Attention bias to threat faces in severe mood dysregulation

Abstract

Background: We used a dot-probe paradigm to examine attention bias toward threat (i.e., angry) and happy face stimuli in severe mood dysregulation (SMD) versus healthy comparison (HC) youth. The tendency to allocate attention to threat is well established in anxiety and other disorders of negative affect. SMD is characterized by the negative affect of irritability, and longitudinal studies suggest childhood irritability predicts adult anxiety and depression. Therefore, it is important to study pathophysiologic connections between irritability and anxiety disorders.

Methods: SMD patients (N = 74) and HC youth (N = 42) completed a visual probe paradigm to assess attention bias to emotional faces. Diagnostic interviews were conducted and measures of irritability and anxiety were obtained in patients.

Results: SMD youth differed from HC youth in having a bias toward threatening faces (P < .01). Threat bias was positively correlated with the severity of the SMD syndrome and depressive symptoms; degree of threat bias did not differ between SMD youth with and without co-occurring anxiety disorders or depression. SMD and HC youth did not differ in bias toward or away from happy faces.

Conclusions: SMD youth demonstrate an attention bias toward threat, with greater threat bias associated with higher levels of SMD symptom severity. Our findings suggest that irritability may share a pathophysiological link with anxiety and depressive disorders. This finding suggests the value of exploring further whether attention bias modification treatments that are effective for anxiety are also helpful in the treatment of irritability.

Keywords: anxiety; biological markers; child and adolescent; cognition; mood disorders.

Conflict of interest statement

Disclosures: Drs. Hommer, Brotman, Leibenluft, Pine, Mogg and Bradley, and Ms. Meyer and Ms. Connolly report no conflicts of interest or outside financial support. Drs. Mogg and Bradley have acted as consultants for GSK for work unrelated to this project; they report no conflicts of interest.

Dr. Stoddard reports stock holdings in Pfizer Inc.

© 2013 Wiley Periodicals, Inc.

Figures

Figure 1

a. SMD Youth Show Attention Bias Toward Threat. Median (IQR) threat bias scores were 8.5 (27.6) ms for SMD (n=74) and −1.5 (26.3) ms for HC (n = 42). Log-transformed threat bias differed between SMD and HC [t(114)=2.73, p=0.007]. SMD youth had a bias toward threatening faces. Bars depict median threat bias scores with interquartile range and reflect original, rather than log-transformed, data. b. Threat Bias Does Not Differ Between SMD Youth With and Without Co-Occurring Anxiety Disorder. Median (IQR) threat bias scores were 8.4 (30.9) ms for SMD+ANX (n = 47), 12.8 (29.3) ms for SMD-ANX (n = 27), and −1.5 (26.3) for HC (n = 42). Log-transformed threat bias differed among the three groups [F(2,113)=3.73, p=0.03]. Bars depict median threat bias scores with interquartile range and reflect original, rather than log-transformed, data.