Article

The Relationship Between Personality Disorders and Axis I Psychopathology: Deconstructing Comorbidity

Department of Psychiatry, The University of Western Ontario, London, Ontario N6A 5W9, Canada
Annual Review of Clinical Psychology (Impact Factor: 12.67). 11/2012; 9(1). DOI: 10.1146/annurev-clinpsy-050212-185624
Source: PubMed

ABSTRACT

The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TRand apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models. Expected final online publication date for the Annual Review of Clinical Psychology Volume 9 is March 26, 2013. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.

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    • "Previous studies have reported a high prevalence of comorbid DSM axis I disorders and SPD [46,47]. For example, in a national epidemiological survey, Pulay et al. found that the prevalence of SPD were 10.7% to 33.1% among respondents with any mood disorder or anxiety disorder [48]. "
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    ABSTRACT: Previous evidence has shown that schizotypal personality disorder (SPD) is part of the schizophrenia spectrum. Few studies have examined latent classes in the developmental trajectories of SPD features over time in individuals with SPD features. We adopted a longitudinal prospective study design to follow up a cohort of 660 college students during a two-year period. Participants' SPD-like symptoms and psychosocial function were measured by a comprehensive set of questionnaires that covered SPD features and cognitive, emotional, and psychosocial functions. Latent class growth analysis was used to examine the trajectory classes. Three trajectory classes were identified: a low, a medium, and a high SPD features group. Participants in the low group reported few SPD features and their symptoms declined over time. The medium group students had more SPD features than the low group and these symptoms stabilized during the follow up period. Participants in the high group reported the most SPD features and their symptoms increased over time. The three groups differed in paranoid thoughts, psychological distress, neurocognition function, and emotional expression over time. Results of multivariate regression analysis suggested that paranoid thoughts, emotional experience and prospective memory were predictors of social functioning in the high SPD feature group. Our findings suggest that individuals with SPD features may be delineated into different developmental subgroups and these subgroups differ significantly in psychosocial function. Delusions, emotion, and prospective memory may be important features to consider in early diagnosis and interventions for individuals predisposed to SPD and schizophrenia.
    Full-text · Article · Nov 2013 · BMC Psychiatry
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    • "Likewise, previous studies have found a high degree of overlap between personality disorder traits and affective, behavioural and interpersonal problems, in both nonclinical (Cohen, 2008; Crawford et al., 2005, 2008) and clinical samples (Links & Eynan, 2013; McGlashan et al., 2000). These data are also consistent with the high levels of comorbidity found not only among patients with PDs, but also between PDs and Axis I disorders (Feenstra, Busschbach, Verheul, & Hutsebaut, 2011; Links & Eynan, 2013; McGlashan et al., 2000). The co-occurrence and persistence of disorders from both diagnostic axes during adolescence is of great interest, since it affects impairment in adulthood (Crawford et al., 2008) and also increases the risk of mood disorders and disruptive behaviour problems in adult life (Johnson et al., 1999). "
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    • "Likewise, previous studies have found a high degree of overlap between personality disorder traits and affective, behavioural and interpersonal problems, in both nonclinical (Cohen, 2008; Crawford et al., 2005, 2008) and clinical samples (Links & Eynan, 2013; McGlashan et al., 2000). These data are also consistent with the high levels of comorbidity found not only among patients with PDs, but also between PDs and Axis I disorders (Feenstra, Busschbach, Verheul, & Hutsebaut, 2011; Links & Eynan, 2013; McGlashan et al., 2000). The co-occurrence and persistence of disorders from both diagnostic axes during adolescence is of great interest, since it affects impairment in adulthood (Crawford et al., 2008) and also increases the risk of mood disorders and disruptive behaviour problems in adult life (Johnson et al., 1999). "
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