Adaptive and maladaptive features of schizotypy clusters in a community sample

Schizotypal personality traits correlate with psychopathology and impaired functional outcome. Yet advantageous aspects of positive schizotypy may exist which could promote resilience and creativity, and several studies have identified a high positive but low negative schizotypy group with some signs of adaptation. The aim of our study was to clarify whether such individuals demonstrate only traits associated with well-being, or they also have traits that predict impairment. Participants (N = 643 students, 71.5% female) completed measures of schizotypy, resilience, self-esteem, self-concept clarity, and absorption. We identified four clusters: an overall low schizotypy, an overall high schizotypy, a disorganised-interpersonal schizotypy and a positive schizotypy cluster. The overall high schizotypy cluster seemed to be the most vulnerable as it was the least resilient and showed widespread maladaptation, whereas the high positive schizotypy cluster had intact self-esteem and high resilience and its elevated absorption may hold the promise for adaptive outcomes such as creativity and positive spirituality. However, the high positive schizotypy cluster lacked self-concept clarity. The results suggest that individuals showing high positive and low negative schizotypy demonstrate features promoting mental well-being to an extent that is higher than in all the other clusters, while their self-concept impairment is similar to that observed in the high and the disorganised-interpersonal schizotypy clusters. Better understanding of these factors could be informative for prevention and treatment of psychosis-spectrum disorders.

signs of psychotic and affective psychopathology 36,37 , however, it also possesses potential sources of resilience such as elevated openness and extraversion 37 , low negative emotionality, and high cooperativeness and selftranscendence 39 and increased sense of coherence 41 . Moreover, enhanced motivational functioning and hedonic capacity in the positive schizotypy group is implicated by findings showing that it has very low levels of negative schizotypy 38 , has an increased capability of experiencing anticipatory and consummatory pleasure, and it is characterised by lower suppression and higher expression of emotions 36 . In contrast, the overall high schizotypy cluster has the worst functional outcome 37 , shows high negative emotionality and reduced cooperativeness 39 , and demonstrates the poorest cognitive performance 38,39 .
Relatedly, several lines of evidence suggest that there might be adaptive aspects of positive schizotypy that may enrich one's life with meaning and can be a source of resilience 42 . Positive schizotypy has been shown to covary with openness 43,44 , which is a robust predictor of creativity 45 , happiness, and quality of life 46 . On a related note, positive schizotypy has a weak positive correlation with creativity 47 , and more specifically, with the phenomenology of artistic creativity 48,49 . Moreover, once adverse correlates of disorganised schizotypy such as reduced intellect or insomnia are statistically adjusted for, disorganised schizotypy positively predicts creative achievements in science and problem solving on the remote associates task, respectively 33 . Another study has found that specific aspects of positive (magical thinking, odd beliefs) and disorganised schizotypy (odd behaviour) predicted higher subjective well-being, once the negative effects of interpersonal impairments were adjusted for 50 .
The motivation of the present study was to further elaborate the idea that positive schizotypy can be adaptive 42 by a fine-grained analysis. First, we assessed traits relevant for creativity and psychopathology in context of the schizophrenia-spectrum such as absorption 44,[51][52][53] and self-concept clarity [54][55][56][57][58] , respectively. Absorption has been conceptualised as the tendency to get deeply immersed in sensory experiences and imagination while suspending a sense of active control 51 . It is associated with openness to experience, synesthetic experiences and appreciation and production of art 59 , and it predicts psychotic-like experiences 53 and hallucinations 52 . Furthermore, absorption mediates the association of positive schizotypy with artistic creativity 49 and predicts spiritual and aesthetic experiences 51 . Self-concept clarity is defined as 'the extent to which the contents of …self-concept are clearly and confidently defined, internally consistent, and temporally stable' 54 and it predicts mental well-being and psychological adaptation 54,55 . Furthermore, in line with theories emphasising the role of narrative selfdisturbance in schizophrenia-spectrum disorders 60,61 , low self-concept clarity predicts thought disorder 62 and schizotypy and psychotic-like experiences [56][57][58] . Second, to gain information on mental health and well-being more broadly, we measured resilience 63 and self-esteem 64 . Resilience is defined as the ability to successfully cope with stressors and adapt when faced with adversity 65 . It has been argued that the interaction between resilience and schizotypy is critical in predicting risk for schizophrenia in that individuals with high schizotypy and low resilience are the most vulnerable 4 . On the other hand, identifying individuals with high schizotypy and high resilience can facilitate the understanding of protective factors. Self-esteem is a general indicator of well-being and it correlates with school and occupational success, happiness and reduced depression 64 . Relatedly, previous studies have shown that positive and negative schizotypy are associated with more negative and less positive valuation of the self, respectively 27 .
