of greater amygdala recruitment in AvPD patients relative to healthy controls when repeatedly viewing negative emotional pictures.…”

Genetic and Neuroimaging Features of Personality Disorders: State of the Art

“…They also reported smaller ventral striatum volumes and greater cortical thickness in orbitofrontal cortex in their sample of cluster C personality disorders. Recently, a research group used fMRI to seek differences between avoidant personality disorder patients and healthy volunteers in reacting to and reappraising aversive social images [151]. They found that the patients with avoidant personality disorder presented heightened activity in the amygdala, particularly during the anticipation of reappraising negative images [151].…”

“…Recently, a research group used fMRI to seek differences between avoidant personality disorder patients and healthy volunteers in reacting to and reappraising aversive social images [151]. They found that the patients with avoidant personality disorder presented heightened activity in the amygdala, particularly during the anticipation of reappraising negative images [151]. Unfortunately, no neuroimaging studies have been conducted exclusively on paranoid personality disorder, although several organic brain injuries might contribute to paranoid symptoms [152] or traits such as jealousy [153].…”