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Cited by 102Personality Disorders and PsychopathologyPersonality Traits and PsychologyBipolar Disorder and Treatment

Personality disorder: a new global perspective

Open access
TYRER, PETER, MULDER, ROGER, CRAWFORD, MIKE, NEWTON-HOWES, GILES, SIMONSEN, ERIK, NDETEI, DAVID, KOLDOBSKY, NESTOR, FOSSATI, ANDREA +2 more·2010·World Psychiatry
DOI 10.1002/j.2051-5545.2010.tb00270.xPMC PMC2816919
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Abstract

Personality disorder is now being accepted as an important condition in mainstream psychiatry across the world. Although it often remains unrecognized in ordinary practice, research studies have shown it is common, creates considerable morbidity, is associated with high costs to services and to society, and interferes, usually negatively, with progress in the treatment of other mental disorders. We now have evidence that personality disorder, as currently classified, affects around 6% of the world population, and the differences between countries show no consistent variation. We are also getting increasing evidence that some treatments, mainly psychological, are of value in this group of disorders. What is now needed is a new classification that is of greater value to clinicians, and the WPA Section on Personality Disorders is currently undertaking this task.

Verified 2026-10-06 · 7 references not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that personality disorder is common, costly, and under-recognized worldwide, with prevalence estimates around 6% globally and 3–10% in community samples. It calls for a new, clinically useful classification and concludes that psychological treatments show promise while drug treatments lack long-term support.

Key findings

  • Recent epidemiological studies report varied prevalence: 4.4% in Great Britain (Coid et al., n=628), 14.8% in the US (Grant et al., n=43,093), and a 10-country survey (Huang et al., n=21,162) found no consistent cross-country pattern; the abstract cites around 6% globally and a 3–10% community range.
  • Comorbid personality disorder predicts poorer outcomes: meta-analytic evidence from more than 60 depression studies indicates roughly double the likelihood of non-recovery, while psychosis studies show prevalence estimates from 4.5% to 100% and poorly studied outcomes.
  • Economic burden estimates include £704 million per year in English health and social care costs for people with personality disorder in contact with general practitioners, rising to £7.9 billion with productivity losses; a Dutch estimate is £11,126 per patient.
  • Treatment and classification: psychotropic drugs are judged to have no proven long-term value; structured team psychological approaches are suggested for borderline personality disorder and cognitive/group approaches for antisocial personality disorder, with rewards preferred over punishment; three quarters of surveyed experts favored replacing DSM-IV, and the WPA Section is developing ICD-11 proposals.

Methods

  • Design: narrative global-perspective review and position paper from the WPA Section on Personality Disorders, not primary research.
  • Data: summarizes three major recent epidemiological studies (Huang et al. 2009, Coid et al. 2006, Grant et al. 2004) and reviews literature on comorbidity, costs, treatment, and classification.
  • Analysis: qualitative synthesis, including reference to a meta-analysis of more than 60 depression studies described as unpublished data and to systematic reviews of treatment trials.

Limitations

  • Stated: epidemiological studies are few because national surveys rarely assess personality disorder and lay-interviewer assessment is difficult; cost estimates rely on service attenders and therefore do not represent the whole personality disorder population, so the true cost remains unknown.
  • Stated: treatment evidence is concentrated on borderline personality disorder, with too few randomized trials for clear conclusions; evidence for other personality disorders is scant, two cluster C trials disagree, and psychosis measurement reliability and outcomes are unclear.
  • Evident from the text: as a review/position piece, it relies on selected literature and some unpublished data, and the proposed dimensional factors are acknowledged to have little validity evidence so far.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/j.2051-5545.2010.tb00270.x

Cites

47 of 54 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 54 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    People with a personality disorder are about twice as likely not to recover from a depressive episode as those without personality disorder.

    “people with a personality disorder are approximately twice as likely not to recover from a de pressive episode as those with no personality disorder”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Newton-Howes, 2006, Personality disorder and the outcome of depression: a meta-analysis of published studies, Br J Psychiatry source

      Not checked in the free run.

  • Premisecitation

    The prevalence of personality pathology in psychotic mental illness ranges from 4.5% to 100%.

    “even the prevalence of personality pathology ranges from 4.5 to 100%”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Newton-Howes, 2008, The prevalence of personality disorder in schizophrenia: rates and explanatory modelling, Psychol Med

      Not checked in the free run.

  • Premisenone given

    Personality disorder has an important influence on the outcome of other mental disorders when comorbid.

