Transdiagnostic Dimensions towards Personality Pathology and Childhood Traumatic Experience in a Clinical Sample: Subtype Classification by a Cross-sectional Analysis

Abstract

Psychiatric disorders are highly heterogeneous syndromes often explained by underlying and internalized personality disorder(PD) traits that are affected by externalized childhood trauma experiences(CTE). The present study investigated the differential subtype model by examining the association between PD traits and CTE in a clinical sample with transdiagnostic psychopathology. Outpatients(n = 2090) presenting for psychiatric treatment completed self-reported measures of PD traits(Personality Diagnostic Questionnaire) and the childhood adversity(Child Trauma Questionnaire). Canonical variates were generated by canonical correlation analysis(CCA) and then used for hierarchical cluster analysis to produce subtypes. A support vector machine(SVM) model was used and validated using a linear kernel to assess the utility of the extracted subtypes of outpatients in clinical diagnosis classifications. The CCA determined two linear combinations: emotional abuse related dissociality PD traits(antisocial and paranoid PD) and emotional neglect related sociality PD traits(schizoid, passive-aggressive, depressive, histrionic, and avoidant PD). A cluster analysis revealed three subtypes defined by distinct and relatively homogeneous patterns along two dimensions, and comprising 17.5%(cluster-1, n = 365), 34.8%(cluster-2, n = 727), and 47.8%(cluster-3, n = 998) of the sample, each with distinctive features of PD traits and CTE. These subtypes suggest more distinct PD trait correlates of CTE manifestations than were captured by clinical phenomenological diagnostic definitions. Our results highlight important subtypes of psychiatric patients that highlight PD traits and CTE that transcend current diagnostic boundaries. The three different subtypes reflect significant differences in PD and CTE characteristics and lend support to efforts to develop PD and childhood trauma targeted psychotherapy that extends to clinical diagnosis-based interventions.

Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study

“…Severity was higher for clusters B and C among mood disorders and for clusters A and B in schizophrenia. 72 The inference is that particular traits associate with particular psychiatric disorders.…”

Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia

“…Widely employed for screening DSM-IV PDs in Chinese psychiatric patients, the PDQ-4+ has shown a high test-retest reliability score (0.92) within the Chinese population, emphasizing the questionnaire’s result reliability. 7 , 30 , 31 For a more comprehensive clinical assessment, the SCID-II is employed. SCID-II is a semi-structured clinical interview that uses DSM-IV criteria for diagnosing PDs.…”

Prevalence of Comorbid Personality Disorder in Psychotic and Non-psychotic Disorders

“…Each PD subscale is scored in several items with "yes" or "no" questions related to the DSM-IV PD diagnosis criteria. Higher PD scores indicate a higher severity of specific traits (29). PD subscales with a composite score of ≥ 4 or 5 were considered clinically relevant.…”