Personality in psychosis decades after onset: Tests of models of the relations between psychopathology and personality.

Abstract

Models have been put forth to describe relations between psychopathology and personality. However, the relation in individuals with psychotic disorders is unclear. As a test of models of psychopathology-personality in psychosis, the current study included 239 individuals, each with one of four psychotic disorders-schizophrenia (SZ), bipolar disorder with psychotic features (BPp), major depressive disorder with psychotic features (MDDp), and substance-induced psychosis (SIP)-and compared their personality to a never-psychotic sample (NP; n = 257). In support of the complication + scar model, we found SZ, BPp, MDDp, and SIP were significantly higher on neuroticism and detachment, and most were higher on mistrust and eccentric perceptions than the NP group (average Cohen's d = |0.83| across all personality measures). Also compared to the NP group, SZ was lower on extraversion, agreeableness, and conscientiousness; MDDp was lower on extraversion and conscientiousness; and SIP was lower on agreeableness and conscientiousness (average Cohen's d = |0.77|). Differences were observed among the psychotic disorder groups (SZ, BPp, MDDp, SIP), with effects up to d = 1.38. In support of the complication model, the non-recovered group was significantly higher on mistrust, eccentric perceptions, and detachment but lower on extraversion and conscientiousness than the recovered group (average d = |0.57| across measures). In support of the scar model, individuals who met threshold for recovery continued to manifest personality deviations, although smaller in magnitude (average d = |0.32| across measures) compared to NP. Overall, we found support for the complication and scar models, suggesting that while symptoms are associated with personality differences, psychosis is associated with permanent personality alterations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).