The Structure of PTSD Comorbidity

描述（由申请人提供）： 创伤后应激障碍（PTSD）是创伤应激对个体素质的作用的产物，这些素质跨越了人类对精神病理学脆弱性的变化范围。这种相互作用在患有PTSD的个体的样品中产生广泛的表型异质性，其一种表现是与通常共发的病症的诊断共病的严重且多样的模式，所述病症的范围从“内化”谱的那些（即，单极情绪和焦虑症）到外化谱（即，反社会行为、成瘾和冲动控制障碍）。米勒博士的研究项目集中在理解持久的，基于气质的倾向对创伤后精神病理学的形式和表达的内化和外化行为的影响。通过一系列的研究，他和他的同事们发现了跨性别和创伤类型的PTSD亚型的内在化和外在化的证据。他最近扩展了这项工作，使用验证性因素分析和生物计量双胞胎建模，暗示这些亚型的内在和外在维度的遗传基础。到目前为止，工作的一个局限性是依赖于横截面数据集，因此无法评估类型学随时间的稳定性，也无法评估阶级成员和生活压力之间可能存在的交易关系。因此，拟议的研究将进行四年（时间2）和六年（时间3）的后续评估的退伍军人谁最近完成了广泛的评估博士米勒的先前的优点审查资助的研究“创伤后应激障碍的结构”。该研究还将包括对时间2和时间3之间发生的新发生活压力源的评估，以检查内化和外化精神病理学的压力产生效应以及此类压力源的症状加重效应。这种经过严格评估的退伍军人样本提供了一个独特的机会，可以对广泛的精神症状进行纵向检查，并对他们的轨迹产生影响。

DESCRIPTION (provided by applicant): Posttraumatic Stress Disorder (PTSD) is the product of traumatic stress operating on individual diatheses that span the spectrum of human variation in vulnerability to psychopathology. This interaction yields extensive phenotypic heterogeneity in samples of individuals with PTSD, one manifestation of which is a severe and diverse pattern of diagnostic comorbidity with commonly co-occurring disorders ranging from those of the "internalizing" spectrum (i.e., the unipolar mood and anxiety disorders) to the externalizing spectrum (i.e., antisocial behavior, the addictions, and disorders of impulse control). Dr. Miller's research program is focused on understanding the influence of enduring, temperament-based propensities towards internalizing and externalizing behavior on the form and expression of posttraumatic psychopathology. Through a series of studies, he and his colleagues have found evidence of internalizing and externalizing subtypes of PTSD across genders and trauma types. He has recently extended this work using confirmatory factor analysis and biometric twin modeling to implicate a genetic basis for the internalizing and externalizing dimensions underlying these subtypes. One limitation of work thus far has been a reliance on cross- sectional datasets and the resulting inability to evaluate the stability of the typology over time or the transactional relationships that likely exist between class membership and life stress. Therefore, the proposed study will conduct four- (Time 2) and six-year (Time 3) follow-up assessments of veterans who recently completed extensive assessments for Dr. Miller's prior Merit Review-funded study "The Structure of PTSD Comorbidity". The study will also include assessment of new onset life stressors occurring between Time 2 and 3 to examine the stress- generative effects of internalizing and externalizing psychopathology as well as the symptom exacerbating effects of such stressors. This intensively-assessed sample of veterans offers a unique opportunity for longitudinal examination of a broad array of psychiatric symptoms and modeling influences on their trajectories.