The heterogeneity of hoarding behavior: characterizing disorder diversity to distinguish etiology and longitudinal symptom course

项目概要/摘要 囤积症（HD）是一种使人衰弱的神经精神和公共卫生问题，影响高达4%的儿童。 一般人群和6%的老年人。尽管在第五次世界大战中被正式承认为独立的诊断， 根据《精神疾病诊断和统计手册》第15版，HD仍然经常被诊断不足， 有效治疗有限。迄今为止，多重挑战阻碍了有效HD的发展 检测和干预工作，包括HD症状的广泛异质性引起的问题 演示文稿.尽管来自其他精神病学研究的证据表明，目前还缺乏更好地了解这种异质性的努力 疾病表明在识别由不同风险因素定义的维度症状亚组方面具有广泛的实用性 并需要独特的预防和干预需求。常见症状模式的识别可能 提高我们检测临床上有意义的囤积行为的能力，并快速引导患者 个性化治疗。因此，本项目的总体目标是区分HD中的异质性 血液学，通过它我将建立独特的档案HD症状和评估的效用症状 亚组用于阐明疾病病因学和纵向病程的变异性。我将通过以下方式实现这一目标： 三个具体目标。首先，我将根据症状特征识别和描述HD亚组， 与混乱相关的功能障碍和安全问题。为此，我将使用以下工具进行数据驱动分析： 从超过35，500名已完成评估的个人中收集的自我报告症状数据 大脑健康登记处（BHR）是一个基于互联网的成人参与者研究登记处， 世卫组织每半年完成一次对健康史和行为的全面自我报告评估。这个有钱的， 流行病学数据源允许在人群水平上对HD进行全面和创新的调查。 其次，我将调查HD病因学的变化，将受试者分为囤积症状 分组。在这个目标中，我将采用一个社会生态框架来量化亚组多样性， HD的个人、人际和社区水平的危险因素。最后，我将评估 HD亚组的囤积症状严重程度的纵向过程。在这个目标下，线性混合效果 模型将用于评估HD亚组区分症状轨迹的预测能力。这 工作将丰富知识的症状表现在HD及其关系的障碍病因， 纵向症状过程，从而加强努力，有效地识别和治疗囤积行为，所有的 同时加强我的技术和专业技能，以支持我作为一个独立的最终职业目标 调查员

Project Summary/Abstract Hoarding disorder (HD) is a debilitating neuropsychiatric and public health problem that affects up to 4% of the general population and 6% of older adults. Despite formal recognition as an independent diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, HD remains frequently underdiagnosed and effective treatment is limited. To date, multiple challenges have precluded the development of effective HD detection and intervention efforts, including problems arising from wide-ranging heterogeneity in HD symptom presentation. Efforts to better understand this heterogeneity are lacking, though evidence from other psychiatric disorders indicates extensive utility in identifying dimensional symptom subgroups defined by distinct risk factors and requiring unique prevention and intervention needs. The identification of common symptom patterns may improve our ability to detect clinically meaningful hoarding behaviors and quickly navigate patients to personalized treatment. Thus, the overall goal of this project is to distinguish heterogeneity in HD symptomatology, through which I will establish unique profiles of HD symptoms and assess the utility of symptom subgroups for elucidating variability in disorder etiology and longitudinal course. I will achieve this goal through three specific aims. First, I will identify and characterize HD subgroups on the basis of symptom profile and clutter-related functional impairment and safety concerns. In this aim, I will conduct data-driven analyses using self-report symptom data collected from more than 35,500 individuals who have completed assessments of hoarding and clutter in the Brain Health Registry (BHR), an internet-based research registry of adult participants who semi-annually complete comprehensive self-report assessments of health history and behavior. This rich, epidemiologic data source allows for comprehensive and innovative investigation of HD on a population-level. Second, I will investigate variation in HD etiology following classification of subjects into hoarding symptom subgroups. In this aim, I will employ a social-ecological framework for quantifying subgroup diversity in intrapersonal, interpersonal, and community-level risk factors for HD. Finally, I will assess the differential impact of HD subgroups on the longitudinal course of hoarding symptom severity. In this aim, linear mixed-effects models will be used to assess the predictive ability of HD subgroups for distinguishing symptom trajectory. This work will enrich knowledge of symptom presentation in HD and its relationship to disorder etiology and longitudinal symptom course, thus enhancing efforts to effectively identify and treat hoarding behavior, all the while strengthening my technical and professional skills to support my ultimate career goal as an independent investigator.