Posttraumatic Obsessive-Compulsive Disorder: A three-factor model.

Wayne, M. Dinn, Catherine L. Harris, Richard C. Raynard

This paper presents a three-factor model of obsessive-compulsive idsorder (OCD) which posits that exposure to long-term traumatic stress generates an inordinate degree of anxiety during the psychological development of the premorbid OCD child.  In response to these conditions the child evolves a distinct cognitive style characterized by exaggeratedthreat appraisal and magical beliefs, and experiences alterations in brain metabolism.  An entire functional brain system (a basal ganglia-orbitofrontal circuit) enters into a state of enhanced responsiveness following exposure to protracted threat.  Over time the threshold for stimulation is dramatically lowered, resulting in a hypersensitivity to cues that signify potential harm.  Individuals adapt to this hypersensitivity through a variety of strategies, which constitute OCD.

Published in Psychiatry, Vol. 62, 1999. 

Adult Attention-Deficit/Hyperactivity Disorder:  Neuropsychological Correlates and Clinical Presentation

Wayne, M. Dinn, Nicole C. Robbins, Catherine L. Harris

In press and Brain and Cognition.

Neurocognitive function in antisocial personality disorder

Wayne M. Dinn and Catherine L. Harris

Recent neuroimaging studies and neuropsychological test findings support the contention that prefrontal dysfunction is associated with psychopathic personality traits and antisocial behavior. However, conflicting results have arisen regarding performance on measures of frontal executive function. We administered a neuropsychological test battery consisting of measures sensitive to frontal lobe dysfunction and a battery of personality questionnaires and clinical scales to antisocial personality disorder (APD) subjects presenting with prominent psychopathic personality features and matched control subjects. We also monitored subjectsÕ electrodermal activity during the presentation of emotionally-charged stimuli. APD subjects showed greater neuropsychological deficits on measures sensitive to orbitofrontal dysfunction in comparison to control participants. Moreover, APD subjects were electrodermally hyporesponsive to aversive stimuli relative to control group members. APD subjects did not demonstrate performance deficits on classical tests of frontal executive function. Participants also underwent clinical assessment. As expected, APD subjects were less conscientious, self-reproaching, guilt-prone, and socially anxious than matched controls. Moreover, scores indicate that APD subjects were more venturesome and uninhibited relative to controls. Contrary to expectation, APD subjects and community controls did not differ on a self-report measure of sensitivity to specific phobic situations.

Under review at Psychiatry Research.

Is there a continuum between normal and disordered groups?  Two studies:

Complex Partial Seizures and Borderline Personality Disorder

Wayne M. Dinn, Jonathan A. Marcinkiewicz, Catherine L. Harris, Richard C. Raynard

Borderline personality disorder (BPD) is a chronic, debilitating syndrome which encompasses a broad spectrum of cognitive, behavioral and neurophysiological abnormalities. Characteristic clinical features include intense and labile affect, hyperirritability, inappropriate anger, recurrent suicidal behavioral, marked impulsivity and behavioral dyscontrol, transient paranoid ideation, volatile interpersonal relationships, and a noncohesive sense of self. The clinical presentation of the borderline syndrome bears a striking resemblance to classical descriptions of the behavioral alterations associated with complex partial seizures (i.e., the temporal lobe personality). Investigators maintained that an interictal (between seizures) behavioral syndrome, generated by recurrent episodes of temporal lobe seizure activity, and distinguished by labile/explosive emotionality, represented a discrete neuropsychiatric entity. Researchers suggested that recurrent complex partial seizures directly induce alterations in the electrophysiology of limbic structures generating a sensory-limbic hyperconnection syndrome. This interictal behavioral syndrome is characterized by an intensification of affective responses, irritability, impulsivity, paroxysmal rage followed by self-recriminations and intense guilt, interpersonal viscosity, hypergraphia, episodic psychoses, anxiety, depression, and dissociative states.

While overlapping symptomatology does not necessarily imply a common etiology, several lines of evidence support the contention that the explosive emotionality and behavioral dyscontrol displayed by BPD patients may represent interictal phenomena. Neuropsychological testing has revealed a pattern of neurocognitive impairment among BPD subjects which supports the hypothesis that temporal lobe dysfunction contributes to the development and maintenance of borderline phenomena. The principal goals of this study are to: 1) determine the frequency of complex partial seizure (CPS)-like symptoms among borderline personality disorder (BPD) patients, in comparison to major depressive disorder, anxiety disorder, and normal control subjects; 2) examine the relationship between Limbic System Checklist-33 scores and performance on a neuropsychological measure sensitive to non-dominant temporal lobe dysfunction (i.e., the Rey-Osterrieth Complex Figure Test); and 3) document episodes of traumatic brain injury (TBI) among BPD patients and explore the relationship between TBI and the emergence of of BPD. This will permit determination of the temporal relation between TBI and the onset of borderline symptoms.

Presented at Eastern Psychological Association, 1999.

Orbitofrontal Dysfunction: A Neurobehavioral Continuum

Catherine L. Harris and Wayne M. Dinn

Orbitofrontal circuit dysfunction underlies a distinct behavioral continuum with specific clinical syndromes, obsessive-compulsive disorder (OCD) and psychopathy, representing extreme deviations in circuit activity. Our research explores the concept of a circuit-specific neurobehavioral continuum which encompasses both psychopathological states and nonclinical variations in personality. In experiment 1, standard personality scales were used to place 38 university students along our proposed personality continuum. Position on this continuum predicted performance on a neuropsychological test sensitive to orbitofrontal dysfunction and predicted the degree of autonomic arousal during the presentation of emotionally-charged stimuli. In experiment 2, we administered a more sophisticated protocol to a small clinical sample (OCD patients and antisocial personality disorder (APD) subjects) and nonclinical controls. Analysis of subjects performance on neuropsychological measures sensitive to orbitofrontal dysfunction revealed significant group differences. Both OCD patients and APD subjects exhibited performance deficits, in comparison to nonclinical controls, on three orbitofrontal measures. However, clinical subjects scored similarly to controls on measures of dorsolateral-frontal function. Moreover, variation in measures of OC/psychopathy-related personality traits among student and community samples strongly correlate with performance on tasks sensitive to orbitofrontal dysfunction.

Manuscript in preparation