Latent class analysis of personality disorders in adults with posttraumatic stress disorder: Results from the national epidemiologic survey on alcohol and related conditions

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-/V 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% Cl, 0.38-0.75) and was more likely to have been prescribed medication for PTSD (OR= 1.65; 95% Cl, 1.20-2.28) and to have used alcohol and drugs to mitigate their PTSD symptoms (OR = 2.77; 95% Cl, 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% Cl, 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.