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Categorical and dimensional stability of comorbid personality disorder symptoms in DSM-IV major depressive disorder: a prospective study.
J Clin Psychiatry. 2010 Mar; 71(3):287-95.JC

Abstract

OBJECTIVE

To investigate the categorical and dimensional temporal stability of Axis II personality disorders among depressive patients, and to determine whether variations in Axis I comorbid disorders or self-reported personality traits predict changes in researcher-assigned personality disorder symptoms.

METHOD

Patients with DSM-IV major depressive disorder (MDD) in the Vantaa Depression Study (N = 269) were interviewed with the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and the Structured Clinical Interview for DSM-III-R Axis II Disorders and were assessed with the 57-item Eysenck Personality Inventory at baseline, 6 months, and 18 months. Baseline interviews occurred between February 1, 1997, and May 31, 1998; follow-up interviews were 6 months and 18 months after baseline for each patient. Of the patients included in the study, 193 remained unipolar and could be interviewed at both follow-ups. The covariation of the severity of depression, anxiety, alcohol use, and reported neuroticism and extraversion with assigned personality disorder symptoms was investigated by using general estimation equations.

RESULTS

The diagnosis of personality disorder persisted at all time points in about half (43%) of the 81 MDD patients diagnosed with personality disorder at baseline. The number of positive personality disorder criteria declined, particularly during the first 6 months, by a mean of 3 criteria. The decline in reported personality disorder symptoms covaried significantly with declines in the severity of depressive and anxiety symptoms (depressive: P = .02 for paranoid, P = .02 for borderline, and P = .01 for avoidant; anxiety: P = .08 for paranoid, P = .01 for borderline, and P < .001 for avoidant). Changes in patients' perceptions of self as measured by neuroticism covaried with changes in paranoid (P = .01) and borderline (P < .001) personality disorder symptoms.

CONCLUSIONS

Among MDD patients, the categorical stability of concurrent personality disorder diagnoses assigned while depressed is relatively poor, but the dimensional stability is moderate. The remission of depression as well as variations in Axis I comorbidity, particularly anxiety disorders, influences personality disorder diagnoses. These diagnostic difficulties most likely reflect broader variations in patients' perceptions of self over time, not merely psychometric problems related to the pertinent diagnostic criteria.

Authors+Show Affiliations

Mood, Depression, and Suicidal Behavior Unit, National Institute for Health and Welfare, Helsinki, Finland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20079331

Citation

Melartin, Tarja K., et al. "Categorical and Dimensional Stability of Comorbid Personality Disorder Symptoms in DSM-IV Major Depressive Disorder: a Prospective Study." The Journal of Clinical Psychiatry, vol. 71, no. 3, 2010, pp. 287-95.
Melartin TK, Haukka J, Rytsälä HJ, et al. Categorical and dimensional stability of comorbid personality disorder symptoms in DSM-IV major depressive disorder: a prospective study. J Clin Psychiatry. 2010;71(3):287-95.
Melartin, T. K., Haukka, J., Rytsälä, H. J., Jylhä, P. J., & Isometsä, E. T. (2010). Categorical and dimensional stability of comorbid personality disorder symptoms in DSM-IV major depressive disorder: a prospective study. The Journal of Clinical Psychiatry, 71(3), 287-95. https://doi.org/10.4088/JCP.08m04621blu
Melartin TK, et al. Categorical and Dimensional Stability of Comorbid Personality Disorder Symptoms in DSM-IV Major Depressive Disorder: a Prospective Study. J Clin Psychiatry. 2010;71(3):287-95. PubMed PMID: 20079331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Categorical and dimensional stability of comorbid personality disorder symptoms in DSM-IV major depressive disorder: a prospective study. AU - Melartin,Tarja K, AU - Haukka,Jari, AU - Rytsälä,Heikki J, AU - Jylhä,Pekka J, AU - Isometsä,Erkki T, Y1 - 2010/01/12/ PY - 2008/08/18/received PY - 2009/01/02/accepted PY - 2010/1/19/entrez PY - 2010/1/19/pubmed PY - 2010/4/9/medline SP - 287 EP - 95 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 71 IS - 3 N2 - OBJECTIVE: To investigate the categorical and dimensional temporal stability of Axis II personality disorders among depressive patients, and to determine whether variations in Axis I comorbid disorders or self-reported personality traits predict changes in researcher-assigned personality disorder symptoms. METHOD: Patients with DSM-IV major depressive disorder (MDD) in the Vantaa Depression Study (N = 269) were interviewed with the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and the Structured Clinical Interview for DSM-III-R Axis II Disorders and were assessed with the 57-item Eysenck Personality Inventory at baseline, 6 months, and 18 months. Baseline interviews occurred between February 1, 1997, and May 31, 1998; follow-up interviews were 6 months and 18 months after baseline for each patient. Of the patients included in the study, 193 remained unipolar and could be interviewed at both follow-ups. The covariation of the severity of depression, anxiety, alcohol use, and reported neuroticism and extraversion with assigned personality disorder symptoms was investigated by using general estimation equations. RESULTS: The diagnosis of personality disorder persisted at all time points in about half (43%) of the 81 MDD patients diagnosed with personality disorder at baseline. The number of positive personality disorder criteria declined, particularly during the first 6 months, by a mean of 3 criteria. The decline in reported personality disorder symptoms covaried significantly with declines in the severity of depressive and anxiety symptoms (depressive: P = .02 for paranoid, P = .02 for borderline, and P = .01 for avoidant; anxiety: P = .08 for paranoid, P = .01 for borderline, and P < .001 for avoidant). Changes in patients' perceptions of self as measured by neuroticism covaried with changes in paranoid (P = .01) and borderline (P < .001) personality disorder symptoms. CONCLUSIONS: Among MDD patients, the categorical stability of concurrent personality disorder diagnoses assigned while depressed is relatively poor, but the dimensional stability is moderate. The remission of depression as well as variations in Axis I comorbidity, particularly anxiety disorders, influences personality disorder diagnoses. These diagnostic difficulties most likely reflect broader variations in patients' perceptions of self over time, not merely psychometric problems related to the pertinent diagnostic criteria. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/20079331/Categorical_and_dimensional_stability_of_comorbid_personality_disorder_symptoms_in_DSM_IV_major_depressive_disorder:_a_prospective_study_ L2 - http://www.psychiatrist.com/jcp/article/pages/2010/v71n03/v71n0310.aspx DB - PRIME DP - Unbound Medicine ER -