DSM-III personality disorders in the community

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
American Journal of Psychiatry (Impact Factor: 12.3). 08/1994; 151(7):1055-62. DOI: 10.1176/ajp.151.7.1055
Source: PubMed


The aims of this study were to estimate the prevalence and investigate the comorbidity and potential consequences of DSM-III personality disorders in the community.
A total of 810 adults were examined in the second stage of the Eastern Baltimore Mental Health Survey in 1981, part of the National Institute of Mental Health Epidemiologic Catchment Area program. The subjects were directly examined by psychiatrists using a semi-structured method that allowed diagnosis of all DSM-III personality disorders as well as other DSM-III psychiatric disorders.
The prevalence of personality disorders in these adults was 5.9% (9.3% when provisional cases were included). Men had higher rates than women, and subjects who were separated or divorced had the highest rates. There was little comorbidity among specific personality disorders. Subjects with personality disorders were significantly more likely to have a history of sexual dysfunctions, alcohol use disorders, and drug use disorders as well as suicidal thoughts and attempts. In addition, they reported significantly more life events in the past year. Among subjects with any axis I disorder, those with personality disorders were judged by the psychiatrists to be more in need of treatment; however, only 21% were receiving treatment.
Personality disorders are relatively common in the community. They are associated with axis I disorders and life events. Only one-fifth of the individuals who qualify for diagnoses of personality disorders in the community are receiving treatment.

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    • "Self-reported indicators of socioeconomic status, such as household income and highest level of education achieved did not appear to be associated with PD in this population (Samuels et al., 1994). "
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    ABSTRACT: Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required. (PsycINFO Database Record
    Full-text · Article · Oct 2015 · Personality Disorders: Theory, Research, and Treatment
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    • "After each interview, the psychologist formulated a final rating for each criterion based on clinical judgment of both subject and informant reports, and completed a case summary describing the personality of each subject. This assessment has been described previously (Samuels et al., 1994). "
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    ABSTRACT: Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions.
    Full-text · Article · Feb 2012 · Psychiatry Research
    • "Thus, the comorbidity rate was 22.7% (5/22). Samuels, Nestadt, Romanoski, Folstein, andMcHugh (1994)reported the frequency of definite and definite or provisional DSM–III PDs in a sample of 810 subjects drawn from the Baltimore site of the Epidemiologic Catchment Area Survey. Diagnoses were based on the Standardized Psychiatric Examination. "
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    ABSTRACT: The DSM-5 Personality and Personality Disorders (PDs) Work Group has recommended a reformulation of the PD section. In the present review I examined the empirical support for the Work Group's criticisms of the DSM-IV approach that were central to the justification for radically changing the diagnostic criteria. The Work Group indicated that comorbidity among the DSM-IV PDs is excessive, and to reduce comorbidity they recommended deleting five PDs. The studies they cited demonstrating high levels of comorbidity were of samples of psychiatric patients. A review of the epidemiological literature shows that comorbidity rates are much lower than in patient samples, and this challenges the proposition that high comorbidity is due to the diagnostic criteria. Moreover, the empirical support for the exclusion of some disorders over others is lacking. The Work Group noted that the diagnostic stability of the PDs is modest. However, modest levels of diagnostic stability may be largely attributable to methodological factors such test-retest unreliability, state effects, regression to the mean, and measurement error due to repeated assessments, rather than a reflection of inadequacies of the diagnostic system. Thus, modest stability is likely to be found in any approach toward diagnosing PDs. The present review therefore suggests that several of the core problems linked to the DSM-IV approach toward diagnosing PDs are more likely due to methodological factors than inadequacies of the criteria themselves. The Work Group's recommendation to delete five PDs is inconsistent with the explicit guidelines established for making revisions for DSM-5 which specify that for a disorder to be deleted there should be a thorough review of that disorder's clinical utility and validity. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
    No preview · Article · Apr 2011 · Personality Disorders: Theory, Research, and Treatment
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