Blunted and Discordant Affect: A Transdiagnostic Construct in Psychopatholog

描述（由申请方提供）：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评估与健康个体相比钝感和不一致情感（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，其作用是降低高情感强度和反应性，例如，过度兴奋易怒或对威胁敏感相反的一极，涉及迟钝和不协调的情感反应，经常被临床医生描述，例如，“关闭”，但很少研究，并且在常见治疗中没有明确解决。临床医生特别注意到这些特征的幸存者的慢性儿童虐待，谁往往有情感的精神病理学。对这一结构的进一步理解，包括其患病率、机制以及与情感高反应性的区别，可能会导致对具有这一特征的个体的专门和有效的治疗。我们将通过在常规任务和近似条件下观察到的150名抑郁症、焦虑症、创伤后应激障碍、和边缘型人格障碍以及50名健康参与者。主要目的，将是检查：1）结构效度的大小，时间过程，和神经机制的钝化和不和谐的影响，2）并发效度的关系，评估措施的钝化和不和谐的影响与自我报告的特质应对和影响结构，如解离，麻木，压抑，抑制，分心，回避，和不和谐的附件。这一目的将该结构置于更广泛的类似文献的背景下，以及3）观察到的结构在滥用史、诊断类别、高反应性、效价和功能方面的外部有效性-特异性。这一目标的特点是，无论是一个维度或综合征，创伤史，轴I和II诊断，效价特异性和功能方面的建设的普遍性。积极的结果可能表明，有必要放弃对患者的自我报告，生理和神经影像学数据进行平均的做法，而是评估高反应性和低反应性对精神病理学的重要性。接下来的步骤将需要检查这些极点是否与传统治疗的治疗结果以及针对高反应性和低反应性的治疗方法的发展有差异。

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.