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Latent Class Analysis of Personality Disorders in Adults With Posttraumatic Stress Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

J Clin Psychiatry 2014;75(3):276-284
10.4088/JCP.13m08466

Objective: To characterize predominant typologies of co-occurring personality disorders among adults with posttraumatic stress disorder (PTSD) and examine their relation to Axis I comorbidities, health-related quality of life, and course and treatment of PTSD.

Method: Latent class analysis was conducted on the 10 DSM-IV personality disorders in a nationally representative sample of 2,463 adults with a lifetime diagnosis of PTSD from Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions.

Results: Three latent classes of personality disorders were identified: a borderline-dysregulated class (11.4%), an obsessive-paranoid class (13.1%), and a no/low personality disorders class (75.5%). The borderline-dysregulated and obsessive-paranoid classes were more likely than the no/low personality disorder class to have a broad range of comorbid Axis I diagnoses and to have ever attempted suicide (ORs = 1.50–8.01), and they reported lower mental health–related quality of life. The borderline-dysregulated class was less likely than the no/low personality disorder class to have experienced remission of their most recent episode of PTSD (OR = 0.54; 95% CI, 0.38–0.75) and was more likely to have been prescribed medication for PTSD (OR = 1.65; 95% CI, 1.20–2.28) and to have used alcohol and drugs to mitigate their PTSD symptoms (OR = 2.77; 95% CI, 1.62–4.74). The obsessive-paranoid class was more likely than the no/low personality disorders class to report sexual assault as their worst trauma (OR = 2.22; 95% CI, 1.36–3.61) and had an earlier age at onset of PTSD symptoms compared to the other 2 classes.

Conclusions: Among US adults with PTSD, the 10 DSM-IV personality disorders can be classified into 3 “person-based” typologies, which are differentially associated with comorbid Axis I disorders, mental health–related quality of life, and clinical and treatment characteristics of this disorder. These results suggest that comprehensive assessment of personality disorders may help inform etiologic models and treatment approaches for PTSD.

J Clin Psychiatry

Submitted: March 12, 2013; accepted July 15, 2013.

Online ahead of print: December 10, 2013 (doi:10.4088/JCP.13m08466).

Corresponding author: Jack Tsai, VA Connecticut Healthcare System, 950 Campbell Ave, 151D, West Haven, CT 06516 (Jack.Tsai@yale.edu).