Abstract
Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. (PsycINFO Database Record
Highlights
Cox proportional hazard regression analyses indicated that overall personality disorders (PDs) symptom severity significantly predicted shorter time to onset of hypomanic and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms
Overall PD symptom severity emerged as a significant predictor of a quicker onset of hypomania (Wald = 16.43; hazard ratios (HRs) = 1.42; 95% CI, 1.20–1.68; p < .001; Table 3),1 major depression (Wald = 20.33; HR = 1.51; 95% CI, 1.26–1.81; p < .001; Table 4),2 and bipolar I disorder (Wald = 26.07; HR = 2.51; 95% CI, 1.76–3.57; p < .001; Table 5),3 suggesting that a higher level of overall PD symptom severity increased the likelihood for prospective onset of hypomania, major depression, and bipolar I disorder by 42%, 51%, and 151%, respectively, for each increase of 1 SD
Post-hoc analyses indicated that among the cluster B PDs, histrionic (Wald = 16.38; HR = 1.54; 95% CI, 1.25–1.90; p < .001; Figure 1)5 and borderline (Wald = 4.60; HR = 1.29; 95% CI, 1.02–1.63; p = .032)6 PD symptom severity predicted a shorter time to onset of a hypomanic episode, whereas narcissistic PD symptom severity (Wald = 5.16; HR = 0.75; 95% CI, 0.59–0.96; p = .023)7 predicted a longer time to onset of a hypomanic episode
Summary
One example is the scar model, which proposes that mood disturbances might influence personality, leaving scar-like deficits (Klein, Kotov, & Bufferd, 2011; Rohde, Lewinsohn, & Seeley, 1990; Shahar & Davidson, 2003; Shahar et al, 2008) Another example is the predisposition model, which proposes that PD symptoms increase risk for the development and/or a worse course of BSDs, perhaps through increasing the likelihood of exposure to psychosocial stressors (e.g., life events), or by increasing sensitivity to such stressors (Bender & Alloy, 2011; Klein et al, 2011; Lyons et al, 1997; Weiss et al, 2015). PDs are operationalized as symptom severity rather than discrete diagnoses
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