    “Personality disorder has been shown to have an im portant influence on the outcome of other mental disorders when present as a comorbid condition”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Personality disorder is common in the general population.

    “research studies have shown it is common”
    Quote in the paperNot a substantial claim
  • Interpretationreasoning

    These cost studies do not provide an estimate of the total economic burden of personality disorder because they used information on people in contact with services.

    “they do not provide an estimate of the total economic burden of personality disorder, because both of them used information on people who were in contact with services”
    Quote in the paperSubstantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Interpretationreasoning

    People with personality disorder and comorbid mental disorders have poorer outcomes, function less well, and are stigmatized by clinicians in secondary services, reducing their odds of receiving optimum care.

    “people with personality disorder and comorbid personality disorder have poorer outcomes, function less well in society and are stigmatized by clinicians in secondary services, reducing the odds they will receive optimum care”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Personality disorder is associated with high costs to services and society.

    “is associated with high costs to services and to society”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The King's Fund estimated health and social care service costs of all people with personality disorder in contact with general practitioners in England at £704 million per year.

    “the King's Fund esti mated the health and social care service costs of all people with personality disorder who are in contact with their gen eral practitioners at £704 million per year”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] McCrone, 2008

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many people with personality disorder are unknown to services, reject treatment rather than seek it, or are in contact with services but have a different primary diagnosis.

    “many of those with personality disorder are un known to services (24), reject treatment rather than seek it (25), or are in contact with services but have a different pri mary diagnosis (26)”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [24] National Institute of Mental Health in England, 2003

      Not checked in the free run.

    • cites [25] Tyrer, 2003, Treatment-rejecting and treatment-seeking personality disorders: Type R and Type S, J Person Disord source

      Not checked in the free run.

    • cites [26] Ranger, 2004, Prevalence of personality disorder in the caseload of an inner city assertive outreach team, Psychiatr Bull source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Clinicians' attitudes may adversely affect delivery of health care and make it harder for patients with personality disorder and comorbid mental disorders to access and receive appropriate management.

    “These attitudes may adversely affect delivery of health care provision and as such make it more difficult for patients with personality disorder and comorbid mental disorders to access and receive appropriate manage ment for either disorder”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    As currently classified, personality disorder affects about 6% of the world population.

    “affects around 6% of the world population”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Prevalence estimates from different countries can be meaningfully compared despite differences in methods and instruments.

  • May combine two claims.

    Premisecitation

    Recent evidence suggests clinicians perceive patients with personality disorders as more difficult, despite objective evidence failing to support this view.

    “recent evidence suggests that clinicians perceive patients with personality disorders as more difficult, despite the objective evidence failing to sup port such a view”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Newton-Howes, 2008, Attitudes of staff towards patients with personality disorder in community health teams, Aust N Z J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The large variation in prevalence of personality pathology in psychosis is related to country, care provided, and measurement tools.

    “This huge variation appears to be related to the coun try of the study, the care provided and the tools used to mea sure personality”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Newton-Howes, 2008, The prevalence of personality disorder in schizophrenia: rates and explanatory modelling, Psychol Med

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Personality dysfunction has a negative effect on function and outcome and remains relatively undertreated.

    “personality dysfunction has a negative effect on function and outcome, but remains relatively undertreated”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    For over two decades, it has been suggested that mental health clinicians dislike patients with personality disorders.

    “For more than two decades, there has been the suggestion that mental health clinicians do not like patients with per sonality disorders”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Lewis, 1988, Personality disorder: the patients psychiatrists dislike, Br J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Soeteman et al calculated the total burden of personality disorder in the Netherlands to be £11,126 per patient.

    “They calculated the total burden of personality disorder in the Netherlands to be £11,126 per patient”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Soeteman, 2008, The economic burden of personality disorders in mental health care, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Community prevalence of personality disorder appears to range from 3% to 10%.

    “the community prevalence of personality disorder appears to range from 3 to 10%”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Including productivity losses, the cost rose to £7.9 billion per year.

    “When pro ductivity losses were included, the cost rose to £7.9 billion per year”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] McCrone, 2008

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Personality disorder in psychotic patients is associated with violence, crime, and hospital readmission.

    “personality disorder in this group often shows itself in terms of violence (15), crime (16), and hospital re admission (17)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Moran, 2003, Impact of co-morbid personality disorder on violence in psychosis - report from the UK700 trial, Br J Psychiatry source

      Not checked in the free run.

