Adverse childhood experiences, personality psychopathology, and alcohol disorders

描述(申请人提供)：酒精使用障碍(AUD)在美国社会中很普遍，与许多残疾、共病和对个人、他们的家庭和社会的伤害有关。因此，了解AUDS发生和持续的危险因素对于预防和干预至关重要。由于AUDS是复杂的疾病，必须以综合的方式调查关键的风险因素。其中一个危险因素是儿童/青少年的不良经历：情感或身体虐待或忽视或性虐待形式的虐待。研究表明，这些经历会影响正常发育，并与后来的饮酒和AUDS有关。然而，关于这些关系仍然存在许多问题。另一个关键风险因素是人格心理病理、持续的适应不良行为、情绪和成年早期的认知，被纳入DSM-IV作为十种人格障碍(PD)。不幸的是，这些在我们的社会中也很普遍。先前规模较小的研究表明，ACE与PD或其症状有关，而其他此类研究表明，PD或PD症状与AUDS有关。然而，这两个关键危险因素对AUDS的联合影响还没有研究。此外，除了反社会性帕金森病外，大型流行病学研究以前从未讨论过全系列的DSM-IV PD与AUD之间的关系。最后，发生的危险因素可能不同于影响预后的因素。关于ACE和全系列PD如何影响AUD的持久性，我们知之甚少。为了审视这些问题，这项研究将结合前所未有的一套资源。作为对PAR-08-005的响应，校外和校内调查人员将合作分析全国酒精及相关疾病流行病学调查(NESARC)第一波(2001-2002年)和第二波(三年后)34,653名参与者的数据。这些参与者被评估了主要的DSM-IV轴I障碍，所有DSM-IV轴II PD，不同类型的ACE，以及许多其他重要的协变量。基础工作将包括彻底调查ACE与PD的关系和PD症状学的结构，这方面存在许多问题。这项基础工作的发现将有助于研究ACE和PD如何与AUDS的发生和持续有关，控制轴I障碍、酗酒家族史和其他重要协变量。 具有公共卫生意义：这项研究的新知识将对以下方面至关重要：(1)更好地确定急性尿毒症的高危个体；(2)对从事酒精使用障碍患者工作的临床医生进行教育，可能会刺激新的治疗方法的开发；(3)开发DSM-V；(4)开发更精细的病因学研究，纳入生物(例如遗传)变异以寻找急性尿毒症的原因及其持久性。

DESCRIPTION (provided by applicant): Alcohol use disorders (AUDs) are prevalent in U.S. society and associated with much disability, comorbidity and harm to individuals, their families and society. Thus, understanding the risk factors for the occurrence and persistence of AUDs is vital for prevention and intervention. Because AUDs are complex disorders, key risk factors must be investigated in an integrated manner. One such risk factor is adverse childhood/adolescent experiences (ACEs): maltreatment in the form of emotional or physical abuse or neglect, or sexual abuse. Studies suggest that these experiences affect normal development and are associated with later drinking and AUDs. However, many questions remain about these relationships. Another key risk factor is personality psychopathology, persistent maladaptive behaviors, emotions and cognitions from early adulthood, included in DSM-IV as ten Personality Disorders (PDs). Unfortunately, these are also prevalent in our society. Prior smaller studies suggest that ACEs are related to PDs or their symptoms, while other such studies suggest that PDs or PD symptoms are related to AUDs. However, the joint impact of these two key risk factors on AUDs has not been studied. Further, aside from antisocial PD, large epidemiologic studies have never previously addressed how the full range of DSM-IV PDs relates to AUDs. Finally, risk factors for occurrence can differ from factors affecting prognosis. Very little is known about how ACEs and the full range of PDs affect the persistence of AUDs. To examine these issues, this study will combine an unprecedented set of resources. Responding to PAR-08-005, extramural and intramural investigators will collaborate in analysis of data from 34,653 participants in Waves 1 (2001- 2002) and 2 (3 years later) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). These participants were assessed for major DSM-IV Axis I disorders, all DSM-IV Axis II PDs, different types of ACEs, and many additional important covariates. Groundwork will consist of thoroughly investigating the relationship of ACEs to PDs and the structure of PD symptomatology, about which there are many questions. The findings from this groundwork will then inform investigation of how ACEs and PDs relate to the occurrence and persistence of AUDs, controlling for Axis I disorders, family history of alcoholism, and other important covariates. PUBLIC HEALTH RELEVANCE: The new knowledge from this study will be vital for (1) better identification of individuals at high risk for AUDs; (2) education of clinicians working with patients with alcohol use disorders, potentially stimulating new treatment development; (3) development of DSM-V; (4) developing more refined studies of etiology incorporating biological (e.g., genetic) variation in the search for causes of AUDs and their persistence.