Autistic Trait Profiles Across Mood and Psychotic Spectrum Disorders: A Transdiagnostic Outpatient Study

Background/Objectives: Autistic traits are distributed dimensionally across psychiatric populations, yet their systematic assessment in mood and psychotic spectrum disorders remains limited. While elevated autistic traits have been documented in schizophrenia spectrum disorders, evidence in bipolar disorder (BD) and major depressive disorder (MDD) is scarce, and no studies have applied the clinician-rated PANSS Autism Severity Score (PAUSS) to mood disorder populations. This study aims to investigate the presence and severity of autistic traits across psychotic spectrum disorder (PSD), BD, and MDD in an outpatient sample using the PAUSS. Methods: In this cross-sectional naturalistic outpatient study, clinically stable adult patients with MDD, BD, or PSD, without autism spectrum disorder, were assessed with the Brief Psychiatric Rating Scale (BPRS) and PAUSS. Group comparisons, adjusted models, correlation analyses, principal component analysis, and multinomial logistic regression were performed. Results: A total of 165 patients were included (MDD, n = 84, BD, n = 45, PSD, n = 36). Compared with the mood disorder groups, PSD patients were younger and showed higher BPRS scores. PSD was also characterized by significantly higher PAUSS total, social, and communication scores, whereas PAUSS RRB did not differ in univariate analyses. In the overall sample, BPRS severity correlated positively with all PAUSS dimensions, while age showed only weak or non-significant associations. Diagnosis-stratified analyses revealed that the association between psychopathology and autistic traits was present in MDD and BD, but not in PSD. PCA showed that autistic trait dimensions converged on a broad common profile and differed across diagnostic groups, with PSD showing the most distinct pattern. In multinomial logistic regression, higher BPRS, higher PAUSS social and communication scores, and younger age independently distinguished PSD from MDD and BD; PAUSS RRB showed an inverse association only in the multivariable model. Conclusions: This study supports a transdiagnostic perspective on autistic traits in adult psychiatric populations, highlighting disorder-specific differences across diagnostic categories. Social and communication impairments emerged as key dimensions distinguishing PSD from mood disorders. Assessing autistic traits in psychiatric settings may improve diagnostic precision and inform personalized, stratified treatment approaches.