The role of childhood maltreatment in the altered trait and global expression of personality in cocaine addiction

https://doi.org/10.1016/j.jpsychires.2015.02.015Get rights and content

Highlights

  • Cocaine dependent individuals with a history of early life stress (Coc+/ELS+) expressed the greatest trait deviations.

  • A hypothesized interaction between cocaine dependence and ELS did not significantly predict any personality trait.

  • Four discrete clusters of personality profiles emerged from the subject sample.

  • Logistic regression showed that subject group (Coc+/ELS+, Coc-/ELS+ or Coc-/ELS-) predicted personality profile expression.

Abstract

Background and aims

Drug addictions are debilitating disorders that are highly associated with personality abnormalities. Early life stress (ELS) is a common risk factor for addiction and personality disturbances, but the relationships between ELS, addiction, and personality are poorly understood.

Methods

Ninety-five research participants were assessed for and grouped by ELS history and cocaine dependence. NEO-FFI personality measures were compared between the groups to define ELS− and addiction-related differences in personality traits. ELS and cocaine dependence were then examined as predictors of personality trait scores. Finally, k-means clustering was used to uncover clusters of personality trait configurations within the sample. Odds of cluster membership across subject groups was then determined.

Results

Trait expression differed significantly across subject groups. Cocaine-dependent subjects with a history of ELS (cocaine+/ELS+) displayed the greatest deviations in normative personality. Cocaine dependence significantly predicted four traits, while ELS predicted neuroticism and agreeableness; there was no interaction effect between ELS and cocaine dependence. The cluster analysis identified four distinct personality profiles: Open, Gregarious, Dysphoric, and Closed. Distribution of these profiles across subject groups differed significantly. Inclusion in cocaine+/ELS+, cocaine-/ELS+, and cocaine-/ELS− groups significantly increased the odds of expressing the Dysphoric, Open and Gregarious profiles, respectively.

Conclusions

Cocaine dependence and early life stress were significantly and differentially associated with altered expression of individual personality traits and their aggregation as personality profiles, suggesting that individuals who are at-risk for developing addictions due to ELS exposure may benefit from personality centered approaches as an early intervention and prevention.

Introduction

Drug addiction remains a major socioeconomic problem associated with marked morbidity and mortality. Genetic and environmental factors are thought to represent the major determinants of drug addiction (Agrawal and Lynskey, 2008, Enoch, 2012), though their impacts are often indirect and intertwined with intermediate factors such as personality variables (Davis and Loxton, 2013, Gorwood et al., 2012). Personality is defined as an individual's set of enduring, largely predictable traits, behaviors, and thought processes and is represented by both individual traits, such as neuroticism and impulsiveness, as well as clusters or profiles that represent global trait organization. Although most personality studies of drug use disorders (DUDs) focus on categorical DSM-defined Axis-II personality disorders (PDs), individuals who have or are at high risk for having a DUD also deviate significantly from general population scores for dimensional, non-pathological personality traits (Allen and Lauterbach, 2007, Drerup Stokes et al., 2013, Franken et al., 2006, Kotov et al., 2010, Sher et al., 2000).

Every stage of the addiction process, from drug use initiation to relapse, is closely associated with altered normative personality trait expression (Elkins et al., 2006, Grekin et al., 2006, Prisciandaro et al., 2011). Certain personality traits predict DUDs (Lukasiewicz et al., 2008, Turiano et al., 2012) and are associated with an early onset of drug use (Anderson et al., 2007, Malmberg et al., 2012, Nees et al., 2012), the transition from impulsive to compulsive drug abuse (Ersche et al., 2013), and an increased risk of drug use relapse (Fisher et al., 1998).

