Elsevier

Biological Psychiatry

Volume 62, Issue 6, 15 September 2007, Pages 553-564
Biological Psychiatry

Original Article
DSM-IV Personality Disorders in the National Comorbidity Survey Replication

https://doi.org/10.1016/j.biopsych.2006.09.019Get rights and content

Background

The population prevalence of DSM-IV personality disorders (PDs) remains largely unknown. Data are reported here on the prevalence and correlates of clinician-diagnosed Clusters A, B, and C DSM-IV PDs in the general population of the United States.

Methods

Personality disorder screening questions from the International Personality Disorder Examination (IPDE) were administered in Part II (n = 5692) of the National Comorbidity Survey Replication (NCS-R). A probability sub-sample was then interviewed with the IPDE and used to link screening question responses with IPDE clinical diagnoses. The method of Multiple Imputation (MI) was then implemented to estimate prevalence and correlates of PDs in the full sample.

Results

The MI prevalence estimates were 5.7% Cluster A, 1.5% Cluster B, 6.0% Cluster C, and 9.1% any PD. All three PD clusters were significantly comorbid with a wide range of DSM-IV Axis I disorders. Significant associations of PDs with functional impairment were largely accounted for by Axis I comorbidity.

Conclusions

Strong Axis I comorbidity raises questions about the somewhat arbitrary separation of PDs from Axis I disorders in the DSM nomenclature. The impairment findings suggest that the main public health significance of PDs lies in their effects on Axis I disorders rather than in their effects on functioning.

Section snippets

Sample

Data are based on the National Comorbidity Survey Replication (NCS-R), a nationally representative, face-to-face household survey of 9282 adults (ages 18+) in the continental United States (Kessler and Merikangas 2004). The NCS-R was carried out by the professional field staff of the Survey Research Center at the Institute for Social Research, University of Michigan, between February 2001 and December 2003. Sampling was based on a multi-stage clustered area probability design. Informed consent

The Prevalence of DSM-IV PDs

Multiple imputation prevalence estimates of IPDE/DSM-IV PDs in the total sample are 5.7%, 1.5%, and 6.0% for Clusters A, B, and C, respectively (Table 2). The MI prevalence estimates of BPD and ASPD are 1.4% and .6%, respectively. These estimates are all slightly lower than the direct estimates obtained in the clinical reappraisal sample. However, the latter are less accurate than the MI estimates, owing to the fact that the clinical reappraisal sample was only a small (n = 214) sub-sample of

Discussion

The finding that roughly one-tenth of United States adults suffer from a diagnosable PD (including those with PD NOS) is broadly consistent with the three earlier United States studies that, although based on less representative samples, used rigorous semi-structured clinical assessments to diagnose PDs in well-characterized non-patient samples. Similar results have been obtained in two European studies (Coid et al 2006, Torgersen et al 2001). A recent report based on a very large United States

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