Jana Ranson, Ph.D. Department of Neurosurgery Medical College of Wisconsin

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1 Different Acute Postinjury Symptoms Mediate the Relation Between Maladaptive Personality and Later PTSD Symptoms in Mild Traumatic Brain Injury (mtbi) and Non-TBI Orthopedic Polytrauma (OT) Civilian Inpatients Jana Ranson, Ph.D. Department of Neurosurgery Medical College of Wisconsin From the Community to the Battlefield: Learning and Training Together Inaugural Symposium December 7, 2017

2 Background ~2.5M US civilians hospitalized annually with traumatic brain or bodily injuries (CDC, 2016) > 50% no PTSD 10 40% PTSD Trauma is necessary but insufficient condition of PTSD Variability in PTSD susceptibility/resilience due to individual differences 2

3 Individual Differences Trait dispositional permanent/consistent premorbid State situational transitory acute Key trait/state PTSD risk factors identified in studies of trauma-injured patients: --premorbid maladaptive and adaptive personality traits --acute psychological response to traumatic injury 3

4 Personality Traits Maladaptive personality traits --more harmful than helpful --negative affect (neuroticism; withdrawal) --disinhibition (impulsivity; risk-taking) --antagonism (grandiosity; attention seeking) --psychoticism (perceptual dysregulation) --detachment (callousness; deceitfulness) Adaptive personality traits --more helpful than harmful --positive emotionality (optimism, self-regard) Maladaptive and adaptive traits can co-occur and interact

5 Acute Psychological Response to Trauma Somatic Symptoms malaise physical complaints Emotional Distress anxiety depression mild traumatic brain injury (mtbi) non-tbi orthopedic polytrauma (OT)

6 Objectives 1. Examine the collective role of maladaptive traits (i.e., maladaptive personality) in chronic PTSD experience* 2. Propose a temporal causal chain explaining how maladaptive personality may influence acute psychological response and how each influence chronic PTSD experience 3. Attempt to disambiguate the relation between acute psychological response (somatization vs. emotional disturbance) and injury type (mtbi vs. OT) wrt PTSD experience 4. Explore whether adaptive personality serves as a resilience factor that reduces chronic PTSD experience *PTSD experience operationalized as PTSD symptom endorsement 6

7 Participants Trauma-injured (mtbi & non-tbi) civilian inpatients --75 mtbi --GCS 13; LOC < 30m; PTA < 24h; other AMS --79 non-tbi OT Age: mtbi: 49.7 ± 20.3 OT: 48.4 ± 18.1 Caucasian: mtbi: 50 (66.7%) OT: 57 (72.2%) Male: mtbi: 35 (46.7%) OT = 55 (69.6%) 3mo PTSD Symptoms Leading injury cause: mtbi: MVC 42 (56.0%) OT: Fall 34 (43.0%) 7

8 Theoretical Framework Adapted diathesis-stress model of vulnerability to disease a ACUTE response Emotional distress Somatic complaints b Mediation Moderated Mediation PRE-EXISTING vulnerability Maladaptive personality c' PRE-EXISTING resilience factor Adaptive personality (positive emotionality) CHRONIC health outcome 3mo PTSD Symptoms Stressor context: traumatic injury

9 Statistical Approach 1. Examine distributional properties; tested mediation and GLM assumptions 2. Validate the maladaptive personality construct using factor analysis on the full sample (N = 154) --Factor scores maladaptive personality variable 3. Test diathesis-stress models using modern mediation analyses --Sig indirect effect (ab) = evidence of mediation (Hayes, 2018) --All model configurations run on both mtbi and OT samples 4. Test interaction of maladaptive X adaptive personality using conditional effects (moderated mediation) analyses --Sig ab + sig interaction (a or c' path) = conditional effect

10 Measures Maladaptive personality --Personality Disorder Inventory for DSM-5 (PID-5) --Negative affect, antagonism, disinhibition, psychoticism, detachment --Multidimensional Personality Questionnaire (MPQ) --Negative emotionality (NEM) --Externalizing Spectrum Inventory (ESI) --Disinhibition (DIS) Adaptive personality --MPQ Positive emotionality (PEM) Emotional distress --Brief Symptom Inventory (BSI-18) --global, anxiety, depression, somatic Somatic symptom/preoccupation --MMPI-RF-2 Somatic Complaints (RC1) PTSD --PTSD Checklist for DSM-5 (PCL-5)

11 Results ab: p.05 mtbi ab: p.05 OT a Acute Somatic Psych Response Symptoms b a Acute Emotional Psych Response Distress b Maladaptive Personality c' 3mo PTSD Symptoms Maladaptive Personality c' 3mo PTSD Symptoms Premorbid Adaptive Personality Premorbid Adaptive Personality Int: p.05 Int: p.05 11

12 Conclusions Understanding individuals psychological makeup can inform postinjury care and preventative treatments (e.g., coping, reframing, self-efficacy) Injury type (mtbi vs non-tbi OT) differentially influences the PTSD trajectory, at least acutely --explains what and how, but not why Trait and state assessments can facilitate early identification PTSDvulnerable individuals --Civilians bedside --Military & Sports pre-exposure 12

Thank you! Manuscript authors: Robyn E. Furger, MA Terri A.

Nelson, PhD The project described was supported by the National Center for

necessarily represent the official views of the NIH.

13 Thank you! Manuscript authors: Robyn E. Furger, MA Terri A. deroon-cassini, PhD James B. Hoelzle, PhD Michael A. McCrea, PhD Lindsay D. Nelson, PhD The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UL1 TR The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH. In addition, this project was funded by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin. 13

Measurement of pathological personality traits according to the DSM-5: A Polish adaptation of the PID-5 Part II empirical results

Measurement of pathological personality traits according to the DSM-5: A Polish adaptation of the PID-5 Part II empirical results Psychiatr. Pol. ONLINE FIRST Nr 99: 1 26 Published ahead of print 21 May 2018 www.psychiatriapolska.pl ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) DOI: https://doi.org/10.12740/pp/onlinefirst/86478