Childhood adversity, which represents a major risk for drug addiction (Dube et al., 2003), is highly associated with personality alterations. Although personality variation is approximately 50% heritable (Turkheimer et al., 2014), personality development is significantly influenced by early-life experience, especially adversity and maltreatment (Congdon et al., 2012). Particular subtypes of childhood maltreatment (e.g., physical abuse, sexual abuse, emotional neglect) are each associated with increased risk for specific PDs (Nederlof et al., 2010, Zhang et al., 2012), and experiencing multiple subtypes of maltreatment increases risk of having one or more PDs (Zhang et al., 2012). PDs are frequently comorbid with other psychiatric disorders such as DUDs with a reported 46% prevalence of one or more PDs in a DUD inpatient population (Langas et al., 2012). As the number of adverse childhood experiences increases, graded increases occur in the prevalence of PDs and the risk of DUDs (Dube et al., 2003, Johnson et al., 2006). Evidence suggests that personality development that has been negatively impacted by early life adversity may act to strengthen the association between susceptibility for DUDs and early life stress (ELS) (Kim et al., 2009) (Oshri et al., 2013). The drug addiction process, therefore, has well-established relationships to both personality development and childhood maltreatment, but—to our knowledge—the distinct personality outcomes associated with ELS, drug addiction and their interaction have not been previously reported. Such new knowledge could support the development of personality-targeted interventions that promote resilience and prevent addictions in at-risk individuals who have a significant history of ELS. Similarly, Conrod and colleagues successfully reduced drug and alcohol use behaviors in adolescents by assessing problematic trait expression (e.g., sensation seeking, impulsivity, anxiety sensitivity, hopelessness) to identify at-risk individuals, who then received cognitive behavioral therapy (Conrod et al., 2010, Conrod et al., 2013). The present study expands these findings by identifying divergences in personality expression between resilient and susceptible subjects who each carry a major risk factor for addiction (i.e., ELS).

The present study investigated relationships between drug (i.e., cocaine) addiction, exposure to childhood maltreatment and personality variation (Fig. 1). We performed a secondary analysis of a case–control, cross-sectional dataset that probed the brain–behavior relationships underlying impulsivity in ninety-five individuals, including participants who were cocaine dependent at the time of recruitment (Elton et al., 2014a, Elton et al., 2014b); therefore, the personality trait scores measured in the present study were taken from individuals who had already developed cocaine dependence. This study does not exhaustively probe the directionality of every possible relationship between ELS, cocaine dependence and normative personality; rather, its purposes are to determine if and how ELS history or absence affects personality expression in cocaine-dependent individuals and whether resilient individuals (those with ELS history but no addiction) display unique personality features. In the present work, we tested the overall study hypothesis that ELS history and cocaine dependence are associated with distinct alterations in personality. As enumerated in Fig. 1, the following specific hypotheses were also tested: 1) that ELS and cocaine dependence each predict altered personality trait expression, 2) that ELS and cocaine dependence interact in predicting altered personality expression, 3) that clusters of distinct trait configurations, referred to as profiles, would emerge from within the sample, and 4) that ELS and cocaine dependence would be selectively associated with specific personality profiles. To test these hypotheses, we compared personality traits (trait-centered approach, Fig. 1A) and trait configurations as profiles (person-centered approach, Fig. 1B) (Crockett et al., 2006) across four groups of adults that differed with respect to the presence and absence of cocaine dependence or moderate to severe ELS. We constructed multiple linear regression models that predict trait expression for ELS and cocaine dependence status. Because clusters of multiple personality dimensions better predict psychopathology and risk profiles than do individual traits (Janson and Mathiesen, 2008, Rettew et al., 2008, Wessman et al., 2012), we used a data-driven cluster analysis of trait expression to uncover the most prevalent combinations of traits (i.e., profiles) among individuals within the sample (see Supporting Information). We also determined how subject group membership affects the odds of expressing each personality profile. The identification and analysis of specific personality traits was based on the well-established five-factor model (FFM) of personality (McCrae and Costa, 1985). To our knowledge, this is the first case–control cross-sectional study design used to test the hypothesis that both cocaine addiction and exposure to childhood maltreatment are associated with significant alterations in personality and that their co-occurrence is associated with increased risk of expressing specific profiles of altered personality traits.

