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.
Highlights
Most CTQ scores were significantly associated with personality disorder (PD) traits (Fig. 1), especially the relationship between emotional abuse and Clusters A and B PD traits, physical abuse and Cluster B PD traits, sexual abuse and Cluster B PD traits, and emotional/physical neglect and Cluster A PD traits
The canonical correlation analysis (CCA) identified a dimensional representation of childhood traumatic experiences (CTE), quantified by the CTQ, that was associated with the dimensional representation of PD traits, quantified by the PDQ-4+
After performing the CCA, we determined two linear combinations of PD trait that were correlated with distinct CTE combinations, which we term “emotion abuse-related dissociality PD traits” (Fig. 2A) and “emotion neglect-related sociality PD traits” (Fig. 2B)
Summary
Www.nature.com/scientificreports manifestations and illness trajectories in major psychiatric categories such as affective disorders[4], anxiety disorders[5,6] and psychosis[7]. We assume that personality pathologies (PD traits) through dimensional approach rather than categorical diagnoses of PD may better reflect different subgroups of psychiatric patients. Previous studies[12,13] have tended to focus on the correlational pattern between PD and CTE, but have not yet tended to use these correlation characteristics to construct subtypes of mental disorders or subgroups of psychiatric patients. The present study applied, for the first time, a canonical correlation analysis (CCA) method for defining subtypes by clustering psychiatric patients, with different clinical diagnoses, according to the patterns of the relationship (canonical variates) between PD traits and CTE. We further tested whether the CCA-derived subtypes differed with regards to demographics, clinical classifications, and PD categories
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