Suicidal and violent behaviors as well as early life adversity are prevalent in clinical high-riskpopulations. Early life adversity is related to developmental dysregulation of behavioral andemotional traits. The neuroendocrine systems involved in the development of dysfunctionalbehavior and impulsive aggressive traits are not fully known. The overall aim of this thesiswas to investigate the relationship between thyroid hormones and personality traits, as well asto exposure to interpersonal violence and violent behavior in two high-risk cohorts of patientswith a history of suicide attempts. In study I we investigated personality traits assessed by the Karolinska Scales of Personalityin relation to peripheral thyroid hormones in 100 euthyroid suicide attempters. In studies II and III, we studied the relationship between exposure to, and expression ofinterpersonal violence and adult levels of thyroid and cortisol hormones in 92 clinicallyeuthyroid women with borderline personality disorder (BPD), with at least two prior suicideattempts. The Karolinska Interpersonal Violence Scale was used to assess exposure to, andexpression of interpersonal violence. Baseline thyroid function was evaluated by measuringplasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroidstimulatinghormone (TSH) with immunoassays. The FT3/FT4 ratio was used to estimate theperipheral deiodination. Plasma cortisol was also measured. In study IV we investigated the screening validity of the Karolinska Interpersonal ViolenceScale, in predicting post-traumatic stress disorder (PTSD) in 106 women with BPD, with atleast two prior suicide attempts. In study I, we found that in male suicide attempters, the T3/FT4 ratio was negativelycorrelated to Aggressiveness and positively correlated to Detachment. In study II, 67% ofwomen with BPD reported Medium High or High levels of exposure to interpersonalviolence as a child. The FT3/FT4 ratio showed a significant negative correlation withexposure to violence as a child. Patients with PTSD had significantly higher plasma cortisollevels. In study III, the mean expression of interpersonal violence as an adult wassignificantly higher in BPD patients as compared to healthy controls. Adult expression ofinterpersonal violence among females with BPD, showed a significant positive correlationwith the T3 levels. T3 and comorbid diagnosis of alcohol abuse were independent predictorsof adult expression of interpersonal violence. In study IV, the PTSD diagnosis was valid for(58%) women with BPD. The KIVS – exposure of lifetime interpersonal violence, displayeda fair accuracy of predicting diagnosis of PTSD. Our findings indicate that peripheral thyroid hormones may be associated with early lifeadversity, adult aggressive traits and interpersonal violence in clinical high-risk psychiatricpopulations. Karolinska Interpersonal Violence Scale may be used for PTSD screening.
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