Abstract
Background:Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and depressive disorders involved in a randomised controlled trial initiated in 1983 had full personality status assessed at baseline. We repeated assessment of personality status on three subsequent occasions over 30 years.Methods:Personality status was recorded using methods derived from the Personality Assessment Schedule, which has algorithms for allocating Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 11th International Classification of Diseases (ICD-11) categories. The category and severity of personality diagnosis were recorded at baseline in the randomised patients with DSM-III anxiety and depressive diagnoses. The same methods of assessing personality status was repeated at 2, 12 and 30 years after baseline.Results:Using the ICD-11 system, 47% of patients, mainly those with no personality disturbance at baseline, retained their personality status; of the others 16.8% improved and 20.4% worsened to more severe disorder. In DSM-III diagnosed patients, those diagnosed as Cluster A and Cluster C increased in frequency (from 14% to 40%, p < 0.001, and 21.5% to 36%, p < 0.001, respectively) over follow-up, while those with Cluster B showed little change in frequency (22% to 18%, p = 0.197).Conclusion:In this population of patients with common mental disorders, personality status showed many changes over time, inconsistent with the view that personality disorder is a persistent or stable condition. The increase in diagnoses within the Cluster A and C groups suggests personality disorder generally increases in frequency as people age.
Highlights
Personality traits tend to be enduring (Costa and McCrae, 2002)
The first is that personality disorder is unstable over time, the second that, rather than attenuating with age, the tendency is for some personality disturbance to become more pronounced, and the third is that the form or type of personality disturbance changes over time to different degrees
Personality disorder should no longer be considered to be a dichotomous entity separating it from no personality disorder
Summary
Personality traits tend to be enduring (Costa and McCrae, 2002). It has been assumed for many years that personality disorder is persistent and so adjectives such as ‘pervasive’, ‘‘ingrained’ and ‘enduring’ have been part of the diagnostic description of personality disorder in both Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) for over 50 years. Several longitudinal studies (Lenzenweger et al, 2004; McGlashan et al, 2005; Zanarini et al, 2003) have demonstrated that personality disorder, using current diagnostic rules, changes greatly over periods of 2–6 years, mainly towards improvement to no personality disorder. In some respects, this is to be expected, as the diagnostic criteria include episodes of symptoms and behaviour that do not necessarily persist. We repeated assessment of personality status on three subsequent occasions over 30 years
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