A Latent Profile Analysis of Age of Onset in Pathological Skin Picking

Background Pathological Skin Picking (PSP) may begin at any age, but the most common age of onset is during adolescence. Age of onset is a potentially useful clinical marker to delineate subtypes of psychiatric disorders. The present study sought to examine empirically defined age of onset groups in adults with PSP and assess whether groups differed on clinical characteristics. Method Participants were 701 adult respondents to an internet survey, who endorsed recurrent skin picking with tissue damage and impairment. Latent profile analysis (LPA) was conducted to identify subtypes of PSP based on age of onset. Then subgroups were compared on demographic and clinical characteristics. Results The best fitting LPA model was a two-class solution comprised of a large group with average age of onset in adolescence (n = 650; 92.9% of the sample; Mean age of onset = 13.6 years) and a small group with average onset in middle adulthood (n = 50; 7.1% of the sample; Mean age of onset = 42.8 years). Relative to the early onset group, the late onset group reported significantly less focused picking, less skin picking-related impairment, lower rates of co-occurring body-focused repetitive behaviors, and trends towards reduced family history of PSP. Individuals in the late onset group also reported increased rates of comorbid depression, anxiety and posttraumatic stress disorder, and were more likely to report that initial picking onset seemed related to or followed depression/anxiety and physical illness. Conclusion Findings suggest the presence of two distinct PSP age of onset groups: (1) an early onset group with average onset in adolescence, clinical characteristics suggestive of greater picking-related burden and familiality, and a profile more representative of the general PSP population; and (2) a late onset group with average onset in middle adulthood, increased co-occurring affective and trauma conditions, and initial onset associated with or following other mental health and physical problems. Future replication is needed to assess the validity and clinical utility of these subgroups

Irritability in youth: A critical integrative review

Irritability, defined as proneness to anger that may reach an impairing extent, is common in youth. There has been a recent upsurge in relevant research. We combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions to address research gaps. Clinicians and researchers should assess irritability routinely; specific assessment tools are now available. Informant effects are prominent, stable, and vary by age and gender. The prevalence of irritability is particularly high in attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Irritability trajectories have been identified that are differentially associated with clinical outcomes; some begin early in life. Youth irritability is associated with increased risk later in life for anxiety, depression, behavioral problems, and suicidality. Irritability is moderately heritable and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for constructs related to irritability, but its efficacy in irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeted to frustration exposure). Associations between irritability and suicidality and the impact of cultural context are important, under-researched topics. Large, diverse, longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, thus affording important translational opportunities

Cognitive aspects of depression

Depression is a prevalent and impairing psychiatric disorder that affects how we feel and how we think about ourselves and the world around us. Cognitive theories of depression have long posited that various thought processes are involved in the development, maintenance, and recurrence of depressive episodes. Contemporary research has utilized experimental procedures to examine cognitive processes in depressed individuals as well as the nature of the relation of these processes to the emotion dysregulation that is central to the disorder. For example, investigators have assessed the ways in which depression alters aspects of information processing, including attention and perception, interpretation, and memory processes; this research has generated relatively consistent findings. In addition, researchers have attempted to identify and elucidate the cognitive mechanisms that may link these biases in information processing to emotion dysregulation in depression. These mechanisms include inhibitory processes and deficits in working memory, ruminative responses to negative mood states, and the inability to use positive and rewarding stimuli to regulate negative mood. Results of these investigations converge on the formulation that depression is associated with increased elaboration of negative information, difficulties in cognitive control when processing this information, and difficulties disengaging from this information. Research examining cognitive aspects of depression not only enhances our understanding of this common and costly disorder, but also has implications for the treatment of depression and for future investigations of the biological foundations of this disorder

Attention to Emotional Information in Social Anxiety Disorder With and Without Co-Occurring Depression

Abstract Despite the high comorbidity of Social Anxiety Disorder (SAD) and Major Depressive Disorder (MDD), we know little about how persons with co-occurring SAD-MDD compare to their counterparts with pure disorders. In the present study we investigated attention to facial emotional stimuli in adult women with SAD only (n = 18), MDD only (n = 24), co-occurring SAD-MDD (n = 24), and healthy controls (CTL; n = 33). Participants were exposed to angry, sad, neutral, and happy faces for 200 and 1,000 ms as cues in a Posner attention task. We examined patterns of attentional engagement, disengagement, and vigilance-avoidance as a function of cue valence. Across the attentional indices, both the SAD and SAD-MDD groups differed most consistently from the MDD and CTL groups: they exhibited differential patterns of attention to angry, sad, and happy faces, including relatively greater vigilance-avoidance for angry faces. There was little evidence for any MDD-associated biases in attention. Findings suggest that the attentional processing of emotional information in SAD generally overrides the potential influence of co-occurring MDD. Implications for the understanding and treatment of co-occurring SAD-MDD are discussed