    • cites [16] Moran, 2004, The correlation of comorbid antisocial personality disorder in schizophrenia, Schizophr Bull source

      Not checked in the free run.

    • cites [17] Tyrer, 2000, Personality abnormality and its influence on outcome of intensive and standard case management: a randomised controlled trial, Eur Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    While there is currently little evidence to support the validity of these factors, they almost certainly provide a better description of the range of personality abnormality than current classifications.

    “While there is currently little evidence to support the va lidity of these factors, they almost certainly provide a better description of the range of personality abnormality than the current classifications”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent survey reported that three quarters of personality disorder experts thought the current DSM-IV system should be replaced.

    “A recent survey reported that three quarters of personality disorder experts thought the current DSM-IV system should be replaced”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Bernstein, 2007, Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system, J Person Disord source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The legacy is a diagnostic system that dissatisfies both researcher and clinician, being neither simple, accurate nor useful.

    “The legacy is a diagnostic system that dissatisfies both the researcher and the clinician, being neither simple, accurate or useful”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    A robust classification should travel well.

    “a robust classifica tion should travel well”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Thuo, 2008, The prevalence of personality disorders in a Kenyan inpatient sample, J Person Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The term 'personality disorder not otherwise specified' is frequently used, often more than any specific category, marking dissatisfaction with the existing classification.

    “the frequent use of the term”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Bernstein, 2007, Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system, J Person Disord source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The true cost of personality disorder remains unknown but is certainly substantial, falling to health, social services, criminal justice, and the wider economy.

    “the true cost of personal ity disorder remains unknown, but it is certainly substantial, falling to many service providing sectors (health, social ser vices, criminal justice) as well as to the economy more wide ly”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Using four or possibly more overlapping factors seems preferable to continuing to treat the ten current personality disorders as separate, when they have repeatedly been found not to be.

    “Using four (or possibly more) overlapping factors seems preferable to continuing to act as though the ten current personality dis orders are separate, when they have repeatedly been found not to be”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    NICE guidelines concluded that if other treatments, mainly psychological, are given, they need a structured team approach for borderline personality disorder and cognitive therapeutic approaches, particularly group management, for antisocial personality disorder.

    “if other treatments (mainly psychological) are to be given, they need to be administered using a structured team approach for borderline personality disorder and using cognitive therapeutic approaches (par ticularly group management) in antisocial personality disor der”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [30] National Institute of Health and Clinical Excellence, 2009

      Not checked in the free run.

    • cites [31] National Institute of Health and Clinical Excellence, 2009

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In some studies, schizoid characteristics overlap with eccentric and odd behaviour and/or paranoid symptoms, and an additional factor, peculiarity, has been suggested for a six-factor model.

    “In some studies these charac teristics overlap with eccentric and odd behaviour and/or paranoid personality disorder symptoms, and an additional factor, peculiarity, has been suggested to make up a six-fac tor model”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Watson, 2008, Structures of personality and their relevance to psychopathology: II. Further articulation of a comprehensive unified trait structure, J Person source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Some studies report a separate psychopathy factor incorporating callousness, lack of remorse, and criminal behaviour, while others find a single broad factor.

    “Some studies report a separation of a factor incorporating callousness, lack of re morse and criminal behaviour (psychopathy), while others find a single broad factor”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Most putative successful treatments for personality disorder are time consuming and resource intensive and need a good theoretical base and therapeutic commitment.

    “Most of the putative successful treatments for personality disorder are time consuming and resource intensive, and need to be buttressed by a good theoretical base and thera peutic commitment”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Although DSM-IV promoted a huge but scattered amount of research, there are now good reasons to consider the DSM-IV approach completely out of date.

    “although it has promoted a huge, but widely scattered, amount of re search on the aetiology, psychopathology, course and treat ment of personality disorders, there are now good reasons to consider the DSM-IV approach completely out of date”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The DSM-IV polythetic diagnoses describe poorly specified psychopathology and fail to identify criteria corresponding to core features of each personality disorder.

    “The DSM-IV polythetic diagnoses describe poorly speci fied psychopathology and so it is natural that they fail to identify criteria that could correspond to the”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The lack of clearly identified core features and a vote-counting approach to diagnosis prevented clinicians from making differential diagnoses within axis II.

    “The lack of clearly identified core features and a”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    An expert panel on management of people with personality disorder suggested there is no quick fix and that in most countries resources are not likely to be available to treat them in this way.

