Threat management systems.

Arbaizar B. Psiquiatria.com. 2013; 17:8.
http://hdl.handle.net/10401/6170

Artículo especial
Threat management systems
Sistemas de manejo de amenazas

Beatriz Arbaizar1*, Paula Suarez-Pinilla2, Javier Llorca3

Resumen
Varios mecanismos de gestión de riesgos están involucrados en la respuesta hacia diferentes
peligros o amenazas potenciales: el sistema de detección de amenazas, dirigido a enfrentarse a
peligros-visicitudes-amenazas reales, y el sistema de respuestas de precaución, dirigido a hacer
frente a amenazas hipotéticas. En este artículo, nos centramos en las relaciones entre estos
sistemas y los trastornos de ansiedad. Nuestro objetivo es sistematizar varios subsistemas, sus
mecanismos de acción y las enfermedades relacionadas con la respuesta alterada de estos
subsistemas.
Palabras claves: Sistema de manejo de amenazas, subsistema de autoprotección, subsistema
de evitación de la enfermedad, sistema de manejo de riesgos.
Abstract
We try to systematize the risk assessment mechanism in two general threat management
systems 1) the threat detection: intended to face current threats, 2) and the precautionary
responses: intended to face hypothetical threats. These mechanisms could act via several
specific subsystems, including the self-protection subsystem, the disease avoidance subsystem,
one that we hypostatize and have called the security sense subsystem, and very probably others.
Keywords: Threat management systems self-protection subsystem, disease avoidance
subsystem, risk management system.

Recibido: 09/11/2012 ­ Aceptado: 03/01/2013 ­ Publicado: 22/02/2013

* Correspondencia: llorcaj@unican.es
1y2 University Hospital Marques de Valdecilla, Santander, Spain.
3 University of Cantabria, Santander, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Spain;
IFIMAV, Santander, Spain.

Psiquiatria.com ­ ISSN: 1137-3148
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Arbaizar B. Psiquiatria.com. 2013; 17:8 - http://hdl.handle.net/10401/6170

Introduction
In this paper we are going to follow an evolutionary perspective, as a result of that we have
assumed that there are several risk assessment mechanisms that have evolved in response
towards different potential dangers or threats, these adaptive patterns would have the task to
enhance the fitness and survival rates of the own specie.
Several risk assessment mechanism in mammals that will increase the opportunities to achieve
reproductive success have been described basing in the evolutionary theory. As result of this
certain mental disorders as the anxiety disorders can be understood as deregulations of these
adaptive mechanisms.
Some confusion could exist in the usual terminology for describing this threat management
system. For instance, security motivation system (Woody and Szechtman.2011), threat detection
and precautionary responses (Stein and Nesse.2011), etc. From here on, we are going to use the
terms contributed by Stein and Nesse; therefore, we use "threat detection" and "precautionary
responses" as the names for the two principal categories of the risk management system; then,
we use the terms "self protection" and "disease avoidance subsystem" (Neuberg et al.2011) for
some subcategories of our attempt to schematizing this risk management system; moreover, we
are going to take advantage of the criterion "inferred-manifested threat" use by Boyer and
Lienard (2006).
We also are going to use the concept of dimensions that have been described in OCD; these
dimensions could have differential neural correlates and treatment responses (Pinto et al.2007;
Pine.2011).
The five described factor-dimensions in OCD we are going to work with are:
·

Symmetry / ordering

·

Hoarding

·

Taboo thoughts: sexual, aggressive, and religious obsessions

·

Doubt / checking

·

Contamination / cleaning

Although several authors integrate the taboo thoughts (violent, sexual, and religious thematic)
with the checking compulsions (Cavallini et al.2002;Katerberg et al.2010; Abramowitz et al.
2010), we follow the classification that other authors obtain after consider separately the
aggression factor of the taboo thoughts (violent, sexual, and religious thematic) of the
unintencional fear of harm in checking compulsions
(Pinto et al.2007;Williams et
al.2011;Wheaton et al.2012).
In this review we are going to center our interest in the "self protection subsystem", the "disease
avoidance subsystem" and in one new theoretical system that we have called "sense control
subsystem" (table 1).

Threat management systems
Adaptive evolutionary patterns increase enduring reproductive success. Threat management
systems have evolved since ancient times to face physical integrity and health protection risks.

