Psychological Medicine

Original Articles

The association of personality disorders with the prospective 7-year course of anxiety disorders

E. B. Ansella1 c1, A. Pintoa2, M. O. Edelena3, J. C. Markowitza2, C. A. Sanislowa4, S. Yena5, M. Zanarinia6, A. E. Skodola7, M. T. Sheaa5, L. C. Moreya8, J. G. Gundersona6, T. H. McGlashana1 and C. M. Griloa1

a1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

a2 Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York State Psychiatric Institute, New York, NY, USA

a3 Rand Corporation, Santa Monica, CA, USA

a4 Department of Psychology, Wesleyan University, Middletown, CT, USA

a5 Department of Veterans Affairs, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

a6 Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA

a7 University of Arizona School of Medicine and the Sunbelt Collaborative, Tucson, AZ, USA

a8 Department of Psychology, Texas A&M University, College Station, TX, USA


Background This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.

Method Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.

Results Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.

Conclusions Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.

(Received March 02 2010)

(Revised July 29 2010)

(Accepted August 05 2010)

(Online publication September 14 2010)


c1 Address for correspondence: E. B. Ansell, Ph.D., Yale University School of Medicine, 2 Church Street South, Suite 209, New Haven, CT 06519, USA. (Email: