Blunted and Discordant Affect: A Transdiagnostic Construct in Psychopatholog

描述(由申请人提供)：我们建议评估钝化和不和谐情绪(BADA)结构在多症状泛诊断个体中的有效性，该个体根据滥用病史和诊断分层，与健康个体相比较。抑郁症、焦虑症、创伤后应激障碍(PTSD)和边缘人格障碍(BPD)的常见治疗方法通常对高达40%-60%的患者有效，可减少高情感强度和高反应性，例如过度唤醒、易怒或威胁敏感。相反的两极，包括钝化和不和谐的情感反应，经常被临床医生描述为“关闭”，但很少被研究，在常见的治疗中也没有明确解决。临床医生特别注意到慢性儿童期虐待幸存者的这些特征，他们通常有情感性精神病理。更好地理解这一概念，包括它的流行、机制以及与情感高反应的区别，可能会导致对具有这种特征的个体进行专门和有效的治疗。我们将通过在常规任务和任务中通过情感评分、生理和神经成像来检验这一结构，这些任务模拟了150名抑郁症、焦虑、创伤后应激障碍和交界性人格障碍患者以及50名健康参与者的功能缺陷情况。主要目的是检验：1)结构效度-钝化和不和谐情感的大小、时间进程和神经机制；2)同时效度-评估的钝化和不和谐情感测量与自我报告的特质应对和情感结构(如分离、麻木、压抑、压抑、分心、回避和不和谐依恋)的关系。这一目的将该结构置于更广泛的相似文献的背景下，以及3)外部效度--观察到的结构关于滥用史、诊断类别、高反应性、价态和功能的特异性。这一目的表征了结构的概括性，无论它是一个维度还是综合征、创伤病史、轴I和轴II的诊断、价态特异性和功能。积极的结果可能表明，有必要放弃对患者的自我报告、生理和神经成像数据进行平均化的做法，转而评估高反应性和低反应性对精神病理学的重要性。下一步将需要检查这些极点是否与常规治疗中的治疗结果不同，以及针对高反应性和低反应性的治疗的发展。 公共卫生相关性：抑郁症和焦虑症的常见机制理论和治疗方法认为，对情绪信息的高反应性。我们建议表明，相反的两极，钝化的情绪反应，是常见的，具有临床意义。我们进一步建议证明这一现象与早期的创伤经历有关。积极的结果将表明，对一种疾病患者的数据进行平均是具有误导性的，因为反应的增加和减少可能会平均化，以掩盖光谱两边的问题。相反，我们将演示对这一现象进行更敏感评估的方法。

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.