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Fear circuitry-Self protection subsystem
The field of action of the self protection system is to detect potential threats to the individual
and to others (Woody and Szechtman.2011). When the fear becomes specific in an immediate
future, a number of possible evolutionarily adaptive behaviors can be adopted depending on the
qualitative evaluation of the danger, such as flight, fight, tonic immobility, etc. The amygdala
constitutes the backbone of the circuit of the fear­self protection subsystem (Flannelly et
al.2007).
The amygdala plays a key role in fear circuitry, but the circuit implicated in detection and
response to potential external threats embraces not only the amygdala but also the anterior
cingulated cortex and regions of the prefrontal cortex; they are connected to the hypothalamus,
pituitary and adrenal (HPA) axis where the autonomic (e.g. heart rate, blood pressure) and
endocrine (hormone release) responses take place (Craig and Halton.2009).
In fact, humans with amygdala damage have deficits in emotional perception of danger (Calder
et al.96), and damage to the amygdala (Bechara et al.1995) also produces deficits in fear
conditioning in humans. Fear conditioning leads to increases in amygdala activity, which can be
measured by functional magnetic resonance imaging (Buchel et al.1998) More specifically, the
fear circuitry is located in the lateral amygdala (LA) - an important site of plasticity in auditory
fear conditioning- and the thalamic afferents towards LA synapses use glutamate as a
neurotransmissor (Radly et al.2007; Sah et al.2003;Tsvetkov et al.2004). It has also been
proved that drugs such as glutamate N-methyl-D-aspartate (NMDA) antagonists may block the
conditioned fear (Garakani et al.2008).
Summarising, the fear circuitry-self protection subsystem is activated by fear emotion and is
centralized in the amygdala.
Disease Avoidance Subsystem
The fear of contamination is the most common object of obsessions, and at least 50% of the
OCD patients suffered it (Rachman.2004;Brady et al.2010).
In the disease avoidance subsystem (Lienard.2011), the goal is to avoid health risks, this
adaptive response ­fear of contamination- could be mediated by disgust sensitivity and its
response could be avoidance behaviors. Disgust sensitivity could be a mediator of contamination
fear and could have an adaptive function in preventing disease acquisition through avoidance of
contact with possibly contaminated stimuli (Deacon and Olatunji.2007;Olatunji et al.2004;
Olatunji et al 2005, Neuberg et al.2011;Brady et al.2010).
Disgust sensitivity is greater in females as possible result of differential investment in offspring
development; increased contamination avoidance is also seen in pregnancy, probably due to the
higher reproductive investment cost (Lienard.2011;Björkland and Hursti 2004). Disgust
sensitivity is also increased during the first trimester of pregnancy, when the immunological
defenses are momentarily diminished (Lienard.2011;Forray et al.2010). Postpartum has also
been associated with the onset of OCD (Forray et al.2010; Labad et al.2005), although
obsessions in this period are usually characterized by the fear of harming the baby, so they are
probably unrelated with disgust sensitivity.
The pattern of activation during a disgust-inducing task in OCD subjects is different to that of
healthy subjects, including greater activation in the right insula, parahippocampal region, and
inferior frontal sites ( Olatunji et al.2004; Olatunji et al 2005;Shapira et al.2003).

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It has recently been noticed that the cingulated cortex and insula are particularly implicated in
less immediate threats ­ such as risk of contamination (Woody and Szechtman.2011;
Fiddick.2011) . According to suggestions of Vogt (Vogt et al.1992), the anterior cingulated cortex
is devoted to scanning ego-generated or internal signals of threat and the posterior cingulated
cortex evaluates environmental threats.
Summarising, the disease avoiding subsystem implicated in fear contamination could be
activated by disgust emotions -mainly involving the cingulated cortex and insula. The
orbitofrontal cortex is implicated in generating the closure signals that end the defensive
responses (Pritchard et al.2008; Szechtman and Woody. 2004). We adopt the Woody and
Szechtman hypothesis (Szechtman and Woody. 2004; Woody and Szechtman. 2011): the lack of
a clear and objective signal that the threat has been removed due the impossibility of
verification that this threat has been neutralized could be the cause of the precaution behavior
becoming a compulsion, and these repetitive behaviors ­ compulsions observed in the
deregulation of disease avoidance subsystem could be the result of the absence of frontal
inhibition.

