The Structure of PTSD Comorbidity

描述(由申请人提供)： 创伤后应激障碍(PTSD)是创伤应激在个体疾病上运作的产物，这些疾病跨越了人类对精神病理易感性的不同范围。这种相互作用在创伤后应激障碍患者的样本中产生了广泛的表型异质性，其表现之一是严重和多样化的诊断共病模式与常见的共生障碍，从内在性障碍(即单相情绪和焦虑障碍)到外在性障碍(即反社会行为、成瘾和冲动控制障碍)。米勒博士的研究计划侧重于了解持久的、基于气质的行为内化和外化倾向对创伤后精神病理学的形式和表现的影响。通过一系列研究，他和他的同事发现了不同性别和创伤类型的创伤后应激障碍亚型内化和外化的证据。他最近利用验证性因子分析和生物统计双胞胎模型扩展了这项工作，以推断这些亚型背后的内化和外化维度的遗传基础。到目前为止，工作的一个局限性是依赖横断面数据集，因此无法评估类型学随时间的稳定性，或者无法评估班级成员和生活压力之间可能存在的交易关系。因此，拟议的研究将对最近完成米勒博士先前功绩审查资助的研究“创伤后应激障碍共病的结构”的退伍军人进行四年(时间2)和六年(时间3)的后续评估。这项研究还将包括对发生在时间2至3之间的新的生活应激源的评估，以检查内化和外化精神病理学的压力生成效果以及这些应激源的症状恶化效果。这一经过密集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，并模拟对其轨迹的影响。

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.