Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia

XiaoLiang Wang; XiaoDong Ni; YanYan Wei; LiHua Xu; XiaoChen Tang; HaiChun Liu; ZiXuan Wang; Tao Chen; JiJun Wang; Qing Zhang; TianHong Zhang

doi:10.2147/NDT.S462346

Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia

Neuropsychiatr Dis Treat. 2024 May 9:20:989-999. doi: 10.2147/NDT.S462346. eCollection 2024.

Authors

XiaoLiang Wang^#¹, XiaoDong Ni^#¹, YanYan Wei¹, LiHua Xu¹, XiaoChen Tang¹, HaiChun Liu², ZiXuan Wang³, Tao Chen^{4

5}, JiJun Wang¹, Qing Zhang¹, TianHong Zhang¹

Affiliations

¹ Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People's Republic of China.
² Department of Automation, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
³ Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, People's Republic of China.
⁴ Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada.
⁵ Labor and Worklife Program, Harvard University, Cambridge, MA, USA.

^# Contributed equally.

Abstract

Introduction: Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients.

Methods: A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form.

Results: Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=-2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ²=4.805, p=0.028) and schizoid (χ²=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ²=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients.

Discussion: These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.

Keywords: abuse; neglect; personality disorder; psychosis; schizophrenia.

Grants and funding

This study was supported by the Ministry of Science and Technology of China, National Key R&D Program of China (2023YFC2506800), National Natural Science Foundation of China (82171544, 82371505, 82151314, 82101623, 82101582).