It remains an open question whether some manifestations of positive schizotypy are linked to increased well-being instead of impaired mental health. We argue that two versions of an adaptive schizotypy hypothesis can be formulated. Both predict a positive schizotypy group with certain adaptive features that can promote well-being and creativity. However, the strong version claims that positive schizotypy in itself can be benign and thus it would predict no psychological maladaptation in this group 39,42 . In contrast, given the specific associations between positive schizotypy and various mental health complaints [26][27][28][29] , a moderate version also seems plausible: this would predict that the positive schizotypy group suffers from subtle psychopathology but also shows greater resilience and improved self-esteem, which effectively counter the effects of an incoherent self and ultimately contribute to increased quality of life. Here, we empirically compare these competing versions of the adaptive schizotypy hypothesis, using a large non-clinical sample and a unique set of highly relevant personality measurements. Considering developmental aspects of schizotypy 66 , and age and sex differences in the prevalence of schizotypal personality disorder and the pattern of comorbid disorders 67 , we also evaluate sex and age differences between the groups.

Methods
Participants. The sample comprised of 643 university students (71.5% female, mean of age = 25.7, SD = 7.9, min = 18, max = 49, skewness = 1.5, kurtosis = 1). Participants were invited to take part in a study on 'Hungarian state of mind' . We have collected data with a convenience sampling method. The only inclusion criterion was to be aged between 18 and 49 years. Individuals with missing schizotypy or resilience data were excluded from the analysis. Participants were informed that the questionnaire battery included multiple questionnaires which have no correct or incorrect answers and were asked to briefly consider the questions and respond according to how they see themselves. Participation was voluntary and participants provided informed consent. The study was conducted in accordance with the Helsinki Declaration. The study is approved by the Institutional Review Board of the University of Pécs (ethical approval No. 6732 PTE/2017). www.nature.com/scientificreports/ and three second-order factors has repeatedly been confirmed 68,69 : this includes a Cognitive-Perceptual/positive schizotypy factor (magical thinking, unusual perceptions, suspiciousness/ideas of reference), an Interpersonal/ negative schizotypy factor (constricted affect/no close friends and social anxiety), and a Disorganised factor (odd speech and eccentric behaviour). Here, we used subscale mean scores corresponding to the second-order factors (possible range 0-4). The construct validity of these scores is implicated by associations with self-reported family history of schizophrenia 71 and psychosis symptoms 72 . Note that SPQ-BR scores indicate schizotypal traits that can be considered as a proxy to 'true schizotypy' (that is, a phenotype indicating genetic risk for schizophrenia). Absorption was measured with the Tellegen Absorption Scale (TAS 73 ; Hungarian adaptation 74 ) which consists of 34 5-point Likert items. Self-concept clarity was examined with the Self-Concept Clarity Scale (SCCS 54 ; Hungarian adaptation 75 ) that includes 12 5-point Likert items. Again, we calculated a mean score (possible range [1][2][3][4][5]. Resilience was assessed with the Connor-Davidson Resilience Scale (CD-RISC-25 65 ; Hungarian adaptation 76 ) contains 25 5-point Likert items that assess tenacity, control under stress, adaptation to and recovery after adversity and finding meaning in life events. We calculated a total score for this scale (possible range 0-100). The CD-RISC-25 total score is a valid indicator of resilience: it correlates with less perceived stress and disability, its change predicts therapeutic response 65 , and it also moderates the association between childhood emotional neglect and subsequent psychiatric symptoms 77 . Finally, participants also completed the Rosenberg Self-esteem (RSE 78 ; Hungarian adaptation 79 ) scale that contains 10 4-point Likert items that assess the subjective evaluative aspect of the self. We calculated an average score for this scale (possible range 1-4).

Statistical analyses.
Statistical analyses were performed with R (v3.5.2) 80 in RStudio (v1.1.463) 81 . Data and the script for the analyses are available here: https:// osf. io/ m7hy2/. Prior to cluster analysis, we examined clustering tendency of the data with the Hopkins-statistic 82 , and also via visual inspection of the ordered dissimilarity image. If the data contains no structure, the Hopkins-statistic will be near 0.5, whereas values closer to zero indicate increasing clustering tendency.
