Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-23T21:47:01.070Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 September 2010

E. B. Ansell ,
A. Pinto ,
M. O. Edelen ,
J. C. Markowitz ,
C. A. Sanislow ,
S. Yen ,
M. Zanarini ,
A. E. Skodol ,
M. T. Shea  and
L. C. Morey
...Show all authors
E. B. Ansell*
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
A. Pinto
Affiliation:
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York State Psychiatric Institute, New York, NY, USA
M. O. Edelen
Affiliation:
Rand Corporation, Santa Monica, CA, USA
J. C. Markowitz
Affiliation:
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York State Psychiatric Institute, New York, NY, USA
C. A. Sanislow
Affiliation:
Department of Psychology, Wesleyan University, Middletown, CT, USA
S. Yen
Affiliation:
Department of Veterans Affairs, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
M. Zanarini
Affiliation:
Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
A. E. Skodol
Affiliation:
University of Arizona School of Medicine and the Sunbelt Collaborative, Tucson, AZ, USA
M. T. Shea
Affiliation:
Department of Veterans Affairs, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
L. C. Morey
Affiliation:
Department of Psychology, Texas A&M University, College Station, TX, USA
J. G. Gunderson
Affiliation:
Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
T. H. McGlashan
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
C. M. Grilo
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
*
*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: emily.ansell@yale.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Chronicityanxiety disorderspersonality disordersrelapseremission
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 5 , May 2011 , pp. 1019 - 1028
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alnæs, R, Torgersen, S (1999). A 6-year follow-up study of anxiety disorders in psychiatric outpatients: development and continuity with personality disorders and personality traits as predictors. Nordic Journal of Psychiatry 53, 409–416.Google Scholar
Angst, J, Gamma, A, Joseph Bienvenu, O, Eaton, WW, Ajdacic, V, Eich, D, Rossler, W (2006). Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort. Psychological Medicine 36, 1283–1292.CrossRefGoogle Scholar
Becker, DF, Grilo, CM, Edell, WS, McGlashan, TH (2000). Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults. The American Journal of Psychiatry 157, 2011–2016.Google Scholar
Boden, JM, Fergusson, DM, Horwood, LJ (2007). Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychological Medicine 37, 431–440.CrossRefGoogle Scholar
Bowen, RC, Senthilselvan, A, Barale, A (2000). Physical illness as an outcome of chronic anxiety disorders. Canadian Journal of Psychiatry 45, 459–464.Google Scholar
Bruce, SE, Yonkers, KA, Otto, MW, Eisen, JL, Weisberg, RB, Pagano, M, Shea, MT, Keller, MB (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry 162, 1179–1187.CrossRefGoogle ScholarPubMed
Cox, DR (1972). Regression models and life tables. Journal of the Royal Statistical Society Series B (Methodological) 34, 187–220.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Version (SCID-I/P), New York State Psychiatric Institute: New York.Google Scholar
Grant, BF, Goldstein, RB, Chou, SP, Huang, B, Stinson, FS, Dawson, DA, Saha, TD, Smith, SM, Pulay, AJ, Pickering, RP, Ruan, WJ, Compton, WM (2009). Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Molecular Psychiatry 14, 1051–1066.CrossRefGoogle ScholarPubMed
Grant, BF, Hasin, DS, Blanco, C, Stinson, FS, Chou, SP, Goldstein, RB, Dawson, DA, Smith, S, Saha, TD, Huang, B (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 1351–1361.Google Scholar
Grilo, CM, Pagano, ME, Skodol, AE, Sanislow, CA, McGlashan, TH, Gunderson, JG, Stout, RL (2007). Natural course of bulimia nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology. Journal of Clinical Psychiatry 68, 738–746.Google Scholar
Grilo, CM, Sanislow, CA, Shea, MT, Skodol, AE, Stout, RL, Gunderson, JG, Yen, S, Bender, DS, Pagano, ME, Zanarini, MC, Morey, LC, McGlashan, TH (2005). Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. Journal of Consulting and Clinical Psychology 73, 78–85.Google Scholar
Gunderson, JG, Shea, MT, Skodol, AE, McGlashan, TH, Morey, LC, Stout, RL, Zanarini, MC, Grilo, CM, Oldham, JM, Keller, MB (2000). The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics. Journal of Personality Disorders 14, 300–315.Google Scholar
Johnson, JG, Cohen, P, Kasen, S, Brook, JS (2006). Personality disorders evident by early adulthood and risk for anxiety disorders during middle adulthood. Journal of Anxiety Disorders 20, 408–426.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.Google Scholar
