Cited by 825Personality Disorders and PsychopathologyPersonality Traits and PsychologyBipolar Disorder and Treatment

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The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients

Zimmerman, Mark, Rothschild, Louis, Chelminski, Iwona·2005·American Journal of Psychiatry

DOI 10.1176/appi.ajp.162.10.1911

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Abstract

OBJECTIVE: The largest clinical epidemiological surveys of personality disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services project is one of the largest clinical epidemiological studies to use semistructured interviews to assess a wide range of psychiatric disorders conducted in general clinical outpatient practice. In the present report, the authors examined the frequency of DSM-IV personality disorders in a patient group and the comorbidity among them. METHOD: Eight hundred fifty-nine psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality upon presentation for treatment. RESULTS: Slightly less than one-third of the patients were diagnosed with one of the 10 official DSM-IV personality disorders (N=270, 31.4%). When the patients with personality disorder not otherwise specified were included, the rate of any personality disorder increased to almost half of the group (N=391, 45.5%). The majority of patients meeting criteria for one of the specific personality disorders were diagnosed with more than one. Avoidant, borderline, and obsessive-compulsive personality disorder were the most frequent specific diagnoses. CONCLUSIONS: Personality disorders, as a group, are among the most frequent disorders treated by psychiatrists. They should be evaluated in all psychiatric patients because their presence can influence the course and treatment of the axis I disorder that patients typically identify as their chief complaint.