Introduction to ABCT’s 50th Anniversary Special Series of Commentaries by Selected Past Presidents of the Association

Welcome to a special series in Cognitive and Behavioral Practice, brought to you by the Committee for the 50th Anniversary of the Association for Behavioral and Cognitive Therapies (ABCT). Comprised of commentary articles, a subset of luminary past presidents present their views of the history of cognitive and behavioral therapies and their ideas on where the field will go next, using the backdrop of their own careers as a point of departure. •A subset of luminary past presidents of ABCT reflect on the first 50 years of the association.•Topics include: where the field should go, the need for increased dissemination efforts.•Many articles emphasize flexibility to meet future challenges and the ever changing field of mental health care delivery

Ecological Momentary Assessment of Youth Anxiety: Evaluation of Psychometrics for use in Clinical Trials dataset

A comprehensive dataset for the data included in the manuscript entitled “Ecological Momentary Assessment of Youth Anxiety: Evaluation of Psychometrics for Use in Clinical Trials.” (https://www.liebertpub.com/doi/full/10.1089/cap.2023.0025). This dataset contains demographic variables, clinical symptoms reported by self, parent, and clinicians, and youth ecological momentary assessment ratings of affective symptoms. Given not all participants consented to share their data, exact replication of analyses is not possible

Sympathetic nervous system dominance during stress recovery mediates associations between stress sensitivity and social anxiety symptoms in female adolescents

Social anxiety disorder (SAD) is one of the most common anxiety disorders diagnosed during adolescence. SAD is associated with both psychological stress reactivity and heightened physiological arousal; however, no study has systematically examined which aspects of autonomic nervous system function mediate the likely links between stress sensitivity and symptoms of SAD in adolescents. In this study, we assessed 163 adolescents (90 females; 12.29±1.39 years) with respect to severity of life stress and social anxiety symptoms and measured respiratory sinus arrhythmia (RSA) and skin conductance levels (SCL) during a well-validated psychosocial stress paradigm composed of baseline, reactivity, and recovery periods. We operationalized stress sensitivity as the residual variance in subjective stress severity after accounting for objective stress severity and changes in autonomic regulation (relative to baseline) during reactivity and recovery using standardized change scores in RSA and SCL. We found that in females only, stress sensitivity and symptoms of SAD were significantly correlated with each other (p<0.001) and with autonomic regulation during both reactivity and recovery (all ps<0.04). Further, sympathetic nervous system dominance during recovery specifically mediated associations between stress sensitivity and symptoms of SAD (B=1.06, 95% CI: 0.02–2.64). In contrast, in males, stress sensitivity, autonomic regulation during reactivity or recovery, and symptoms of SAD were not significantly associated (all ps>0.1). We interpret these results in the context of psychobiological models of SAD and discuss implications for interventions targeting autonomic processes in this disorder

Empirically Derived Patterns of Psychiatric Symptoms in Youth: A Latent Profile Analysis

BACKGROUND: By conceptualizing domains of behavior transdiagnostically, the National Institute of Mental Health Research Domain Criteria (NIMH RDoC) initiative facilitates new ways of studying psychiatric symptoms. In this study, latent profile analysis (LPA) was used to empirically derive classes or patterns of psychiatric symptoms in youth that transect traditional nosologic boundaries. METHODS: Data were drawn from 509 children and adolescents (ages 7 to 18 years; mean age = 12.9 years; 54% male) who were evaluated in the NIMH Emotion and Development Branch and were heterogeneous with respect to presenting diagnoses and symptoms. Youth and/or their parents completed measures of several core symptom dimensions: irritability, anxiety, depression, and attention deficit hyperactivity disorder (ADHD). LPA was used to parse response patterns into distinct classes, based on the levels of, and interrelations among, scores on the different measures. RESULTS: Five classes emerged: low levels of symptomatology (52% of sample); anxiety and mild depressive symptoms (17%); parent-reported irritability and ADHD (16%); irritability and mixed comorbid symptoms (10%); and high levels of irritability, anxiety, depression, and ADHD (5%). Importantly, these latent classes cut across informants and the clinical conditions for which youth were initially evaluated. Further, the classes characterized by irritability exhibited the poorest overall functioning. LIMITATIONS: These data were cross-sectional. Examination of external validators, including neurobiological correlates and symptom course, is warranted. CONCLUSIONS: Results inform our understanding of the structure of psychiatric symptoms in youth and suggest new ways to operationalize psychopathology and examine it in relation to neurobiology