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Children’s obsessive compulsive symptoms and fear-potentiated startle responses

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Highlights

  • We examine emotional correlates of OC symptoms in children.

  • We examine startle magnitude and subjective report of negative emotion in standardized threat paradigm.

  • OC symptoms are positively associated with greater startle magnitude during the baseline startle assessment as well as the safe condition, lower startle magnitude during the threat paradigm, and more self-reported negative emotion following the startle paradigm.

  • Findings have implications for the hypothesis that OCD is associated with difficulty distinguishing between threat and safety, or insensitivity to context.

Abstract

Although clinical observations suggest that youth with obsessive compulsive disorder (OCD) are unable to down-regulate physiological fear responses in innocuous situations, to date no studies have directly addressed this question. In this report we lay the groundwork for future investigation of the emotion regulation processes of youth with obsessive compulsive (OC) symptoms. Using a non-clinical community sample of school-aged children, we evaluated the association between parent-reported child OC symptoms and children’s startle responses to experimental conditions with differing levels of threat. Children with higher OC symptoms evidenced signs of context insensitivity in their startle response and greater subjective distress. Specifically, greater OC symptoms were associated with higher startle magnitude during baseline and safe conditions, but lower startle magnitude during threat. Our findings have important implications for the conceptualization and assessment of emotion regulation difficulties among children displaying OC symptoms.

Introduction

Obsessive Compulsive Disorder (OCD) is characterized by a broad set of cognitions and behaviors leading to significant impairment and distress (American Psychiatric Association [APA], 2013). OCD affects 1–2% of children and adolescents (Chabane et al., 2005, Zohar, 1999), is associated with wide-ranging impairments (Piacentini, Bergman, Keller, & McCracken, 2003), and when left untreated often persists into adulthood (Micali et al., 2010). Obsessions are distressing repetitive thoughts and images; compulsions are repetitive behaviors or mental activities used to reduce the distress caused by the obsessions (American Psychiatric Association, 2013). The most commonly reported obsessions in children are intrusive thoughts about contamination or violent images, whereas the most commonly reported compulsions by children include ritualistic washing and checking, as well as repeating, counting, ordering, and hoarding (Carter and Pollock, 2000, Libby et al., 2004, Riddle et al., 1990).

Section snippets

Emotion regulation and OCD

Consistent with a developmental psychopathology framework (e.g., Cicchetti & Rogosch, 2002), examining risk for the development of clinically significant problems such as OCD is crucial for understanding developmental pathways for these problems. This perspective highlights the importance of studying community samples of youth in order to understand pathways to typical and pathological development, as well as to identify risk factors (Grados, Labuda, Riddle, & Walkup, 1997).

Emotion regulation,

Hypervigilant threat detection in children with OC or anxiety symptoms

Researchers have discussed the central role that hypervigilance towards threat plays in creating and maintaining OCD symptoms. Phenotypically, the symptoms appear inherently focused on threat-detection processes—for instance, obsessions usually pertain to threat (contamination, injury, social exclusion), whereas compulsions are aimed at removing the threat (Borelli et al., 2010, Boyer and Liénard, 2006). Only recently, however, have researchers explored the association between OCD and threat

Measuring emotional reactions to threat: the startle paradigm

The fear-potentiated startle reflex is a response to a surprising or aversive stimulus delivered through auditory, tactile, and visual media measured using the eye blink reflex (Grillon, 2002). The fear-potentiated startle paradigm allows for the comparison of startle response across conditions, affording an assessment of differences in emotion regulation. The paradigm enables measurement of startle response during conditions of baseline, threat, and safety. Because the fear-potentiated startle

The present study

We examine the association between children’s parent-reported OC symptoms and their emotion regulation in response to simulated threat using a potentiated startle paradigm. We focus on middle childhood (8–12 year olds) because it is a relatively understudied age range with respect to OC-related pathology and because building developmental models of the disorder requires understanding correlates of its symptoms across developmental phases (Farrell & Barrett, 2006). Further, conducting these

Participants

Eighty-one 8–12-year-old boys (56%) and girls (Mage=9.95, SDage=1.55) were recruited from an urban community through flyers and Craigslist internet postings. Children with a diagnosis of autism spectrum disorder or mental retardation were not permitted to participate, and children and parents needed to speak and read English in order to participate. Approval from the Human Investigation Committee was obtained for the protocol prior to beginning data collection. Children were primarily Caucasian

Results

Table 1 presents descriptive statistics for all variables by child gender. Parents of boys reported that their children had more GAD symptoms, t=2.04, p=0.04. Bivariate correlations revealed that younger child age was associated with greater child-reported temperamental fear and startle magnitude during threat (see Table 2). Child OC symptoms were positively associated with startle magnitude during the safe condition. Onset of startle peak was faster in the threat as compared to the safe

Discussion

Despite discussion in the literature about an association between OC symptoms and emotion dysregulation, little empirical work has examined this relationship. Even fewer studies have utilized methodologies employing multiple modes of assessing emotional response (e.g., physiological, subjective). Here we tested whether school-aged children’s OC symptoms would be associated with dysregulated negative emotion in response to a standardized threat paradigm.

The results confirmed our hypotheses.

Conclusions

In sum, our findings provide preliminary support for clinical observations that youth with OC symptoms have difficulty regulating their emotional reactions in response to safety cues. Future work examining these questions in patient samples and using longitudinal designs will be well-positioned to speak to the clinical utility of this perspective.

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