M M E Riem1, M J van Hoof2, A S Garrett3, S A R B Rombouts4, N J A van der Wee5, M H van IJzendoorn6, R R J M Vermeiren7. 1. Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands. 2. Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute of Brain and Cognition (LIBC), Leiden University, the Netherlands. Electronic address: M.J.van_Hoof@lumc.nl. 3. Department of Psychiatry, Texas University at San Antonio, San Antonio, USA. 4. Leiden Institute of Brain and Cognition (LIBC), Leiden University, the Netherlands; Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Leiden University, Institute of Psychology, Leiden, the Netherlands. 5. Leiden Institute of Brain and Cognition (LIBC), Leiden University, the Netherlands; Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, the Netherlands. 6. Department of Psychology, Education and Child studies, Erasmus University, Rotterdam, the Netherlands; Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands; Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, United Kingdom. 7. Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute of Brain and Cognition (LIBC), Leiden University, the Netherlands; Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
Abstract
BACKGROUND: A dimensional approach of psychopathology focuses on features and risk factors that are shared across diagnoses. In support for this dimensional approach, studies point to a general psychopathology factor (GPF) associated with risk for multiple psychiatric disorders. It is, however, unknown how GPF relates to white matter integrity (WMI). In the current diffusion tensor imaging (DTI) study, we examined how GPF relates to abnormalities in a skeleton representation of white matter tracts, taking into account a trans-diagnostic risk factor: unresolved-disorganized attachment (Ud) resulting from loss or trauma. METHODS: Unique associations between GPF, Ud, and WMI were examined in a combined sample of adolescents (N = 63) with childhood sexual abuse-related posttraumatic stress disorder (N = 18), anxiety and depressive disorders (N = 26) and without psychiatric disorder (N = 19). WMI was measured using DTI. Ud was measured using the Adult Attachment Interview. We controlled for puberty stage, gender, age, and IQ. RESULTS: Controlling for GPF, Ud was associated with reduced fractional anisotropy (FA) in the splenium and inferior fronto-occipital fasciculus (IFOF). Controlling for Ud, GPF was associated with reduced FA in the genu and body of the corpus callosum. CONCLUSIONS: Decreasing WMI in the genu and body with increasing psychopathology across diagnoses suggests demyelinization in these areas and may underlie comorbidity and presence of symptoms that transcend psychopathological diagnoses. In contrast, trauma-related WMI reductions in the splenium and IFOF may account for heterogeneity within diagnostic categories as a function of childhood trauma. These findings support the importance of a dimensional approach in addition to traditional diagnostic classifications in clinical research and practice.
BACKGROUND: A dimensional approach of psychopathology focuses on features and risk factors that are shared across diagnoses. In support for this dimensional approach, studies point to a general psychopathology factor (GPF) associated with risk for multiple psychiatric disorders. It is, however, unknown how GPF relates to white matter integrity (WMI). In the current diffusion tensor imaging (DTI) study, we examined how GPF relates to abnormalities in a skeleton representation of white matter tracts, taking into account a trans-diagnostic risk factor: unresolved-disorganized attachment (Ud) resulting from loss or trauma. METHODS: Unique associations between GPF, Ud, and WMI were examined in a combined sample of adolescents (N = 63) with childhood sexual abuse-related posttraumatic stress disorder (N = 18), anxiety and depressive disorders (N = 26) and without psychiatric disorder (N = 19). WMI was measured using DTI. Ud was measured using the Adult Attachment Interview. We controlled for puberty stage, gender, age, and IQ. RESULTS: Controlling for GPF, Ud was associated with reduced fractional anisotropy (FA) in the splenium and inferior fronto-occipital fasciculus (IFOF). Controlling for Ud, GPF was associated with reduced FA in the genu and body of the corpus callosum. CONCLUSIONS: Decreasing WMI in the genu and body with increasing psychopathology across diagnoses suggests demyelinization in these areas and may underlie comorbidity and presence of symptoms that transcend psychopathological diagnoses. In contrast, trauma-related WMI reductions in the splenium and IFOF may account for heterogeneity within diagnostic categories as a function of childhood trauma. These findings support the importance of a dimensional approach in addition to traditional diagnostic classifications in clinical research and practice.
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