Hierarchical cluster analysis reveals replicable trait approach-avoidance motivation profiles and heterogeneous dysfunction in mood disorders.

Mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD) are characterized by core approach and avoidance (AA) motivational system dysfunction. However, patterns of AA motivation dysfunction in mood disorders are markedly heterogeneous across studies, which is inconsistent with a singular pattern of AA motivation dysfunction in mood disorders. Thus, we utilized hierarchical cluster analysis (HCA) to classify multiple, distinct AA motivational profiles in both healthy control samples (Study 1: n = 427 and n = 462) and patients with MDD or BD (Study 2: n = 111). In both healthy control and clinical samples, we identified and replicated three distinct AA motivational profiles that were generally characterized as: 1). High Approach + Moderate Avoid, 2). Low Approach + Low Avoid, or 3). Low Approach + High Avoid. In both studies, AA motivational profiles were further characterized by multivariate, non-linear differences in self-reported reward and threat sensitivity. Compared to healthy controls, patients with mood disorders exhibited AA motivation dysfunction that systematically varied in severity across AA motivational profiles. Together, these results suggest that mood disorders may be more accurately characterized by multiple, distinct patterns of AA motivational dysfunction, which may ultimately be useful towards informing precision-medicine frameworks.