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“However, ASPD and BPD have a number of similarities in symptoms, which is reflected by a high comorbidity rate (Zimmerman et al., 2005; Freestone et al., 2013).”
Background
An Integrative Relational Step-Down Model of Care: The Project Air Strategy for Personality Disorders
Grenyer, B. F. S. (2014) · Research Online (University of Wollongong) · Cited by 38
Is there adequate empirical justification for radically revising the personality disorders section for DSM-5?
Zimmerman, M. A. (2011) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0022108 · Cited by 41
Self-citation
Health care costs of borderline personality disorder and matched controls with major depressive disorder: a comparative study based on anonymized claims data
Bode, K., Vogel, R., Walker, J., & Kröger, C. B. (2016) · The European Journal of Health Economics · doi:10.1007/s10198-016-0858-2 · Cited by 43
The General Assessment of Personality Disorder (GAPD) as an Instrument for Assessing the Core Features of Personality Disorders
Berghuis, H., Kamphuis, J. H., Verheul, R., Larstone, R., & Livesley, J. (2012) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1811 · Cited by 39
Severe war-related trauma and personality pathology: a case-control study
Munjiza, J., Britvić, D., Radman, M., & Crawford, M. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1269-3 · Cited by 39
Emotional dysregulation in borderline personality disorder and its influence on communication behavior and feelings in romantic relationships
Miano, A., Grosselli, L., Roepke, S., & Dziobek, I. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.06.002 · Cited by 38
Patient factors predicting early dropout from psychiatric outpatient care for borderline personality disorder
De Panfilis, C., Marchesi, C., Cabrino, C., Monici, A., Politi, V., Rossi, M., & Maggini, C. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.03.016 · Cited by 37
“First, BPD is frequently diagnosed among outpatients attending general psychiatric settings (Zimmerman et al., 2005).”
Background
Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial
Beck, E., Bo, S., Gondan, M., Poulsen, S., Pedersen, L., Pedersen, J., & Simonsen, E. H. (2016) · Trials · doi:10.1186/s13063-016-1431-0 · Cited by 37
“between 9 and 22 % in outpatient settings [10, 11], and up to 40 % in inpatient settings [12].”
Background
Faking Good: An Investigation of Social Desirability and Defensiveness in an Inpatient Sample With Personality Disorder Traits
Williams, M. M., Rogers, R., Sharf, A. J., & Ross, C. A. (2018) · Journal of Personality Assessment · doi:10.1080/00223891.2018.1455691 · Cited by 44
“As addressed previously, the omission of validity scales in the development of the PID–5 represents a significant professional concern, due to the high prevalence rates of personality pathology within an inpatient population (e.g., Lenzenweger et al., 2007; Zimmerman et al., 2005).”
Background
Childhood Adversity, Mental Disorder Comorbidity, and Suicidal Behavior in Schizotypal Personality Disorder
Lentz, V. J., Robinson, J. A., & Bolton, J. M. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181f9804c · Cited by 39
“This is consistent with the 2 previous studies having examined such a relationship (Coid et al., 2006; Zimmerman et al., 2005).”
Result
Parentalités limites et prises en charge thérapeutiques
Nestour, A. L., Apter, G., Héroux, C., Mourgues, B., & Patouillot, I. (2008) · La psychiatrie de l enfant · doi:10.3917/psye.501.0125 · Cited by 37
Personality traits and maladaptivity: Unipolarity versus bipolarity
Williams, T. F., & Simms, L. J. (2017) · Journal of Personality · doi:10.1111/jopy.12363 · Cited by 40
Are Impairments in Theory of Mind Specific to Borderline Personality Disorder?
Normann‐Eide, E., Antonsen, B. T., Kvarstein, E. H., Pedersen, G., Vaskinn, A., & Wilberg, T. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_417 · Cited by 40
Pain in patients with borderline personality disorder
Biskin, R. S., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2014) · Personality and Mental Health · doi:10.1002/pmh.1265 · Cited by 37
Structure of borderline personality disorder symptoms in a nonclinical sample
Taylor, J. E., & Reeves, M. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20398 · Cited by 36
An Investigation of Adherence to Diagnostic Criteria, Revisited: Clinical Diagnosis of theDSM-IV/DSM-5Section II Personality Disorders
Morey, L. C., & Benson, K. T. (2015) · Journal of Personality Disorders · doi:10.1521/pedi_2015_29_188 · Cited by 36
Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up
Fassbinder, E., Schuetze, M., Kranich, A., Sipos, V., Hohagen, F., Shaw, I. A., Farrell, J. M., Arntz, A., & Schweiger, U. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01851 · Cited by 39
“Prevalence is estimated to be 2.7% in non-clinical samples (Trull et al., 2010) and up to 10% in outpatient and 25% in inpatient populations (Widiger and Weissman, 1991; Zimmerman et al., 2005).”
Influential
Evaluation of DSM‐5 and ICD‐11 personality traits using the Personality Inventory for DSM‐5 (PID‐5) in a Brazilian sample of psychiatric inpatients
Lugo, V., de Oliveira, S. E. S., Hessel, C. R., Monteiro, R. T., Pasche, N. L., Pavan, G. N., Motta, L. S., Pacheco, M. A., & Spanemberg, L. (2018) · Personality and Mental Health · doi:10.1002/pmh.1436 · Cited by 40
Epidemiology of personality disorders
Guzzetta, F., & de Girolamo, G. (2012) · doi:10.1093/med/9780199696758.003.0111 · Cited by 34
Components of Brief Admission as a Crisis Intervention for Patients With a Borderline Personality Disorder: Results of a Delphi Study
Helleman, M., Goossens, P. J. J., van Achterberg, T., & Kaasenbrood, A. (2017) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390317728330 · Cited by 34
Is Borderline Personality Disorder a Serious Mental Illness?
Le, H., Hashmi, A. M., Czelusta, K.-L. T., Matin, A., Moukaddam, N. J., & Shah, A. A. (2020) · Psychiatric Annals · doi:10.3928/00485713-20191203-02 · Cited by 34
Trait-based assessment of borderline personality disorder using the NEO Five-Factor Inventory: Phenotypic and genetic support.
Few, L. R., Miller, J. D., Grant, J. D., Maples, J. L., Trull, T. J., Nelson, E. C., Oltmanns, T. F., Martin, N. G., Lynskey, M. T., & Arpana Agrawal, A. (2015) · Psychological Assessment · doi:10.1037/pas0000142 · Cited by 34
Conceptual changes to the definition of borderline personality disorder proposed for DSM-5.
Samuel, D. B., Miller, J. D., Widiger, T. A., Lynam, D. R., Pilkonis, P. A., & Ball, S. A. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0025285 · Cited by 34
PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial
Fassbinder, E., Assmann, N., Schaich, A., Heinecke, K., Wagner, T., Sipos, V., Jauch-Chara, K., Hüppe, M., Arntz, A., & Schweiger, U. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1905-6 · Cited by 33
Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours
Kells, M., Joyce, M., Flynn, D., Spillane, A., & Hayes, A. (2020) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-020-0119-y · Cited by 33
Stigma: Content analysis of the representation of people with personality disorder in the UK popular press, 2001–2012
Bowen, M. (2016) · International Journal of Mental Health Nursing · doi:10.1111/inm.12213 · Cited by 33
Patients with Cluster A Personality Disorders in Psychotherapy: An Effectiveness Study
Bartak, A., Andrea, H., Spreeuwenberg, M. D., Thunnissen, M. M., Ziegler, U. M., Dekker, J., Bouvy, F., Hamers, E. F. M., Meerman, A. M. M. A., Busschbach, J. J. V., et al. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000320587 · Cited by 33
Standard 12 month dialectical behaviour therapy for adults with borderline personality disorder in a public community mental health setting
Flynn, D., Kells, M., Joyce, M., Corcoran, P. E., Gillespie, C., Suarez, C., Weihrauch, M., & Cotter, P. (2017) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-017-0070-8 · Cited by 33
“This is similar to what has been reported in other countries including the United Kingdom [7], North America [8] and other parts of Europe (e.”
Result
Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care
Asp, M., Lindqvist, D., Fernström, J., Ambrus, L., Tuninger, E., Reis, M., & Westrin, Å. (2020) · PLoS ONE · doi:10.1371/journal.pone.0227364 · Cited by 38
“using TDA and are more frequently identified with semi-structured interviews [27].”
Method

Authors: Zimmerman, M., Rothschild, L., & Chelminski, I.
Affiliations: Lifespan (US)
ORCID: Zimmerman, Mark
Rothschild, Louis
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2005-10-01
Volume: 162
Issue: 10
Pages: 1911-1918
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.162.10.1911
OpenAlex: W2162488020
Cited by: 825
References: 42
Citations by year: 2026: 13 · 2025: 24 · 2024: 17 · 2023: 39 · 2022: 33 · 2021: 51 · 2020: 78 · 2019: 47 · 2018: 48 · 2017: 56 · 2016: 36 · 2015: 50 · 2014: 63 · 2013: 38 · 2012: 60
FWCI: 22.37
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r29mh048732-05)
National Institute of Mental Health (MH-56404, MH48732)
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, DSM-IV personality disorders, prevalence, psychiatric outpatients, comorbidities, avoidant personality disorder, borderline personality disorder, obsessive-compulsive personality disorder, semi-structured interviews, clinical epidemiology
MeSH terms: Adult, Ambulatory Care, Mental Disorders, Female, Humans, Male, Personality Disorders, Psychiatric Status Rating Scales, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders

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The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients

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