Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study

Abstract Background Early exposure to trauma is a known risk factor for personality disorder (PD), but evidence for late-onset personality pathology following trauma in adults is much less clear. We set out to investigate whether exposure to war trauma can lead to lasting personality pathology in ad...

Full description

Bibliographic Details
Main Authors: Jasna Munjiza, Dolores Britvic, Mike J. Crawford
Format: Article
Language:English
Published: BMC 2019-01-01
Series:BMC Psychiatry
Subjects:
War
Online Access:http://link.springer.com/article/10.1186/s12888-018-1975-5
id doaj-e66f2006212748cd9c87691363ab36f6
record_format Article
spelling doaj-e66f2006212748cd9c87691363ab36f62020-11-25T01:51:06ZengBMCBMC Psychiatry1471-244X2019-01-011911910.1186/s12888-018-1975-5Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort studyJasna Munjiza0Dolores Britvic1Mike J. Crawford2Centre for Psychiatry, Faculty of Medicine, Imperial College LondonDepartment of Psychiatry, School of Medicine Split, University of SplitCentre for Psychiatry, Faculty of Medicine, Imperial College LondonAbstract Background Early exposure to trauma is a known risk factor for personality disorder (PD), but evidence for late-onset personality pathology following trauma in adults is much less clear. We set out to investigate whether exposure to war trauma can lead to lasting personality pathology in adults and to compare the mental health and social functioning of people with late–onset personality problems with those with PD. Methods We recruited patients who scored positively on the International Personality Disorder Examination (IPDE) in southern Croatia 15 years after the Croatian war of independence and used a semi-structured interview to establish when the person’s personality-related problems arose. All participants also completed Harvard Trauma Questionnaire, and measures of mental health and social functioning. Results Among 182 participants with probable personality disorder, 65 (35.7%) reported that these problems started after exposure to war-trauma as adults. The most prevalent personality problems among those with late-onset pathology were borderline, avoidant, schizotypal, schizoid and paranoid. Participants with late-onset personality pathology were more likely to have schizotypal (75.4% vs. 47.3%) and schizoid traits (73.8% vs. 41.1%) compared to those with PD. Participants with late-onset personality pathology were three times more likely to have complex personality pathology across all three DSM-IV clusters compared to those with PD (OR = 2.96, 95% CI 1.54 to 5.67) after adjusted for gender and marital status. The prevalence of depression and social dysfunction were as high among those with late-onset personality pathology as among those with personality disorder. Conclusion Retrospective accounts of people with significant personality pathology indicate that some develop these problems following exposure to severe trauma in adulthood. Personality-related problems which start in adulthood may be as severe as those that have an earlier onset. These findings highlight the long term impact of war trauma on the mental health and have implications for the way that personality pathology is classified and treated.http://link.springer.com/article/10.1186/s12888-018-1975-5Late-onset personality pathologySevere traumaPTSDPersonality disorderWar
collection DOAJ
language English
format Article
sources DOAJ
author Jasna Munjiza
Dolores Britvic
Mike J. Crawford
spellingShingle Jasna Munjiza
Dolores Britvic
Mike J. Crawford
Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
BMC Psychiatry
Late-onset personality pathology
Severe trauma
PTSD
Personality disorder
War
author_facet Jasna Munjiza
Dolores Britvic
Mike J. Crawford
author_sort Jasna Munjiza
title Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
title_short Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
title_full Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
title_fullStr Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
title_full_unstemmed Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
title_sort lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study
publisher BMC
series BMC Psychiatry
issn 1471-244X
publishDate 2019-01-01
description Abstract Background Early exposure to trauma is a known risk factor for personality disorder (PD), but evidence for late-onset personality pathology following trauma in adults is much less clear. We set out to investigate whether exposure to war trauma can lead to lasting personality pathology in adults and to compare the mental health and social functioning of people with late–onset personality problems with those with PD. Methods We recruited patients who scored positively on the International Personality Disorder Examination (IPDE) in southern Croatia 15 years after the Croatian war of independence and used a semi-structured interview to establish when the person’s personality-related problems arose. All participants also completed Harvard Trauma Questionnaire, and measures of mental health and social functioning. Results Among 182 participants with probable personality disorder, 65 (35.7%) reported that these problems started after exposure to war-trauma as adults. The most prevalent personality problems among those with late-onset pathology were borderline, avoidant, schizotypal, schizoid and paranoid. Participants with late-onset personality pathology were more likely to have schizotypal (75.4% vs. 47.3%) and schizoid traits (73.8% vs. 41.1%) compared to those with PD. Participants with late-onset personality pathology were three times more likely to have complex personality pathology across all three DSM-IV clusters compared to those with PD (OR = 2.96, 95% CI 1.54 to 5.67) after adjusted for gender and marital status. The prevalence of depression and social dysfunction were as high among those with late-onset personality pathology as among those with personality disorder. Conclusion Retrospective accounts of people with significant personality pathology indicate that some develop these problems following exposure to severe trauma in adulthood. Personality-related problems which start in adulthood may be as severe as those that have an earlier onset. These findings highlight the long term impact of war trauma on the mental health and have implications for the way that personality pathology is classified and treated.
topic Late-onset personality pathology
Severe trauma
PTSD
Personality disorder
War
url http://link.springer.com/article/10.1186/s12888-018-1975-5
work_keys_str_mv AT jasnamunjiza lastingpersonalitypathologyfollowingexposuretoseveretraumainadulthoodretrospectivecohortstudy
AT doloresbritvic lastingpersonalitypathologyfollowingexposuretoseveretraumainadulthoodretrospectivecohortstudy
AT mikejcrawford lastingpersonalitypathologyfollowingexposuretoseveretraumainadulthoodretrospectivecohortstudy
_version_ 1724998566860029952