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社交快感缺失的跨诊断视角

A Transdiagnostic Perspective on Social Anhedonia.

作者信息

Barkus Emma, Badcock Johanna C

机构信息

Cognitive Basis of Atypical Behaviour Initiative (CBABi), School of Psychology, University of Wollongong, Wollongong, NSW, Australia.

Centre for Clinical Research in Neuropsychiatry (CCRN), Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.

出版信息

Front Psychiatry. 2019 Apr 24;10:216. doi: 10.3389/fpsyt.2019.00216. eCollection 2019.

Abstract

Humans are highly social beings, yet people with social anhedonia experience reduced interest in or reward from social situations. Social anhedonia is a key facet of schizotypal personality, an important symptom of schizophrenia, and increasingly recognized as an important feature in a range of other psychological disorders. However, to date, there has been little examination of the similarities and differences in social anhedonia across diagnostic borders. Here, our goal was to conduct a selective review of social anhedonia in different psychological and life course contexts, including the psychosis continuum, depressive disorder, posttraumatic stress disorder, eating disorders, and autism spectrum disorders, along with developmental and neurobiological factors. Current evidence suggests that the nature and expression of social anhedonia vary across psychological disorders with some groups showing deficient learning about, enjoyment from, and anticipation of the pleasurable aspects of social interactions, while for others, some of these components appear to remain intact. However, study designs and methodologies are diverse, the roles of developmental and neurobiological factors are not routinely considered, and direct comparisons between diagnostic groups are rare-which prevents a more nuanced understanding of the underlying mechanisms involved. Future studies, parsing the wanting, liking, and learning components of social reward, will help to fill gaps in the current knowledge base. Consistent across disorders is diminished pleasure from social situations, subsequent withdrawal, and poorer social functioning in those who express social anhedonia. Nonetheless, feelings of loneliness often remain, which suggests the need for social connection is not entirely absent. Adolescence is a particularly important period of social and neural development and may provide a valuable window on the developmental origins of social anhedonia. Adaptive social functioning is key to recovery from mental health disorders; therefore, understanding the intricacies of social anhedonia will help to inform treatment and prevention strategies for a range of diagnostic categories.

摘要

人类是高度社会化的生物,但患有社交快感缺乏症的人对社交情境的兴趣或从中获得的奖励会减少。社交快感缺乏症是分裂型人格的一个关键方面,是精神分裂症的一个重要症状,并且越来越被认为是一系列其他心理障碍的一个重要特征。然而,迄今为止,很少有人研究跨越诊断界限的社交快感缺乏症的异同。在这里,我们的目标是对不同心理和生命历程背景下的社交快感缺乏症进行选择性综述,包括精神病连续体、抑郁症、创伤后应激障碍、饮食失调和自闭症谱系障碍,以及发育和神经生物学因素。目前的证据表明,社交快感缺乏症的性质和表现因心理障碍而异,一些群体在对社交互动的愉悦方面的学习、享受和预期方面存在缺陷,而对另一些群体来说,这些成分中的一些似乎仍然完好无损。然而,研究设计和方法多种多样,发育和神经生物学因素的作用没有被常规考虑,诊断组之间的直接比较很少——这妨碍了对所涉及的潜在机制有更细致入微的理解。未来的研究,剖析社交奖励的渴望、喜欢和学习成分,将有助于填补当前知识库中的空白。在各种障碍中一致的是,社交快感缺乏症患者从社交情境中获得的愉悦减少、随后退出社交以及社交功能较差。尽管如此,孤独感往往仍然存在,这表明对社交联系的需求并非完全不存在。青春期是社会和神经发育的一个特别重要的时期,可能为社交快感缺乏症的发育起源提供一个有价值的窗口。适应性社交功能是从心理健康障碍中康复的关键;因此,了解社交快感缺乏症的复杂性将有助于为一系列诊断类别提供治疗和预防策略。

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