Psychiatry - Theses
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ItemPersonality and the trajectory of posttraumatic psychopathology( 2015-02-06)Objective: Comorbidity between psychiatric disorders is the rule rather than the exception, with some patterns of comorbidity more common than others. The tendency for disorders to cluster together in predictable patterns can be accounted for by the existence of higher order internalising and externalising dimensions. These dimensions, in turn, are underpinned by personality traits. The relationship between personality and psychopathology has been a particular focus of researchers interested in explaining the diverse range of psychopathology experienced by survivors of traumatic events. However, extant research in this field has been limited to cross-sectional investigations of PTSD comorbidity, despite the fact that PTSD patients represent only a small minority of trauma survivors. In addition, the relationship between personality and posttraumatic functioning outside of the mental health domain has received minimal attention. Perhaps most importantly, the influence of personality on the longitudinal trajectory of posttraumatic disorders has not been examined. Therefore it is not known whether personality profiles varying on the internalising and externalising dimensions respond differently to trauma exposure over time. Aims: In light of the limitations of the extant literature, this study aimed to 1) investigate whether and how pre-trauma personality influences the trajectory of a range of common posttraumatic disorders, and 2) establish the relationship between personality and non-psychiatric maladaptive responses to trauma. Method: During hospitalisation for serious physical injury, 323 Australian adults completed a retrospective assessment of pre-injury personality and psychiatric history. Post-injury psychiatric diagnoses were assessed 3 and 12 months later using a structured clinical interview. A range of non-psychiatric outcomes were also assessed at 12 months post-injury (e.g., disability, quality of life, anger, risk of re-injury, exposure to trauma and life stress). Latent profile analysis conducted on initial personality scores identified subgroups of participants, while latent change modelling examined differences in disorder trajectories controlling for psychiatric history. Regression analyses were used to investigate the influence of personality on non-psychiatric outcomes. Results: Three personality-based classes of trauma survivors were identified, corresponding to internalising, externalising, and normal personality profiles. After controlling for psychiatric history, the internalising class showed a high risk of developing all disorders. Unexpectedly, however, the normal personality class was not always at lowest risk of disorder. Rather, the externalising class, while more likely than the normal personality class to develop substance use disorders, were less likely to develop PTSD and depression. In terms of non-psychiatric outcomes, internalisers reported poorer health and higher levels of life stress and trauma exposure in the year after injury, while externalisers were more likely to engage in activities that put them at risk of re-injury. These relationships, however, were largely accounted for by gender and the experience of pain at 12 months post-injury. Conclusions: Results suggest that personality is an important mechanism in influencing the development and form of psychopathology and related outcomes after trauma. These findings suggest that screening and early intervention using a personality-based approach may be an effective method of predicting and subsequently preventing much of the burden of posttraumatic problems across both mental health and related domains.