Rejection sensitivity and social interaction problems in psychiatric patients with childhood maltreatment – a transdiagnostic study on psychological and neurobiological mechanisms

儿童期虐待（CM）作为早期逆境和创伤（EAT）谱中的一种不良经历形式，已被广泛证实为严重心理健康问题发展的核心风险因素。大约25%的精神疾病患者报告CM，并且该亚群的特征在于更复杂的精神病理学，更明显的功能障碍和慢性病程。具有CM高患病率的精神障碍的另一个常见临床特征，例如边缘型人格障碍（BPD）、持续性抑郁障碍（PDD）或复杂创伤后应激障碍（cPTSD），是严重的社会互动问题（例如在维持关系和修复破裂的合作方面），其特别影响长期的心理社会功能，甚至可能妨碍心理治疗。拒绝敏感性（Rejection Sensitivity，RS）是一种对社会反应具有焦虑期待、容易感知和强烈反应的人格倾向，它很容易强化退缩和拒绝的恶性循环。反过来，高RS与几种负面的心理健康结果相关，并植根于婴儿依恋侵犯和CM，包括父母拒绝和不同形式的虐待（情感，身体，性）的经历。拟议的研究旨在建立一种新的transdiagnosis方法，并调查CM和RS作为精神病理学的中央transdiagnosis决定因素的不同集群/累积风险之间的关联。为此，我们将遵循目前精神病学中的“TRANSD”诊断研究建议，并打算在包括四种精神障碍（BPD，PDD，cPTSD，发作性抑郁症）和非临床对照的跨诊断样本中证明跨诊断结构（CMxRS）。为了研究RS的不同组成部分，将使用标准化的实验设置，并评估实验诱导的社会排斥/排斥的反应改变和人际应对策略受损。通过一系列伴随的心理测量、内源性（外周催产素和皮质醇）、神经生理学（皮肤电导水平、心率）和神经遗传学（催产素系统中的表观遗传修饰和遗传变异）测量，将研究潜在的神经生物学过程。更深入地了解社会互动问题的ethiopathology可以为开发基于机制的干预措施确定新的目标点，以改善CM患者的心理治疗。

Childhood maltreatment (CM) as a form of adverse experience in the spectrum of Early Adversity and Trauma (EAT) has been widely confirmed as core risk factor for the development of severe mental health problems. Around 25% of patients with psychiatric disorders report CM, and this subpopulation transdiagnostically characterizes by more complex psychopathology, more pronounced functional impairment and chronic courses of disease. Another common clinical feature of mental disorders with high prevalence of CM, such as borderline personality disorder (BPD), persistent depressive disorder (PDD) or complex posttraumatic stress disorder (cPTSD), are serious problems of social interaction (e.g. in maintaining relationships and repairing broken cooperation), that particularly impact long-time psychosocial functioning and may even hamper psychotherapy. Rejection Sensitivity (RS), i.e. the personality disposition to anxiously expect, readily perceive and intensely react to social reaction, can easily reinforce the vicious circle of withdrawal and rejection. In turn, high RS has been associated with several negative mental health outcomes and has been rooted to infant attachment violation and CM including experiences of parental rejection and different forms of abuse (emotional, physical, sexual). The proposed study aims to establish a novel transdiagnostic approach and investigates the association between distinct clusters/cumulative risk of CM and RS as central transdiagnostic determinant for psychopathology. For this purpose, we will follow the current "TRANSD"iagnostic research recommendations in psychiatry and intend to demonstrate the transdiagnostic construct (CMxRS) in an across-diagnoses sample including four mental disorders (BPD, PDD, cPTSD, episodic depression) and non-clinical controls. To study the different components of RS, a standardized experimental setting will be used and altered reactions and impaired interpersonal coping strategies to experimentally induced social rejection/exclusion will be assessed. By a broad set of concomitant psychometric, endogene (peripheral oxytocin and cortisol), neurophysiological (skin conductance levels, heart rates) and neurogenetic (epigenetic modifications and genetic variations in the oxytocin system) measurements, underlying neurobiological processes will be investigated. A deeper understanding of the ethiopathology of social interaction problems could set the path to identify novel target points for developing mechanism-based interventions in order to improve psychotherapy in patients with CM.