    “an expert panel on the management of people with personality disorder (37), which also suggested that there is no”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Crawford, 2008, Dedicated community-based services for adults with personality disorder: Delphi study, Br J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Such findings add weight to the case for re-classifying personality disorder to ensure clinical utility.

    “Such findings add weight to the case for re-classifying personality disorder to ensure that the system used has clinical utility”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    If the epidemiological figures are accepted, 3-10% of adult inhabitants in countries of the world have a personality disorder.

    “If we accept the epidemiological figures, 3-10% of the adult inhabitants in the countries of the world have a per sonality disorder”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    NICE guidelines concluded psychotropic drugs are of no proven long-term value in borderline and antisocial personality disorders, and adverse effects normally preclude use except for short periods and crisis.

    “psychotropic drugs are of no proven value in the long term in these personality disorders, and their adverse effects normally preclude their use except for short periods and in crisis”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [30] National Institute of Health and Clinical Excellence, 2009

      Not checked in the free run.

    • cites [31] National Institute of Health and Clinical Excellence, 2009

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    The fourth factor comprises obsessionality, compulsivity, and perfectionism, and empirical data suggest it can be separated from the internalizing factor.

    “The fourth factor comprises obsessionality, compulsivity and perfectionism and, although these are cur rently part of the cluster C grouping, the empirical data sug gests they can be separated”
    Quote in the paperSubstantial claim
33 of 33

  • The paper relies on this without support.

    People with severe personality disorder cause the most disruption to services and society.

    “it is the people in this group who cause the most disruption to services and to society”

  • The paper relies on this without support.

    Prevalence estimates from different countries can be meaningfully compared despite differences in methods and instruments.

    “the differences between countries show no consistent variation”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Personality disorders as classified in DSM-IV affect about 6% of the world's population.

    “PDs as currently classified in the DSM-IV system affects about 6 % of the world’s population [9, 11]”

    From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [11]

  • Personality disorders have been associated with similar or higher societal costs than mood and anxiety disorders.

    “Personality disorders (PDs) are now being accepted as important conditions in mainstream psychiatry and have been associated with similar or higher costs to society than mood and anxiety disorders [9–11]”

    From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [11]

  • Personality disorders are relatively common in the community, and effective treatment is available for some.

    “As PDs are relatively common in the community, and effective treatment is available for some, health care workers should be aware of the strong link between PDs and work force exclusion.”

    From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [11]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • One listed study falls outside the stated five-year period

    Minor

    The paper is dated February 2010, so a study published in 2004 was not published within the preceding five years.

  • Reported prevalence range excludes a listed survey

    Minor

    The paper gives a community prevalence range of 3-10%, but Table 1 lists 14.8% for a random sample in the United States.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Newton-Howes, 2008, The prevalence of personality disorder in schizophrenia: rates and explanatory modelling, Psychol Med, 37, 1
  2. National Institute of Health and Clinical Excellence, 2009, Borderline personality disorder: treatment and management
  3. National Institute of Health and Clinical Excellence, 2009, Antisocial personality disorder: treatment, management and prevention

Cited by

Sorted by citations

Related

Authors
TYRER, P., MULDER, R., CRAWFORD, M., NEWTON-HOWES, G., SIMONSEN, E., NDETEI, D., KOLDOBSKY, N., FOSSATI, A., MBATIA, J., & BARRETT, B.
Affiliations
  • Imperial College London (GB)
  • University of Otago (NZ)
  • University of Nairobi (KE)
  • Universidad Nacional de La Plata (AR)
  • IRCCS Ospedale San Raffaele (IT)
  • Ministry of Health and Social Welfare (TZ)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2010-02
Volume
9
Issue
1
Pages
56-60
ISSN
1723-8617 (ISSN-L)
DOI
10.1002/j.2051-5545.2010.tb00270.x
PMC
PMC2816919
OpenAlex
W1754023234
Semantic Scholar
8d4efb26c114a92c0a53f3f1cac169031babde8a
Cited by
102
References
54
Citations by year
2026: 1 · 2025: 4 · 2024: 2 · 2023: 8 · 2022: 10 · 2021: 14 · 2020: 7 · 2019: 8 · 2018: 11 · 2017: 8 · 2016: 3 · 2015: 7 · 2014: 4 · 2013: 1 · 2012: 5
FWCI
5.28
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 2038 d)
Locations
  • World Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • Americanae (AECID Library) (submittedVersion, cc-by-nc-sa)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • RUCforsk (Roskilde University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
personality disorders, global prevalence, morbidity, service costs, psychological intervention, personality disorder classification

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