First, we performed hierarchical cluster analysis using z-standardised cognitive-perceptual, interpersonal, and disorganised schizotypy subscale scores of the SPQ-BR. Based on previous studies, we planned to compare solutions involving 3 and 4 clusters. Dendrograms obtained with single, average, and complete linkage were visually inspected. We expected to find three or four clusters, characterised by: (a) overall low schizotypy, (b) overall high schizotypy, (c) high positive but low interpersonal and disorganised schizotypy, and (d) low positive but high interpersonal and disorganised schizotypy. We evaluated the goodness of clustering according to theoretical considerations and we also examined their internal statistical validity by computing connectivity, the Dunn-index, silhouette width 83 and the S_Dbw index 84 . For descriptive purposes, we compared the clusters in terms of sex ratio and age.
Then, to determine the extent of adaptation vs. maladaptation in the positive schizotypy group, we compared the clusters in terms of resilience (CD-RISC-25), absorption (TAS), self-esteem (RSE) and self-concept clarity (SCCS). We performed Kruskal-Wallis tests, and if a test was significant, it was followed up by Mann-Whitney tests, with Cliff 's Delta calculated as effect size.

Results
First, we examined whether there were groups in the dataset. Clustering tendency in the data was implicated by the Hopkins-statistics (average over 10 iterations was 0.32, min = 0.31, max = 0.33) and by visual inspection of the ordered dissimilarity image (Supplementary Fig. S1). After comparing the dendrograms yielded by different linkage methods, we chose complete linkage as it produced a relatively balanced solution, which contrasted with the strongly asymmetric single and average linkage dendrograms ( Supplementary Fig. S2).
Identifying the schizotypy clusters. We examined clustering solutions that yielded three and four clusters. Our aim was to find and characterise a positive schizotypy cluster, that is, a group of individuals showing high level of positive and low level of negative schizotypy.
The four-cluster solution was better suited to address our research question as it yielded a small group characterised by remarkably high levels of positive schizotypy but only intermediate levels of disorganisation and a rather low extent of negative schizotypy. Additionally, the four-cluster solution was superior in terms of internal validity (see Supplementary Fig. S3), although silhouette width was relatively low, which suggests that the clusters were not clearly separated.
Comparing the schizotypy clusters in terms of resilience, absorption, and valuation and integrity of the self. Then, we compared the clusters in terms of resilience, absorption, self-esteem, and self-concept clarity. Critically, the two competing versions of the adaptive schizotypy hypothesis give different predictions about the positive schizotypy group: according to the strong version, this group should have no impairment, while the moderate version expects a mix of impairment and traits promoting well-being. The differences are visualised in Fig. 2. Descriptive statistics and the results of the statistical analyses are shown in Table 2. The positive schizotypy cluster had the highest and the high schizotypy cluster had the lowest resilience scores. Crucially, the positive schizotypy cluster was more resilient even relative to the low schizotypy cluster. Each schizotypy cluster had significantly higher absorption scores than the low schizotypy cluster. Importantly,    Table 2 for the results of the statistical analyses. Note that the points are jittered to facilitate visibility. www.nature.com/scientificreports/ the positive schizotypy cluster was again superior to every other cluster. The mixed schizotypy cluster had significantly worse self-esteem, relative to every other cluster. The positive schizotypy cluster had better self-esteem than the mixed and the disorganised-interpersonal cluster, while it did not differ significantly from the low schizotypy cluster. Self-concept clarity strongly differentiated the low schizotypy cluster from the other clusters; in addition, the mixed schizotypy cluster demonstrated significantly lower self-concept clarity than the disorganised-interpersonal group. Adjusting for age and sex did not essentially change the pattern of findings (see Supplementary materials). To sum up, the positive schizotypy cluster had remarkably high resilience and absorption, while it did not show a significant decrement in self-esteem, relative to the low schizotypy cluster. At the same time, it showed impaired self-concept clarity.

Discussion
The aim of our study was to compare a strong and a moderate version of the adaptive schizotypy hypothesis 42 by examining a set of indicators related to well-being and impairment in a group characterised by high positive and low negative schizotypy. We collected data in a large sample of university students using a set of wellestablished, reliable, and valid instruments. We extracted four clusters: a larger, overall low and a smaller, overall high schizotypy cluster, and two smaller clusters with intermediate levels of schizotypy. One of the latter groups was characterised by high disorganised schizotypy, intermediate negative schizotypy and lower positive schizotypy, while the other group, termed the positive schizotypy cluster, showed an inverse pattern: in this group we observed high positive schizotypy, intermediate disorganisation and low negative schizotypy. Comparison of the clusters supported the moderate version of the adaptive schizotypy hypothesis: the positive schizotypy cluster showed intact self-esteem, very high levels of absorption that may promote creativity 49 and spirituality 51 and its high resilience can preserve mental health in the face of adversity 65,77 . Yet, this group also demonstrated a sign of dysfunctional personality organisation: in the positive schizotypy group, self-concept clarity was drastically impaired.
