Heterogeneity in Fear Processing across and within Anxiety, Eating, and Compulsive Disorders
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Background To assess within and across diagnosis variability we examined fear processing in healthy controls (HC) and three diagnostic groups that share symptoms of pathological anxiety: obsessive compulsive disorder (OCD); social anxiety disorder (SAD), and anorexia nervosa (AN).Methods Unmedicated adults (N=166) participated in a paradigm assessing associative fear acquisition, extinction, extinction recall, and fear renewal. Data were analyzed from two perspectives: comparison of each disorder to HC and exploratory latent class analysis (LCA) of the combined data.Results The diagnosis-based analyses indicated significantly increased fear renewal in OCD and trends toward decreased extinction recall in OCD and increased renewal in SAD. The LCA indicated four Response Types, none of which were congruent with the diagnostic categories. Most participants had a normative response (50%) or a moderate extinction recall deficit (30%). The two remaining groups (8% each) had more extreme responses: one showed complete failure of extinction recall; the other persistent arousal in expectation of, but prior to, actual conditioning (threat sensitivity).Limitations Due to small sample size (N=20) results for AN are regarded as preliminary.Conclusions Our diagnosis-based findings are consistent with previous data suggesting an association between pathological anxiety and difficulties maintaining fear extinction. The LCA reveal substantial within-diagnosis heterogeneity in fear processing and support inclusion of empirically driven approaches as a complement to standard analyses. This heterogeneity may also have implications for treatment, particularly cognitive behavioral therapy, which relies on strengthening extinction recall and requires patients to tolerate anxious expectation in order to engage with feared situations.
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Individuals with OCD have difficulty extinguishing learned fear responses.
“There is also evidence that individuals with OCD have difficulty extinguishing learned fear responses [37, 40–42]”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [42]
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- Authors
- Fyer, A. J., Schneier, F. R., Simpson, H. B., Choo, T. H., Tacopina, S., Kimeldorf, M. B., Steinglass, J. E., Wall, M., & Walsh, B. T.
- Affiliations
- Columbia University Irving Medical Center (US)
- New York State Psychiatric Institute (US)
- Corresponding author
- Fyer, Abby J.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 275
- Pages
- 329-338
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC7398449
- OpenAlex
- W3044296426
- Cited by
- 28
- References
- 51
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 3 · 2021: 5
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- fear processing, fear extinction, fear renewal, extinction recall, obsessive-compulsive disorder, social anxiety disorder, anorexia nervosa, latent class analysis, threat sensitivity, cognitive behavioral therapy, anxiety disorders
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Compulsive Personality Disorder, Extinction, Psychological, Fear, Humans
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