Security-control sense subsystem
In this text, we use the term ritualized as a repetitive response: mental compulsions or repetitive
external behaviors that are logically unconnected with intrusive thought; compulsion will be
used as a repetitive behavior with an apparently logical connection with the initial thought, such
as washing or doubting compulsions.
The taboo thoughts, mainly religious, sexual, and aggressive, tend to appear together (Grant et
al.2006) and as several authors described OCD patients with taboo thought concerns especially
engage in mental rituals [Williams et al.2011], which usually neutralize these obsessions in an
illogic manner.
It should be remarked that humans have the capacity of anticipation; they can represent
different scenes of their past and of their future through cognitive mechanisms, and this quality
allows humans to anticipate the possible dangerous consequences of some actions.
Rituals are widely present in our daily activity; they appear in numerous social activities
(Turbott.1997; Boyer and Lienard.2006). They are repeated actions that must be executed
according to certain procedures and serve to confer a sense of controllability of dangerous
situations that are beyond our rational capacity of control; they usually serve to ensure good
luck or avoid misfortune (Turbott.1997; Eilam et al.2011), repeating the same acts following a
few very precise procedures enables the reduction of danger from an abstract or internal source.
Using a stereotyped series of actions, carried out according to a strict procedure, the most
unpredictable dangers are avoided or good luck is invoked. Ritualistic responses are usually
unconnected in a realistic way to the specific fear and behavior is unrelated to the original
context, incorporating a change in its function. Our suggestion is that the security-control sense
subsystem could be associated to taboo thoughts ­ sexual, religious and aggressive obsessions;
in this case, the origin of the threat is preferentially internal, and it could be neutralized by an
illogical way through the so-called "magic thinking".

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Summarizing neurobiology of OCD

Now we briefly review some relevant aspects of the neurobiology of OCD
The cortico-striato-thalamo-cortical circuitry ­that include orbitofrontal cortex(OFC), anterior
cingulate cortex(ACC),dorsolateral prefrontal cortex(DLPFC), thalamus and amygdala- has been
repeatedly implicated in OCD symptomatology (Woody and Szechtman.2011;Fineberg et
al.2011;Wu et al.2012;Pittenger et al.2001;Albelda and Joel.2012; Goddard et
al.2008;Andersenet al.2010). The two major neurotransmitters of cerebrum are glutamate as
excitatory transmitter and GABA as inhibitory transmitter. Both of them are modulated by
dopamine and serotonin; there is an increasing number of data ­neurobiological, genetic,
pharmacological, animal modelspointing at alterations involving the glutaminergic,
dopaminergic and serotoninergic transmission, although we cannot forgot that serotonin and
dopamine have also complex interactions with each other.
The serotoninergic hypothesis comes from the clinical observation that OCD patients improve
with SSRIs. Although the SSRIs have been the most recognized pharmacological treatment for
OCD, the response rates are poor, and 30 to 50% of patients remain refractory to this treatment;
even the responders are usually only partially responders (Piggot and Seay.1998; Goddard et
al.2008;Andersenet al.2010). These data have favoured the emergency of the
hyperdopaminergic hypothesis.
Behavioral models of OCD/compulsive behaviors would seem to be compatible with
hyperdopaminergic hypothesis. Psychostimulant drug administration is known to induce
stereotypic behaviors in animals, while dopamine agonist and psychostimulant drugs can induce
OCD symptoms in humans (Guegant and Crochette.2000;Yang et al 2003).
Thus, it is not surprising that atypical antipsychotics combining D2 receptor blockade and 5HT2A antagonism show a favourable profile of effects in resistant forms of OCD ( Goddard et
al.2008). We also know that the dopamine D1 and D2 receptor antagonists decrease the
repetitive and compulsive behavior in rabbits [Hoffman and Rueda Morales.2012]. In fact
Tourette's syndrome is characterized by the presence of brief, stereotyped motor or vocal
behaviors that respond preferentially to DA antagonists, and usually the SSRIs do not have
beneficial effects in them.
The motor manifestation of compulsive behaviors in OCD is controlled from the striatum, more
specifically by the dorsal striatum, also called the motor striatum; cingulotomy is effective in
reducing obsessive symptoms, but is totally ineffective in reducing tics associated with
Tourette's syndrome (Baer et al.1994).
The more recent contributions link the difficulty to initiate new actions to glutamate
hyperactivity in frontal and cingulated areas, while the motor aspect of compulsions-rituals
could be executed in the striatum area, where we might find that dopaminergic hyperactivity
holds the inhibitory frontal control and, itself, is controlled by the brainstem serotonergic
inhibition (Woody and Szechtman. 2011; Pritchard et al.2008;March and Maia .2009;Finenberg
et al.2010).
Some normal childhood behaviors resemble some OCD symptoms, it has been supposed that
these behaviors will disappear when the maturation of the prefrontal cortex takes place, in fact it
is supposed that some compulsions could be the result of a failure in the orbitofrontal inhibitory

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control mainly due a hiperglutaminergic activation in this cortex.(Fineberg et al.2011;Wu et
al.2012; Pittenger et al.2001;Rosenberg et al.2004;Whiteside et al.2006).
OCD has also been associated with the so-called cognitive flexibility alteration, this could be
related with the inability of these patients to stop the already initiated action and change it for a
new response; this function could be preferentially located in the frontal lobe (Boulougouris et
al.2009); as a result, some authors think that this difficulty to initiate new actions could be
linked to glutamate hyperactivity in frontal and cingulated areas (Pritchard et al.2008).