Our findings are in line with the literature showing an association of positive schizotypy with indicators of resilience. Positive schizotypy predicts creativity in the arts 33,[47][48][49] , and it correlates with increased capacity to experience and express pleasure 36 and with enhanced effort to obtain rewards 85 . Further underscoring the protective potential of positive schizotypy, it predicts personal and family history of better mental health, over and above the negative effect of disorganised schizotypy 86 .
One may speculate that the contrasting profiles of disorganised-interpersonal and the positive schizotypy clusters indicate differential vulnerability for motivational deficit vs. cognitive distortions/positive symptoms in schizophrenia spectrum disorders, respectively. Relatedly, groups that resemble our clusters have been found among patients. A study has reported a "Kraepelinian Schizophrenia" latent class with elevated disorganisation, negative, and positive symptoms, mania and depression (paralleled by our overall high schizotypy cluster), an "Affective Psychosis" latent class with average disorganisation and average negative symptoms, but high levels of mania, depression and positive symptoms (analogous to the high positive cluster in our study), and a "Deficit Nonpsychosis" class with higher disorganisation and negative symptoms, but below-average mania, depression and positive symptoms (resembled by the disorganised-interpersonal cluster we found) 87 . Whether the clusters identified here are predictive of risk for developing the above-mentioned symptom-profiles is to be examined by longitudinal studies. Nevertheless, available follow-up data that used continuous scores to predict risk implicates that the clusters indeed have predictive validity. In the Chapman's 10-year longitudinal study, positive schizotypy uniquely and specifically predicted psychotic, depressive and manic disorders, while negative schizotypy had a unique relationship with schizoid personality, whereas both traits predicted being diagnosed with any schizophrenia-spectrum disorder 14 .
The study has several limitations. First, recruiting students could have introduced a sampling bias, as attending university demands a certain level of global and academic functioning, intelligence, and socio-economic status. Individuals developing schizophrenia-spectrum disorders have been shown to have a particularly high rate of drop-out from high school 88 . Therefore, it may seem likely that those who are more impaired and are at higher risk for developing such disorders are underrepresented among university students. On the other hand, we detected a high schizotypy cluster in our sample that had high levels of all dimensions of schizotypy and showed the greatest impairment in terms of self-esteem and resilience. Relatedly, longitudinal studies suggest that a combination of high positive and high negative schizotypy predicts the greatest impairment and the highest risk of psychotic disorders at a 10-year follow-up 13,14 . Nevertheless, positive schizotypy predicts unique aspects of impairment such as drug or alcohol abuse, mood disorders and suicide attempts 14 , leaving the possibility open that individuals with extremely high levels of positive schizotypy-comparable to the positive schizotypy cluster-and low resilience are too impaired to attend university. Future studies should attempt to replicate the findings in demographically more heterogeneous community samples. Second, we relied exclusively on selfreport measures, which could be prone to recall and social desirability biases. Finally, the items of the SPQ-BR are based on the diagnostic criteria for schizotypal personality disorder, thus, they are more inclined to be worded in a way that captures impairing aspects of schizotypy (e.g. 'I often feel that others have it in for me'), which could confound positive schizotypy with high distress and preclude detection of a high positive schizotypy group with no signs of maladaptation or impairment. This might be remedied by using somewhat less clinically worded indicators of positive schizotypy, such as the Oxford-Liverpool Inventory of Feelings and Experiences 89 , or, an instrument which separately assesses the intensity and the distressing nature of positive schizotypal experiences, such as the Peters et al. Delusions Inventory 90 or the Cardiff Anomalous Perceptions Scale 91 .
Our study provides novel insight about whether positive schizotypy can have purely beneficial, non-pathological forms. Its strengths include the use of a large undergraduate sample and a set of well-established and reliable questionnaires. Moreover, the extraction of four clusters was supported by data-driven indicators of cluster www.nature.com/scientificreports/ goodness, not just by theoretical considerations. Critically for our research question, we have detected a group of individuals with high positive, low negative, and intermediate disorganised schizotypy. This group had a profile that strongly contrasted with groups that showed either high or low levels of all dimensions of schizotypy. It was characterised by extremely high levels of traits related to increased well-being such as resilience and absorption, but also had impaired self-concept clarity, which is known to signal a proneness to mental health problems. Our findings speak for a moderate version of the adaptive schizotypy hypothesis, which recognises both the benefits and vulnerabilities associated with positive schizotypy.