Blunted and Discordant Affect: A Transdiagnostic Construct in Psychopatholog

描述（由申请人提供）：我们建议在根据滥用史和诊断分层的多症状泛诊断个体中，与健康个体相比，评估钝化和不协调影响（BADA）结构的有效性。抑郁症、焦虑症、创伤后应激障碍（PTSD）和边缘型人格障碍（BPD）的常见治疗通常对高达40-60%的患者有效，这些治疗旨在降低高情感强度和反应性，例如，过度兴奋、易怒或威胁敏感性。另一极，包括迟钝和不协调的情感反应，经常被临床医生描述为“关闭”，但很少被研究，并且在普通治疗中没有明确解决。临床医生特别注意慢性儿童虐待幸存者的这些特征，他们通常有情感性精神病理。提高对这一结构的理解，包括其流行程度、机制和与情感性超反应的区别，可以为具有这种特征的个体提供专门和有效的治疗。我们将通过对150名抑郁、焦虑、创伤后应激障碍和边缘型人格障碍患者以及50名健康参与者在常规任务和近似条件下观察功能缺陷时的影响评分、生理和神经成像来检验这一结构。主要目的是检验：1)构念效度——钝化和不协调情感的大小、时间过程和神经机制；2)并发效度——钝化和不协调情感的评估测量与自我报告的特质应对和情感构念（如分离、麻木、压抑、抑制、分心、回避和不协调依恋）之间的关系。3)观察到的构念在滥用史、诊断类别、高反应性、效价和功能方面的外部有效性-特异性。这一目的表征了该结构的普遍性，包括它是一个维度还是综合征、创伤史、I轴和II轴诊断、价特异性和功能。阳性结果可能表明有必要放弃对患者的自我报告、生理和神经影像学数据进行平均的做法，转而评估高反应性和低反应性对精神病理学的重要性。接下来的步骤将包括检查这些极点是否与常规治疗的治疗结果有差异，以及开发针对高反应性和低反应性的治疗方法。

DESCRIPTION (provided by applicant): We propose to assess the validity of a blunted and discordant affect (BADA) construct in multiply- symptomatic pan-diagnostic individuals stratified on abuse history and diagnosis, compared to healthy individuals. Common treatments for depression, anxiety, Post-Traumatic Stress Disorder (PTSD), and Borderline personality disorder (BPD), which are typically effective for up to 40-60% of patients, work to reduce high affective intensity and reactivity, e.g., hyperarousal, irritability, or threat sensitivity. The opposite pole, involving blunted and discordant affective responses, is frequently described by clinicians, e.g., as "shutting down", but is rarely researched, and is not as explicitly addressed in common treatments. Clinicians particularly note these features in survivors of chronic childhood abuse, who often have affective psychopathologies. Improved understanding of this construct, including its prevalence, mechanisms, and differentiation from affective hyper-reactivity, could lead to specialized and effective treatment for individuals characterized by it. We will examine this construct via affect-rating, physiological, and neuroimaging during conventional tasks and tasks that approximate conditions in which functional deficits are observed in 150 patients with depression, anxiety, PTSD, and Borderline Personality Disorder as well as 50 healthy participants. Primary aims, will be to examine: 1) Construct validity-the magnitude, time course, and neural mechanisms of blunted and discordant affect, 2) Concurrent validity-relationships of the assessed measures of blunted and discordant affect with self-reported trait coping and affect constructs such as such as dissociation, numbing, repression, suppression, distraction, avoidance, and discordant attachment. This aim puts the construct in the context of the broader similar literature, and 3) External validity-specificity of observed constructs with respect to abuse history, diagnostic category, hyper-reactivity, valence, and functioning. This aim characterizes the generalizability of the construct with regard to whether it is a dimension or syndrome, trauma history, axis I and II diagnoses, valence specificity, and functioning. Positive results could suggest it is necessary to abandon the practice of averaging self-report, physiological, and neuroimaging data across patients and instead assess both hyper- and hypo-reactivity as important to psychopathology. Next steps would entail examining whether these poles are differentially associated with treatment outcome in conventional treatments and development of treatments to target both hyper- and hypo-reactivity. PUBLIC HEALTH RELEVANCE: Common mechanistic theories of and treatments for depression and anxiety disorders regard hyper-reactivity to emotional information. We propose to show that the opposite poles, blunted emotional responses, are common and clinically meaningful. We further propose to show that this phenomenon is related to early traumatic experiences. Positive results would suggest that averaging data across patients with a disorder is misleading as increased and decreased reactions could average out to hide problems on both sides of the spectrum. Rather, we will demonstrate methods for more sensitive assessments of this phenomenon.