Discussion
In our opinion there are several entities, such as compulsive cleaning, reassuring, phobic fear of
certain animals, hypochondria and possibly other disorders that could be included in disorders
related to deregulations of threat management systems. We propose differentiating several
subsystems for facing threats: the self protection subsystem, when the threat is external and
expected in an immediate o proximal future; the security ­control sense subsystem, when the
threat is internal ­inacceptable thoughts- that could be neutralized through magic thinking and
ritualised behaviors, and disease avoidance subsystem, when the threat is inferred but his
resolution is not totally verifiable, then the message of stop action to the frontal inhibition
centre would not occur and the precaution response would become a compulsion.
In our scheme, the doubt-checking compulsions, hoarding and symmetry/ordering would also
be integrated in the precautionary responses; in the doubt-checking compulsion cases,
symmetry/ordering compulsions and hoarding we would have to hypothesize a primary
deregulation in the frontal inhibition center, this could corresponded with the characteristic
cognitive process described in OCD patients and denominated cognitive inflexibility; it has
been interpreted as a possible OCD cognitive endophenotype [Chamberlain et al 2007].
Our suggestion is that rituals ­mental compulsions as repetitive unrelated behaviors- observed
in taboo obsessions could be an instrumentation of a security control sense subsystem towards
the aggressive, sexual and religious thoughts; this subsystem could neutralize this unacceptable
thoughts trough the magic thinking process that would serve to provide the individual with a
sensation of control over his/her existence and future.
We are conscious that our try to schematizing is very simple and need further contributions and
exhausted revisions. It's only an attempt to introduce some order in an important and recent
appeared concepts.In spite the immaturity of our initial scheme we think it could be an step for
other authors later development structuration in this area of the correspondence between
anxiety disorders and the threat management systems.

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Table 1. Suggested threat management systems

Threat detection

Threat

Mediator

System

Pathological/ normal response

Future Immediate extern danger

Fear circuitry

Self
subsystem

protection

Panic attack./flight-flee

Future immediate extern danger

Avoidance

Self
subsystem

protection

Animal phobias, thunder phobia.../flee

Future proximate extern potential
danger

Rumination

Self
subsystem

protection

General Anxiety Disorder /Anticipation-Precaution

Internal

Magic thinking

Security sense subsystem

Mental compulsions-repetitive unrelated behaviors / sense
of control

Disgust

Disease
subsystem

avoidance

Cleaning compulsions/ Cleaning

Vigilance/check

Disease
subsystem

avoidance

Hypochondria/ Self-care

Avoidance

Social
subsystem.

protection

Social anxiety disorder/ Caution

Doubt

Verification subsystem?

Aggression-ethical concerns
Precautionary
responses

Inferred
Risk for health
Inferred
Threat for health
Inferred
Conspecific threat
Inferred

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© 2013 Arbaizar B, Suarez-Pinilla P, Llorca J.

Checking compulsions/Security

Arbaizar B. Psiquiatria.com. 2013; 17:8 - http://hdl.handle.net/10401/6170

Unintentional harm
Inferred
Future preservation ?

Verification?

Inferred

Accumulation?

Verification system?

Symmetry / ordering compulsions.

Prevention system?

Hoarding

Future availability ?

2

Arbaizar B. Psiquiatria.com. 2013; 17:8.
http://hdl.handle.net/10401/6170

Correspondencia
Javier Llorca
Facultad de Medicina
Avda. Herrera Oria s/n
39011 Santander (Cantabria)
Spain
Tel. 34-942 201 993
Fax. 34-942 201 903
Email. llorcaj@unican.es

Cite este artículo de la siguiente forma (estilo de Vancouver):
Arbaizar B, Suarez-Pinilla P, Llorca J. Threat management systems. Psiquiatria.com [Internet].
2013 [citado 22 Feb 2013];17:8. Disponible en: http://hdl.handle.net/10401/6170

Psiquiatria.com ­ ISSN: 1137-3148
© 2013 Arbaizar B, Suarez-Pinilla P, Llorca J.



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