A Strategy to Address High Comorbidity of Personality Disorders in a Chinese Population: A Principal and Subordinate Diagnostic Model
Abstract
Objective: Multiple and overlapping diagnoses of personality disorders (PDs) have been a major obstacle in clinical practice and research. This study aims to investigate the comorbidity of PDs in a sample of a high-risk clinical population. We propose a diagnostic model to address this critical issue.Methods: The sample population included 982 PD patients. The PD diagnoses were concluded based on self-reported and face-to-face interviews. To address the issue of overlapping PD diagnoses, we defined the criteria for clinically distinguishing principal and subordinate PDs, and determined the frequency of each condition.Results: Diagnostic overlap among PDs was quite common across all categories. Of all 982 PD patients, 436 (44.4%) met the criteria for more than one PD. In terms of specific PD diagnoses, the comorbidity rate of each PD was nearly 47.1–74.7%. The principal and subordinate PDs were distinguished accordingly. Avoidant, obsessive-compulsive, and borderline PD remain the most prevalent types of principal PD in this clinical population.Conclusions: The principal/subordinate model may be one strategy of resolving the issue of PD comorbidity in Chinese clinical settings.
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The PDQ-4+ has high test-retest reliability (0.92) in the Chinese population.
“It has demonstrated high test-retest reliability (0.92) in the Chinese population, confirming its consistency in producing reliable results (5, 14, 21).”
From Age-related differences in borderline personality disorder traits and childhood maltreatment: a cross-sectional study (2025) · cites this paper as [21]
The PDQ-4+ has high sensitivity (0.89) and acceptable specificity (0.65) for screening DSM-IV PDs among Chinese psychiatric patients.
“The PDQ-4+ has high sensitivity (0.89) and acceptable specificity (0.65), making it a widely used tool for screening DSM-IV PDs among Chinese psychiatric patients.”
From Age-related differences in borderline personality disorder traits and childhood maltreatment: a cross-sectional study (2025) · cites this paper as [21]
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Self-citation
- Authors
- Wang, J., Chen, Z., Sun, W., Zheng, Y., Hui, L., Liu, X., Wang, J., Wu, H., Qiao, Y., & Zhang, T.
- Affiliations
- Punan Hospital (CN)
- Corresponding author
- Zhang, TianHong
- Venue
- Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2019-04-24
- Volume
- 82
- Issue
- 3
- Pages
- 1-11
- ISSN
- 0033-2747 (ISSN-L)
- 1943-281X
- OpenAlex
- W2941596009
- Cited by
- 15
- References
- 24
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 2
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Science and Technology of China, National Key R&D Program of China (2016YFC1306803)
- National Natural Science Foundation of China (81671329)
- Shanghai Key Laboratory of Psychotic Disorders (13dz2260500)
- Shanghai Shenkang Hospital Development Center, Clinical Research Plan of SHDC (16CR2015A)
- Shanghai Key Basic Research Project (16JC1420201)
- Suzhou Municipal Science and Technology Bureau, China (sys2018097)
- Shanghai Mental Health Center Foundation (2016-FX-01)
- Shanghai Academic Research Leader (16XD1402400)
- Ministry of Science and Technology of the People’s Republic of China (2016YFC1306803)
- Program of Shanghai Academic Research Leader (16XD1402400)
- 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, comorbidities, diagnostic overlap, Chinese patients, avoidant personality disorder, obsessive-compulsive personality disorder, borderline personality disorder, diagnosis
- MeSH terms
- Adolescent, Adult, China, Female, Humans, Male, Middle Aged, Models, Psychological, Personality Disorders, Comorbidity, Prevalence, Asian People, Young Adult, Self Report
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