Enhanced error-related negativity (ERN) as a transdiagnostic risk marker of the anxiety and obsessive-compulsive spectrum.

Whenever humans commit an error, they are faced with potential harm on the one hand but on the other hand, they can also learn from an error and thus improve their upcoming behavior. Neuroscientific research often investigates neural correlates of error monitoring in humans via the event-related potential (ERP) called error-related negativity (ERN; Falkenstein et al., 1991; Gehring et al., 1993) peaking at approx. 50ms after erroneous responses. Another performance associated ERP is the correct-response negativity (CRN; Vidal et al., 2003; Vidal et al., 2000) occurring shortly after correct responses.

Previous studies conceive error monitoring a transdiagnostic risk marker along the lines of internalizing and externalizing mental disorders (Pasion & Barbosa, 2019): ERN amplitudes are enhanced for anxiety (Moser et al., 2013; Saunders & Inzlicht, 2020) and obsessive-compulsive disorders (Riesel, 2019), while they are attenuated for substance use disorder (Luijten et al., 2014) and attention deficit hyperactivity disorder (Geburek et al., 2013; but see Kaiser et al., 2020). However, studies with subclinical levels of anxiety report less consistently enhanced ERN amplitudes (Härpfer, Carsten, Spychalski, et al., 2020; Saunders & Inzlicht, 2020; Seow et al., 2020). Within the anxiety and obsessive-compulsive spectrum, ERN amplitudes are elevated in generalized anxiety disorder (GAD; Meyer et al., 2012; Weinberg et al., 2010), social anxiety disorder (SAD; Endrass et al., 2014), health anxiety (Riesel et al., 2017), and obsessive-compulsive disorder (OCD; Riesel, 2019) but not in post-traumatic stress disorder (PTSD; Gorka et al., 2016; Rabinak et al., 2013) and specific phobia (Hajcak et al., 2003). This inconsistency might stem from differences in latent symptom dimension profiles of anxiety and obsessive-compulsive disorders (Cox et al., 2010; Krueger, 1999). Specifically, overactive error monitoring seems to be driven by anxious apprehension—as opposed to anxious arousal—which is supported by previous studies (Hajcak et al., 2003; Lin et al., 2015; Moran et al., 2012; Moser et al., 2012; but see Härpfer, Carsten, Spychalski, et al., 2020) as well as meta-analyses (Moser et al., 2013; Saunders & Inzlicht, 2020). These transdiagnostic findings might translate into diagnostic categories, whereby disorders characterized by anxious apprehension were more closely linked to ERN variations (e.g., GAD, SAD, and OCD compared to PTSD and specific phobia).

Consequently, a dimensional and transdiagnostic conceptualization of the anxiety and obsessive-compulsive spectrum might better elucidate the anxiety dimensions (i.e., anxious apprehension and anxious arousal) that are associated with overactive error monitoring while broad disorder categories are likely to overshadow specific associations.