Adverse childhood experiences, personality psychopathology, and alcohol disorders

描述（由申请人提供）：酒精使用障碍（AUDs）在美国社会普遍存在，并与许多残疾、合并症和对个人、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预防和干预至关重要。由于aud是一种复杂的疾病，关键的危险因素必须以综合的方式进行调查。其中一个风险因素是不良的童年/青少年经历（ace）：以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aud有关。然而，这些关系仍然存在许多问题。另一个关键的风险因素是人格精神病理学，持续的适应不良行为，情绪和认知，从成年早期开始，包括在DSM-IV中作为十种人格障碍（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aud有关。然而，这两个关键危险因素对aud的共同影响尚未得到研究。此外，除了反社会PD之外，大型流行病学研究以前从未解决过DSM-IV中所有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。对于ace和全范围pd如何影响aud的持续存在，我们知之甚少。为了研究这些问题，这项研究将结合一套前所未有的资源。为响应PAR-08-005，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第1阶段（2001- 2002年）和第2阶段（3年后）34,653名参与者的数据。这些参与者被评估为主要的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。深入研究ace与帕金森病的关系和帕金森病的症状结构是本研究的基础。这一基础研究的发现将为ace和pd与aud的发生和持续存在的关系、控制轴I障碍、酗酒家族史和其他重要协变量的调查提供信息。

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.