Section snippets

Subjects

Ninety-five participants ages 18 to 50 (37 female, mean age 38 ± 8.8 years) were enrolled in the study. Recruitment advertisements targeting individuals with childhood maltreatment, current cocaine dependence and healthy comparison subjects were posted in the community (Little Rock, AR), including city buses, and in area newspapers. A phone screening preliminarily assessed study eligibility and described the study procedures; eligible participants provided written informed consent to

Subject groups

Cocaine-dependent subjects were significantly older than non-cocaine-dependent subjects (P < 0.0083, one-way ANOVA with Bonferroni's correction for six pairwise comparisons). There were significant group differences in the proportion of subjects with education beyond high school (χ2 = 22.56, df = 3, P < 0.0001); subjects in cocaine-dependent groups were less educated than those in non-cocaine-dependent groups. Groups did not differ in sex, race, income, and employment. As expected,

Discussion

The present study demonstrated that individuals with both cocaine dependence and childhood maltreatment histories have significant and distinct alterations in the expression of both individual personality traits and configurations of traits compared with individuals who have zero or only one of the independent variables. As a group, cocaine-dependent individuals with a history of ELS were significantly more neurotic and less open, agreeable, and conscientious than controls. These findings

Role of funding source

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Contributors

Participated in research design: Brents, Tripathi, Young, James, Kilts. Data Acquisition: Young. Performed data analysis: Brents, Tripathi. Wrote or contributed to the writing of the manuscript: Brents, Tripathi, Young, James, Kilts.

Declarations of interest

The authors declare no conflicts of interest. Funding for this study was provided by the National Institutes of Health (NIH) National Institute on Drug Abuse (RO1DA019999 and T32DA022981) and the NIH Clinical and Translational Science Award (CTSA) program (UL1TR000039 and KL2TR000063). The CTSA program is led by the NIH's National Center for Advancing Translational Sciences (NCATS).

Acknowledgments

The authors acknowledge Dr. Margaret E. Brenner (UAMS Office of Grants and Scientific Publications) for her efforts in editing the manuscript.

References (59)

  • D.C. Rettew et al.

    Latent profiles of temperament and their relations to psychopathology and wellness

    J Am Acad Child Adolesc Psychiatry

    (2008)
  • N.A. Turiano et al.

    Personality and substance use in midlife: conscientiousness as a moderator and the effects of trait change

    J Res Personal

    (2012)
  • T. Zhang et al.

    Role of childhood traumatic experience in personality disorders in China

    Compr Psychiatry

    (2012)
  • J.S. Adelstein et al.

    Personality is reflected in the brain's intrinsic functional architecture

    Plos One

    (2011)
  • A. Agrawal et al.

    Are there genetic influences on addiction: evidence from family, adoption and twin studies

    Addiction

    (2008)
  • B. Allen et al.

    Personality characteristics of adult survivors of childhood trauma

    J Trauma Stress

    (2007)
  • N. Castellanos-Ryan et al.

    Sensitivity and specificity of a brief personality screening instrument in predicting future substance use, emotional, and behavioral problems: 18-month predictive validity of the Substance Use Risk Profile Scale

    Alcohol Clin Exp Res

    (2013)
  • R.B. Cattell

    The description of personality: basic traits resolved into clusters

    J Abnorm Soc Psychol

    (1943)
  • C.R. Cloninger et al.

    A psychobiological model of temperament and character

    Arch Gen Psychiatry

    (1993)
  • E. Congdon et al.

    Early environment and neurobehavioral development predict adult temperament clusters

    Plos One

    (2012)
  • P.J. Conrod et al.

    Brief, personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence

    Arch Gen Psychiatry

    (2010)
  • P.J. Conrod et al.

    Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: a cluster randomized controlled trial

    JAMA Psychiatry

    (2013)
  • P.T. Costa et al.

    Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual

    (1992)
  • L.J. Crockett et al.

    Psychological profiles and adolescent adjustment: a person-centered approach

    Dev Psychopathol

    (2006)
  • L. Drerup Stokes et al.

    Family environment, personality, and psychological symptoms in adults sexually abused as children

    J Child Sex Abuse

    (2013)
  • S.R. Dube et al.

    Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study

    Pediatrics

    (2003)
  • I.J. Elkins et al.

    Personality traits and the development of nicotine, alcohol, and illicit drug disorders: prospective links from adolescence to young adulthood

    J Abnorm Psychol

    (2006)
  • A. Elton et al.

    Childhood maltreatment is associated with a sex-dependent functional reorganization of a brain inhibitory control network

    Hum Brain Mapp

    (2014)
  • A. Elton et al.

    Neural network activation during a stop-signal task discriminates cocaine-dependent from non-drug-abusing men

    Addict Biol

    (2014)
  • Cited by (16)

    • Adolescent social isolation increases cocaine seeking in male and female mice

      2019, Behavioural Brain Research
      Citation Excerpt :

      We suggest that this increased behavioral responsivity to cocaine may be mediated by heightened glutamate activity within reward and stress related circuitry. Early life stress is a risk factor for the development of addiction in humans [5–7]. Social stressors are highly prevalent and among the most powerful stressful stimuli experienced by humans [24].

    • Personality variables modify the relationship between childhood maltreatment history and poor functional outcomes

      2018, Psychiatry Research
      Citation Excerpt :

      The NEO-FFI is a well-validated instrument used to assess the five-factor model personality traits of neuroticism, extraversion, openness to experience, agreeableness and conscientiousness (McCrae and Costa, 2004; Saucier, 1998). The present study focused on the traits neuroticism and agreeableness, as these traits have been associated with outcomes of childhood maltreatment histories (Brents et al., 2015). The NEO-FFI is a self-report survey composed of 60 items presented in a first-person, self-descriptive narrative (e.g., “I often feel tense and jittery” “I would rather cooperate with others than compete with them”).

    • Personality traits as possible mediators in the relationship between childhood trauma and depressive symptoms in Chinese adolescents

      2018, Journal of Psychiatric Research
      Citation Excerpt :

      Childhood traumas not only result in children's fear, anxiety and depressed emotion at that time, but also shape children's insecure and incredible understanding to person and the world (Carver et al., 2014). Children who experienced long term and lasting negative stress in growing up processes are likely to develop unfavorable personality and cognitive style (Brents et al., 2015; Hovens et al., 2016; Lee and Song, 2017). When encountering stressful events in later life, they may cope with the stress based on their maladaptive personality, further be prone to produce learning helplessness and suffer from depression.

    • Childhood maltreatment, maladaptive personality types and level and course of psychological distress: A six-year longitudinal study

      2016, Journal of Affective Disorders
      Citation Excerpt :

      The Five Factor Model (FFM) according to which individual differences in personality can be grouped along the five major dimensions of neuroticism, extraversion, openness, agreeableness, and conscientiousness presently constitutes one of the dominant models to study personality (dys)functioning in a comprehensive way (Kotov et al., 2010) and easily to implement short self-report scales for measuring the Big Five traits are available (such as the NEO-FFI; Costa and McCrae, 1992). Cross-sectional (Rogosch and Cicchetti, 2004; Brents et al., 2015) and longitudinal (Oshri et al., 2013) epidemiological studies in children have demonstrated an association of childhood maltreatment with psychopathology, which was mediated by FFM personality traits or personality organization. Epidemiological studies in adults also yield evidence for an association of childhood maltreatment with FFM personality traits, in particular neuroticism (Allen and Lauterbach, 2007; Collishaw et al., 2007; Kendler and Gardner, 2011; Moran et al., 2011; Robinson et al., 2014).

    View all citing articles on Scopus
    View full text