Childhood Adversities in Narcissistic Personality Disorder in China

Adverse childhood experiences in patients with schizophrenia: related factors and clinical implications

The relationship between adverse childhood experiences (ACEs) and the development of psychotic symptoms is not well understood. Therefore, this study aimed to investigate the frequency and distribution of ACEs among patients with schizophrenia and their potential correlation with symptomatology and personality pathology. We conducted a cross-sectional study involving 571 patients with schizophrenia in Shanghai, China. Symptomatology was assessed using the Positive and Negative Symptoms Scale (PANSS) and personality pathology was assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). ACEs were assessed using the Child Trauma Questionnaire-Short Form (CTQ-SF). ACEs were highly prevalent, with 80.8% of the patients with schizophrenia reporting at least one ACE. The three most common types of ACE were physical neglect (69.8%), emotional neglect (28.2%), and emotional abuse (22.9%). For specific ACE, emotional abuse was significantly associated with PD traits, whereas emotional and physical neglect types of ACE was significantly associated with negative symptoms. A higher level of physical abuse was more commonly reported by men, younger individuals, and those with a higher level of antisocial PD traits. Higher levels of physical neglect were associated with more severe negative symptoms. ACEs are commonly observed in patients with schizophrenia. Therefore, it is strongly recommended that this clinical population be provided with a comprehensive assessment and individualized intervention for those exposed to specific ACEs.

Sex differences in personality disorders in a Chinese clinical population

INTRODUCTION

Sex differences in the frequency and severity of personality disorders (PDs) have been widely reported in Western countries. However, limited literature suggests a similar sex distribution in the Chinese clinical population. This study investigated sex differences in self-reported and interviewed patients with PDs in a clinical population in China.

MATERIALS AND METHODS

The participants were 1,389 consecutive outpatients with a mean age of 30.5 years, including 634 (45.6%) males and 755 (54.4%) females. Self-reported PD traits were assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). PDs were diagnosed according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis II (SCID-II).

RESULTS

Male outpatients reported more paranoid, schizotypal, antisocial, and passive-aggressive PD traits, whereas females reported more borderline PD traits on the PDQ-4+. Self-reported PD traits in male outpatients were more likely to reach the positive threshold of antisocial PD than in females (χ² = 5.293, p = 0.021). Males were more likely to meet the criteria for schizoid (χ² = 5.050, p = 0.025), narcissistic (χ² = 27.244, p < 0.001), antisocial (χ² = 11.430, p = 0.001), avoidant (χ² = 5.098, p = 0.024), and obsessive-compulsive PD (χ² = 5.496, p = 0.019) diagnoses in the SCID-II. In contrast, females were more likely to meet the criteria of histrionic (χ² = 12.327, p = 0.001), borderline (χ² = 28.538, p < 0.001), and dependent (χ² = 4.919, p = 0.027) diagnoses.

DISCUSSION

These findings indicate gender differences in the traits, frequency, and pattern of PDs when assessed in a Chinese clinical population.

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

Introduction: The burden of personality disorders (PDs) in China is large and the focus on mental health services is increasing. However, there is a lack of sufficient evidence regarding the prevalence of comorbid PD in psychotic and non-psychotic disorders, and whether PDs have different distributions. We aimed to investigate the PD comorbidity distribution pattern between psychotic and non-psychotic disorders using a clinical population-based study. Materials and Methods: We conducted a cross-sectional study of 1,497 patients in Shanghai. PDs were screened using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). All patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis II (SCID-II). We compared the differences in PD comorbidities classified as the 10 types of PDs in the DSM-IV, in 531 patients with psychosis and 966 patients with non-psychotic disorders. Results: More than one-third (37%) of patients with psychotic disorders met the criteria of at least one PD. Approximately half (46%) of patients with non-psychotic disorders met the criteria of at least one PD. Patients with non-psychotic disorders were more likely to meet the criteria of borderline (χ² = 20.154, p < 0.001) and obsessive-compulsive PD (χ² = 21.164, p < 0.001) diagnoses compared to those with psychotic disorders. In contrast, patients with psychotic disorders were more likely to meet the criteria of paranoid (χ² = 11.144, p = 0.001) and schizotypal PD (χ² = 14.004, p < 0.001) diagnoses than those with non-psychotic disorders. Discussion: PD comorbidity is common and comorbidity distribution pattern is varied in patients with psychotic and non-psychotic disorders, implicating the development of specific strategies that could screen and assess PDs in psychiatric clinical practice.

Comparing the Self-Reported Personality Disorder Traits and Childhood Traumatic Experiences Between Patients With Schizophrenia Vs. Major Depressive Disorder

Introduction: Personality disorder (PD) and childhood traumatic experience (CTE) are well- recognized risk factors for the development of schizophrenia (SZ) and major depressive disorder (MDD). The relationship between CTE and PD is extremely close, and both conditions can affect subsequent psychiatric disorders. Little is known about the differences of these factors in patients with SZ and those with MDD. Materials and Methods: A total of 1,026 outpatients participated in the study, including 533 (51.9%) with SZ and 493 (48.1%) with MDD who were sequentially sampled. The PD traits were assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). The Child Trauma Questionnaire Short Form (CTQ-SF) was used to assess childhood adversities. The scores and associations of PDQ-4+ and CTQ-SF between patients with SZ and those with MDD were compared. Results: The MDD group exhibited more PD traits and more childhood emotional neglect than the SZ group. In patients with MDD, the correlation between PD traits and CTE was significantly higher than that in patients with SZ. Patients with SZ vs. those with MDD showed different PD traits and CTE. The schizotypal and antisocial PD traits, as well as sexual abuse and physical neglect CTE, were significantly related to SZ. In contrast, the borderline, narcissistic and avoidant PD traits, and emotional abuse/neglect CTE were significantly associated with MDD. Discussion: These findings indicated a robust relationship between CTE and PD traits. Moreover, patients with SZ or MDD, have different interactive patterns. Both CTE and PD traits have the potential to be premorbid risk factors that could be targeted for preventative interventions.