DP-IPI: A Hybrid Differential Privacy Text Rewriting Mechanism for Indirect Personal Identifiers in Clinical Texts

Differential Privacy (DP) for text matured from disjointed word-level substitutions to contiguous sentence-level rewriting by leveraging the generative capacity of language models. While this form of text privatization is best suited for balancing formal privacy guarantees with grammatical coherence, its impact on the register identity of text remains largely unexplored. By conducting a multidimensional stylistic profiling of differentially-private rewriting, we demonstrate that the cost of privacy extends far beyond lexical variation. Specifically, we find that rewriting under privacy constraints induces a systematic functional mutation of the text's communicative signature. This shift is characterized by the severe attrition of interactive markers, contextual references, and complex subordination. By comparing autoregressive paraphrasing against bidirectional substitution across a spectrum of privacy budgets, we observe that both architectures force convergence toward a non-involved and non-persuasive register. This register-blind sanitization effectively preserves semantic content but structurally homogenizes the nuanced stylistic markers that define human-authored discourse.

Protecting patient privacy in clinical narratives is essential for enabling secondary use of healthcare data under regulations such as GDPR and HIPAA. While manual de-identification remains the gold standard, it is costly and slow, motivating the need for automated methods that combine privacy guarantees with high utility. Most automated text de-identification pipelines employed named entity recognition (NER) to identify protected entities for redaction. Although methods based on differential privacy (DP) provide formal privacy guarantees, more recently also large language models (LLMs) are increasingly used for text de-identification in the clinical domain. In this work, we present the first comparative study of DP, NER, and LLMs for Dutch clinical text de-identification. We investigate these methods separately as well as hybrid strategies that apply NER or LLM preprocessing prior to DP, and assess performance in terms of privacy leakage and extrinsic evaluation (entity and relation classification). We show that DP mechanisms alone degrade utility substantially, but combining them with linguistic preprocessing, especially LLM-based redaction, significantly improves the privacy-utility trade-off.

The growing use of large language models has increased interest in sharing textual data in a privacy-preserving manner. One prominent line of work addresses this challenge through text rewriting under Local Differential Privacy (LDP), where input texts are locally obfuscated before release with formal privacy guarantees. These guarantees are typically expressed by a parameter $\varepsilon$ that upper bounds the worst-case privacy loss. However, nominal $\varepsilon$ values are often difficult to interpret and compare across mechanisms. In this work, we investigate how to empirically calibrate across text rewriting mechanisms under LDP. We propose TeDA, which formulates calibration via a hypothesis-testing framework that instantiates text distinguishability audits in both surface and embedding spaces, enabling empirical assessment of indistinguishability from privatized texts. Applying this calibration to several representative mechanisms, we demonstrate that similar nominal $\varepsilon$ bounds can imply very different levels of distinguishability. Empirical calibration thus provides a more comparable footing for evaluating privacy-utility trade-offs, as well as a practical tool for mechanism comparison and analysis in real-world LDP text rewriting deployments.