The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls
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.
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The neuroimaging aberrations map onto BII phobia symptoms and embody the cornerstones of the pathophysiological brain circuits involved in BII phobia genesis.
“Taken together it can be reasoned, that the neuroimaging aberrations stated above map, more or less, onto BII phobia symptoms and thus embody the cornerstones of the pathophysiological brain circuits involved in BII phobia genesis.”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [52]
The Discussion reports associations between provoked fear and disgust and activation in several brain regions, supporting a link between imaging findings and symptoms. But it explicitly says neuroimaging cannot establish the aetiology of mental disorders, so the claim that these findings identify circuits involved in BII phobia’s genesis goes beyond the source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFunctional neuroimaging studies have revealed dysfunction of the dorsolateral and ventromedial prefrontal cortex, the thalamus and insula, as well as the anterior cingulate and occipital cortex in BII phobia patients.
“Several functional neuroimaging studies have revealed dysfunction of the dorsolateral and ventromedial prefrontal cortex, the thalamus and insula, as well as the anterior cingulate and occipital cortex in BII phobia patients.”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [52]
The fMRI results and Comparisons between phobia types report altered responses in the thalamus, occipital regions, medial prefrontal cortex, anterior cingulate cortex and insula in BII phobia, depending on the comparator. The Discussion also reports reduced dorsal and ventral medial prefrontal activation in a previous BII study. The copy does not identify dorsolateral prefrontal dysfunction, and its findings for the anterior cingulate and insula are specifically differences relative to spider phobia, not a general finding of dysfunction in BII patients. (LLM, conf=0.84)
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- Authors
- Caseras, X., Giampietro, V., Lamas, A., Brammer, M., Vilarroya, O., Carmona, S., Rovira, M., Torrubia, R., & Mataix-Cols, D.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- King's College London (GB)
- Corresponding author
- Caseras, X.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2009-05-13
- Volume
- 40
- Issue
- 1
- Pages
- 125-134
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2075616173
- Cited by
- 69
- References
- 27
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 7 · 2022: 4 · 2021: 4 · 2020: 3 · 2018: 6 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 7
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- blood-injection-injury phobia, spider phobia, specific phobia, functional neuroanatomy, thalamus, dorsal anterior cingulate cortex, anterior insula, occipitotemporal cortex, disgust, anxiety, animal phobia
- MeSH terms
- Animals, Arousal, Blood, Brain, Brain Mapping, Cerebellum, Cerebral Cortex, Dominance, Cerebral, Fear, Frontal Lobe, Gyrus Cinguli, Humans, Injections, Magnetic Resonance Imaging, Occipital Lobe, Oxygen Consumption, Phobic Disorders, Spain, Spiders, Students, Temporal Lobe, Thalamus, Wounds and Injuries, Prefrontal Cortex
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