Neural correlates of an attentional bias to health-threatening stimuli in individuals with pathological health anxiety

Corticolimbic structural alterations linked to health status and trait anxiety in functional neurological disorder

“…As previously noted, fMRI studies have consistently identified increased amygdalar activity during affective processing in FND,16 22 23 25 and heightened amygdalar activity has been recently linked to negative attentional bias in individuals with pathological health anxiety 51. In healthy subjects, individual differences in trait anxiety mediate amygdalar activity during unconscious emotional processing,52 and trait-level differences in fearfulness,53 anxiety54 and negative affect55 correlate positively with amygdalar volumes.…”

“…Patients with functional movement disorders also show exaggerated startle responses to both positively and negatively valenced stimuli, supporting a negative attentional bias in this population 69. Nocebo hyperalgesia has been linked to decreased opioid and dopaminergic activity in the insula and periaqueductal grey,70 and negative attentional bias has been linked to increased amygdalar activity in somatic symptom disorders 51. Future studies investigating health status-related biomarkers in FND should collect both self-reported and objective markers of physical and affective symptoms to further clarify the relationships identified in this study.…”

Scary symptoms? Functional magnetic resonance imaging evidence for symptom interpretation bias in pathological health anxiety

“…Stimuli were presented by Visu-aStim video goggles (Resonance Technology Inc, Northridge, CA, USA). Prior to the IAT, participants completed an emotional Stroop task [38].…”

“…Hence, the investigation of patients with PHA is pending. So far, only two fMRI studies included participants with PHA [38,39]. Both studies applied an emotional Stroop task.…”

“…Although the results indicate that patients with PHA show increased cognitive elaboration for all disorder-related threats, the PHA group was considered as a clinical control group and no PHAspecific word material was used. Mier et al [38] used PHAspecific word materials. The PHA group showed amygdala and rostral anterior cingulate hyperactivation in comparison to patients with depression and healthy controls, suggesting both an enhanced emotional reaction and a disability to cognitively disengage from potential health threats.…”