Personality traits in recent-onset-of-psychosis patients compared to a control sample by gender
Introduction
The study of personality in psychosis is increasing. Personality in patients with psychosis has been studied with three different models: the five- factor model (McCrae and John, 1992), the psychobiological model of temperament and character (TCI; Cloninger et al., 1993) and the clinical or pathological personality model (Millon, 1976).
Focusing on the latter model, this model considers that normative and clinically significant personalities lie along a continuum, with disordered character being an exaggeration of normative traits. Normative and clinically significant personalities share the same traits; nonetheless in clinically significant personalities these traits are rigid and maladaptive (Millon, 1990). However, even within the same model results are complex and difficult to compare because of the different variables included such as instruments used to measure personality, the psychosis sample considered, and the study of present versus premorbid personality. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association (APA), 1996) considers three personality clusters: cluster A that includes paranoid, schizotypal, and schizoid personality disorders, cluster B that includes histrionic, narcissistic, antisocial and borderline personality disorders and cluster C that includes dependent, compulsive and avoidant personality disorders. Traditionally, Cluster A personality disorders are regarded as schizophrenia-spectrum disorders and may represent an underlying vulnerability for psychosis (Ellison et al., 1998, Nuechterlein et al., 2002). Other literature supports a high prevalence of cluster B and C disorders and clinically significant personality traits in patients later converting to psychosis and patients with psychosis (Schultze-Lutter et al., 2012, Wickett et al., 2006). In this context using the Millon Multiaxial Inventory (MCMI; Millon, 1994), Hogg et al. (1990) found in a sample of recent onset schizophrenia patients that the most common clinically significant personality traits were dependent, narcissistic, avoidant and schizoid. Wickett et al. (2006) found that within cluster B and C were avoidant, dependent, borderline and antisocial in a sample of chronic patients with psychosis. Finally, Simonsen et al. (2008) found avoidant, schizoid, borderline and schizotypal to be the more common in a recent-onset-of-psychosis (ROP) patients' sample.
The implications of the comorbidity of having a personality disorder or a high severity of a certain clinical trait are being studied. High rates of cluster B personality traits in schizophrenia spectrum disorders have been related with different variables in relation to neurocognition and childhood abuse (Lysaker et al., 2004). Cuesta et al. (2002) suggested that premorbid personality may shape the expression of psychosis. In relation to this, Sevilla-Llewellyn-Jones et al. (2017) and Wickett et al. (2006) found correlations between some psychotic symptoms and clinical personality traits. In addition, the last study found that emotional discomfort was more related to borderline traits and psychiatric admissions to avoidant traits in patients with schizophrenia and schizoaffective disorder. There are studies that support the idea that patients with a psychotic disorder who also have a comorbid personality disorder may benefit less from treatment than patients who do not have personality disorders (Therien et al., 2014). Therefore it seems of crucial importance to study personality in patients with psychosis because of the clinical and psychosocial implications.
Gender differences have been found regarding clinical, functional and personality variables (Ochoa et al., 2012). There are two previous studies that examined gender in premorbid personality disorders in patients with psychosis. The first found that women diagnosed with schizophrenia had more explosive traits than men (Dalkin et al., 1994). The second found that female patients with an earlier onset scored higher in avoidant and depressive traits in comparison to late onset women, and also found that early onset men scored higher in paranoid and schizoid in comparison to late onset who scored higher in narcissistic personality traits (Skokou and Gourzis, 2014). However, to our knowledge there is no research investigating current clinical personality traits in ROP patients by gender.
Little is known about patient personality profiles in comparison with a control sample. A few studies have compared normative personality traits in ROP patients with a control group (Beauchamp et al., 2006, Hori et al., 2008, Miralles et al., 2014). These studies found that ROP patients significantly differ in personality traits when compared to a control group. Furthermore, Hori et al. (2008) compared male and female patients to a control sample using the TCI (Cloninger et al., 1993). In this study they found that male patients personality traits compared with controls were more pronounced than females with their counterparts. To our knowledge there is only one study that has analyzed personality with the clinical model in psychosis and a control group (Keshavan et al., 2005). They found that patient's personality dimensions scores were all significantly higher in patients than in the controls. However, no study has compared clinical personality traits of ROP patients with those of a control sample by analyzing male and female separately.
This study aimed to examine differences in clinical personality traits and clinically significant personality traits in a group of ROP patients compared with a healthy control sample by analyzing male and females separately, using the clinical personality model of Millon (Millon, 1976). Using this model, we analyzed MCMI personality traits both dimensionally and categorically, the latter by dichotomizing traits into normative and clinically significant categories.
Section snippets
Subjects
Our study was conducted at two ROP rehabilitation day programs in the Malaga and Granada regions. ROP was defined by the duration of psychosis—operational definition of a maximum of five years after fully first psychotic symptoms started (Breitborde et al., 2009).
Study participation was offered to 102 patients; 6 of them refused participation and 2 had an invalid personality profile in the MCMI-III. Therefore, 96 patients participated, and 94 (92.6%) had usable data. Data collection was done
Demographic and clinical variables by gender
The majority of the clinical sample were men and had diagnoses of schizophrenia or schizoaffective disorder, with other diagnoses less common. The age of onset of psychosis of the patient sample was (22.63 ± 4.47). Men had an earlier age of onset of psychosis than women (22.11 ± 4.11 vs 24.55 ± 5.27 p = 0.029). The duration of the illness at assessment measured in months in the patient sample was (24.9 ± 19.8). However, no differences were found between men and women (25.20 ± 20.74 vs 24.20 ± 16.398 p =
Discussion
This was the first known study to compare ROP versus healthy control samples on personality traits, both dimensionally and based on clinical significance, and included detailed analyses of men and women. Our results revealed significant differences between ROP patients and the control group in terms of clinical personality traits. One main finding of this study was that ROP patients had higher levels on clinical personality traits in all but histrionic, narcissistic and compulsive traits. In
Conflict of interest
There is no conflict of interest.
Contributors
JSLL designed the study, managed the literature searches, and wrote the protocol and the first draft of the manuscript; PCD, ALM, and AEE conducted assessments. BMK did a critical reading of the protocol and SO undertook the statistical analysis, supervised all the phases of the study and review, and revised the manuscript. All authors contributed to and have approved the final manuscript.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
The authors thank the participating patients for their time and effort.
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