Abstract
Irritability and anxiety frequently co-occur in pediatric populations. Studies separately looking at the neural correlates of these symptoms have identified engagement of similar neural systems - particularly those implicated in emotional processing. Both irritability and anxiety can be considered negative valence emotional states that might relate to emotion dysregulation. However, previous work has not examined the neural responding during the performance of an emotion regulation task as a function of interaction between irritability and anxiety simultaneously. This fMRI study involved 155 participants (90 with significant psychopathologies and 92 male) who performed the Affective Stroop Task, designed to engage emotion regulation as a function of task demands. The Affective Reactivity Index (ARI) was used to index irritability and the Screen for Child Anxiety Related Emotional Disorders (SCARED) was used to index anxiety. Levels of irritability, but not anxiety, was positively correlated with responses to visual images within the right rostro-medial prefrontal cortex and left anterior cingulate cortex during view trials. The second region of ventral anterior cingulate cortex showed a condition-by-emotion-by-ARI score-by-SCARED score interaction. Specifically, anxiety level was significantly correlated with a decreased differential BOLD response to negative relative to neutral view trials but only in the presence of relatively high irritability. Atypical maintenance of emotional stimuli within the rostro-medial prefrontal cortex may exacerbate the difficulties faced by adolescents with irritability. Moreover, increased anxiety combined with significant irritability may disrupt an automatic emotional conflict-based form of emotion regulation that is particularly associated with the ventral anterior cingulate cortex.
Highlights
Irritability is defined as an ‘increased propensity to exhibit anger relative to one’s peers’ (Leibenluft, 2017, p.277) and a ‘relative dispositional tendency to respond with anger to blocked goal attainment, and includes both mood and behavioral dysregulation’ (Camacho, Karim, & Perlman, 2019; Fishburn et al, 2019, p.69; Stringaris et al, 2012; Wakschlag et al, 2018)
There was a significant positive correlation between: (i) the Affective Reactivity Index (ARI) and Screen for Child Anxiety Related Emotional Disorders (SCARED) scores (r = 0.429, p < 0.001); (ii) both and IQ (r = −0.228 and 0.218, p = 0.004 and p = 0.006, respectively); (iii) SCARED scores and sex [r = −0.265, p = 0.001; SCARED scores were higher in females but not ARI scores and sex (r = 0.003, p = 0.973)]; and (iv) neither and age (r = 0.142 and −0.014, p = 0.078 and p = 0.865, respectively)
Like Kircanski et al (2018) we found that increasing irritability was associated with increased BOLD responses within Rostro-medial prefrontal cortex (rmPFC)/ventromedial prefrontal cortex (vmPFC)
Summary
Irritability is defined as an ‘increased propensity to exhibit anger relative to one’s peers’ (Leibenluft, 2017, p.277) and a ‘relative dispositional tendency to respond with anger to blocked goal attainment, and includes both mood (trait) and behavioral (reactive state) dysregulation’ (Camacho, Karim, & Perlman, 2019; Fishburn et al, 2019, p.69; Stringaris et al, 2012; Wakschlag et al, 2018) It is the hallmark symptom of the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) criteria for Disruptive Mood Dysregulation Disorder (DMDD) (American Psychiatric Association, 2013). Studies separately looking at the neural correlates of these symptoms have identified engagement of similar neural systems – those implicated in emotional processing Both irritability and anxiety can be considered negative valence emotional states that might relate to emotion dysregulation. Increased anxiety combined with significant irritability may disrupt an automatic emotional conflict-based form of emotion regulation that is associated with the ventral anterior cingulate cortex
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