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Profiles of patients with a personality disorder admitted in a day hospital treatment program: Revealing spectra from the Hierarchical Taxonomy of Psychopathology

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Abstract

Research has shown so far the efficacy of day hospital treatment programs for patients with a personality disorder experiencing a crisis episode. However, relatively few studies have relied on a dimensional definition of personality pathology, despite the rise of dimensional models of personality disorders in recent years. The objective of this study is therefore to delimit profiles of patients with a personality disorder admitted in a day hospital treatment program using dimensional models of personality and attachment, and psychological distress. A total of 287 patients with a personality disorder completed a series of self-report measures assessing the Big Five personality traits, the Dark Triad components, insecure attachment dimensions, and psychological distress. Cluster analysis, successively using hierarchical and TwoStep algorithms, yielded a three-cluster solution. The three clusters were labeled: Externalizing-Antagonistic, Internalizing-Detached, and Relational and Emotional Difficulties. Each cluster showed a specific pattern of scores on Big Five personality traits, Dark Triad components, and insecure attachment dimensions, and all clusters were associated with clinically significant levels of psychological distress. Results highlight that features from the externalizing, internalizing, and/or detachment spectra of psychopathology distinguish clusters of PD patients admitted in a day hospital treatment program. These clusters are aligned with descriptions found in the recently proposed Hierarchical Taxonomy of Psychopathology. A continuum of severity in personality impairments across the three clusters was also discovered. The clinical and conceptual implications of the three-cluster solution are discussed.

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Data Availability

The data that support the findings of this study could be shared upon reasonable request and contingent upon the approval of an amendment by the ethics committee that authorized the study. Requests to access the data should be directed to claudia.savard@fse.ulaval.ca.

Notes

  1. The exact cluster B diagnosis was unspecified.

  2. The exact PD diagnoses were unspecified.

  3. The exact cluster C diagnosis was unspecified.

  4. A total of 64 patients had multiple PD diagnoses.

  5. A total of 186 patients also had comorbid diagnoses.

  6. Of note, no multicollinearity was found among these variables (tolerance > 0.10 for all variables, Hair et al., 1995; all bivariate correlations between variables < 0.90, Tabachnick & Fidell, 2013).

  7. Nonparametric mean comparisons were preferred, given that the distributions of the continuous variables under study were found to be non-normal (Tabachnick & Fidell, 2013) based on graphical (histogram), numerical (skewness and kurtosis coefficients), and statistical (Shapiro-Wilk test) indicators. Moreover, the possibility that clusters would be of different sizes could not be ruled out at this point.

  8. A total of n = 5 participants had to be excluded from the cluster analysis because of missing data on at least one endogenous variable.

  9. Based on the cut-off scores described in Lambert et al. (2004): > 63 for Total Score; > 36 for Symptom Distress; > 15 for Interpersonal Relations; and > 12 for Social Role.

  10. Based on secondary Student’s t-tests comparing Ms and SDs from the PD sample with Ms and SDs from community samples reported in Mezquita et al. (2019; BFPTSQ scales), Savard et al. (2017; DTDD scales) and Gamache, Savard, Faucher, et al. (2021; ECR-12 scales).

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Acknowledgements

We gratefully thank the clinical staff at the day hospital treatment program of the Centre de traitement le Faubourg Saint-Jean for their thoughtful comments and their support in the realization of this study.

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Authors and Affiliations

  1. Département de psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada

    Jonathan Faucher & Dominick Gamache

  2. Département des fondements et pratiques en éducation, Université Laval, Québec, QC, Canada

    Claudia Savard

  3. CERVO Brain Research Centre, Québec, QC, Canada

    Claudia Savard & Dominick Gamache

  4. Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada

    Maude Payant

  5. École de psychoéducation, Université de Montréal, Montréal, QC, Canada

    Julien Morizot

  6. Centre de traitement le Faubourg Saint-Jean, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada

    Marie-Chantal Tremblay-Canuel

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Correspondence to Jonathan Faucher.

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Marie-Chantal Tremblay-Canuel is an employee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, where the study was conducted. The other authors have no conflict of interest to declare.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Comité d’éthique de la recherche sectoriel en neurosciences et santé mentale from the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (No. 2017 − 171, 436–2016).

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Faucher, J., Savard, C., Payant, M. et al. Profiles of patients with a personality disorder admitted in a day hospital treatment program: Revealing spectra from the Hierarchical Taxonomy of Psychopathology. Curr Psychol 43, 2293–2306 (2024). https://doi.org/10.1007/s12144-023-04388-5

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  • DOI: https://doi.org/10.1007/s12144-023-04388-5

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