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date: 14 August 2020

Abstract and Keywords

High trait anxiety and its neural substrate (the behavioral inhibition system [BIS]) are linked frequently to internalizing disorders. The authors propose that low BIS activity and reactivity (including reduced arousal and reduced attention) contribute to externalizing disorders. They argue that the BIS contributes to externalizing disorders largely through its prefrontal components, with more indirect effects on hippocampus and other subcortical components. BIS contributes to attention-deficit/hyperactivity disorder (ADHD) and similar symptoms in phenylketonuria (PKU) largely via its prefrontal components; conduct disorder through prefrontal and temporal components; and psychopathy through prefrontal, temporal, and amygdalar components. Furthermore, neurological damage to brain regions involved in more than one externalizing disorder underlie comorbidity among them. The authors propose that frontal and subcortical BIS dysfunction acts synergistically with other dysfunctional neural systems to generate externalizing disorders, and the variation in patterns of neural dysfunction accounts for phenotypic differences across externalizing disorders and their subtypes.

Keywords: behavioral inhibition system, attention-deficit/hyperactivity disorder, conduct disorder, psychopathy, externalizing disorders, anxiety

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