Keller, MB, Shapiro, RW, Lavori, PW, Wolfe, N (1982 a). Recovery in major depressive disorder: analysis with the life table and regression models. Archives of General Psychiatry 39, 905–910.CrossRefGoogle ScholarPubMed
Keller, MB, Shapiro, RW, Lavori, PW, Wolfe, N (1982 b). Relapse in major depressive disorder: analysis with the life table. Archives of General Psychiatry 39, 911–915.CrossRefGoogle ScholarPubMed
Kessler, RC, Brandenburg, N, Lane, M, Roy-Byrne, P, Stang, PD, Stein, DJ, Wittchen, HU (2005). Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychological Medicine 35, 1073–1082.CrossRefGoogle ScholarPubMed
McGlashan, TH, Grilo, CM, Skodol, AE, Gunderson, JG, Shea, MT, Morey, LC, Zanarini, MC, Stout, RL (2000). The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandinavica 102, 256–264.CrossRefGoogle Scholar
McKay, D, Kulchycky, S, Danyko, S (2000). Borderline personality and obsessive-compulsive symptoms. Journal of Personality Disorders 14, 57–63.Google Scholar
Maina, G, Albert, U, Salvi, V, Pessina, E, Bogetto, F (2008). Early-onset obsessive-compulsive disorder and personality disorders in adulthood. Psychiatry Research 158, 217–225.Google Scholar
Massion, AO, Dyck, IR, Shea, MT, Phillips, KA, Warshaw, MG, Keller, MB (2002). Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Archives of General Psychiatry 59, 434–440.CrossRefGoogle ScholarPubMed
Milrod, BL, Leon, AC, Barber, JP, Markowitz, JC, Graf, E (2007). Do comorbid personality disorders moderate panic-focused psychotherapy? An exploratory examination of the American Psychiatric Association practice guideline. Journal of Clinical Psychiatry 68, 885–891.Google Scholar
Newton-Howes, G, Tyrer, P, Anagnostakis, K, Cooper, S, Bowden-Jones, O, Weaver, T (2010). The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams. Social Psychiatry and Psychiatric Epidemiology 45, 453–460.CrossRefGoogle ScholarPubMed
Ozkan, M, Altindag, A (2005). Comorbid personality disorders in subjects with panic disorder: do personality disorders increase clinical severity? Comprehensive Psychiatry 46, 20–26.CrossRefGoogle ScholarPubMed
Ralevski, E, Sanislow, CA, Grilo, CM, Skodol, AE, Gunderson, JG, Tracie Shea, M, Yen, S, Bender, DS, Zanarini, MC, McGlashan, TH (2005). Avoidant personality disorder and social phobia: distinct enough to be separate disorders? Acta Psychiatrica Scandinavica 112, 208–214.Google Scholar
Reich, J (2000). The relationship of social phobia to avoidant personality disorder: a proposal to reclassify avoidant personality disorder based on clinical empirical findings. European Psychiatry: Journal of the Association of European Psychiatrists 15, 151–159.Google Scholar
Reich, J (2009). Avoidant personality disorder and its relationship to social phobia. Current Psychiatry Reports 11, 89–93.CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Cowley, DS (1994). Course and outcome in panic disorder: a review of recent follow-up studies. Anxiety 1, 151–160.Google Scholar
Ruscio, AM, Lane, M, Roy-Byrne, P, Stang, PE, Stein, DJ, Wittchen, HU, Kessler, RC (2005). Should excessive worry be required for a diagnosis of generalized anxiety disorder? Results from the US National Comorbidity Survey Replication. Psychological Medicine 35, 1761–1772.Google Scholar
Skodol, AE, Gunderson, JG, Shea, MT, McGlashan, TH, Morey, LC, Sanislow, CA, Bender, DS, Grilo, CM, Zanarini, MC, Yen, S, Pagano, ME, Stout, RL (2005). The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. Journal of Personality Disorders 19, 487–504.Google Scholar
Skodol, AE, Oldham, JM, Hyler, SE, Stein, DJ, Hollander, E, Gallaher, PE, Lopez, AE (1995). Patterns of anxiety and personality disorder comorbidity. Journal of Psychiatric Research 29, 361–374.Google Scholar
Warshaw, MG, Dyck, I, Allsworth, J, Stout, RL, Keller, MB (2001). Maintaining reliability in a long-term psychiatric study: an ongoing inter-rater reliability monitoring program using the longitudinal interval follow-up evaluation. Journal of Psychiatric Research 35, 297–305.CrossRefGoogle Scholar
Weisberg, RB (2009). Overview of generalized anxiety disorder: epidemiology, presentation, and course. Journal of Clinical Psychiatry 70 (Suppl. 2), 4–9.Google Scholar
Yates, WR (2009). Phenomenology and epidemiology of panic disorder. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists 21, 95–102.Google Scholar
Yonkers, KA, Bruce, SE, Dyck, IR, Keller, MB (2003). Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depression and Anxiety 17, 173–179.Google Scholar
Zanarini, MC, Frankenburg, FR, Sickel, AE, Yong, L (1996). Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). McLean Hospital: Belmont, MA.Google Scholar
Zanarini, MC, Skodol, AE, Bender, D, Dolan, R, Sanislow, C, Schaefer, E, Morey, LC, Grilo, CM, Shea, MT, McGlashan, TH, Gunderson, JG (2000). The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses. Journal of Personality Disorders 14, 291–299.Google Scholar