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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“The prevalence of BPD in the community is estimated at about 2% of the adult population [8], but it is present in 9% of psychiatry outpatients [9] and is also common among inpatients [10].”
Background
Understanding Borderline Personality Disorder Across Sociocultural Groups: Findings, Issues, and Future Directions
Neacsiu, A. D., Eberle, J. W., Keng, S., Fang, C. M., & Rosenthal, M. Z. (2017) · Current Psychiatry Reviews · doi:10.2174/1573400513666170612122034 · Cited by 28
An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results
Dalrymple, K. L., Morgan, T. A., Lipschitz, J. M., Martinez, J. H., Tepe, E., & Zimmerman, M. (2014) · Behavior Modification · doi:10.1177/0145445513518422 · Cited by 22
Self-citation
Validity aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder construct
Karterud, S., Øien, M., & Pedersen, G. (2010) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2010.11.001 · Cited by 23
“This is supported by other researchers as well [12,35], who found a prevalence of 2.”
Result
Poor Validity of the DSM-IV Schizoid Personality Disorder Construct as a Diagnostic Category.
Hummelen, B., Pedersen, G., Wilberg, T., & Karterud, S. (2015) · Journal of Personality Disorders · doi:10.1521/pedi_2014_28_159 · Cited by 14
Interdiagnostician Reliability of the DSM-5 Section II and Section III Alternative Model Criteria for Borderline Personality Disorder
Morey, L. C. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_362 · Cited by 22
Personality disorder and population mental health
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Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities
Horn, E. K., Bartak, A., Meerman, A. M. M. A., Rossum, B. V., Ziegler, U. M., Thunnissen, M. M., Soons, M. B. J., Andrea, H., Hamers, E. F. M., Emmelkamp, P. M. G., et al. (2014) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1904 · Cited by 24
A Hierarchical Integration of Person-Centered Comorbidity Models: Structure, Stability, and Transition Over Time
Kim, H., & Eaton, N. (2017) · Clinical Psychological Science · doi:10.1177/2167702617704018 · Cited by 21
Narcissistic personality disorder
Ronningstam, E. F. (2011) · Personality and Mental Health · doi:10.1002/pmh.172 · Cited by 22
Ruminations on narcissistic personality disorder.
Trull, T. J. (2014) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000009 · Cited by 20
Childhood maltreatment and adult personality disorder symptoms in a non-clinical sample
Carr, S. N., & Francis, A. J. P. (2009) · Australian Psychologist · doi:10.1080/00050060903136847 · Cited by 20
A Bayesian Account of Psychopathy: A Model of Lacks Remorse and Self-Aggrandizing
Prosser, A., Friston, K. J., Bakker, N., & Parr, T. (2018) · Computational Psychiatry · doi:10.1162/cpsy_a_00016 · Cited by 21
Schema Modes and Personality Disorder Symptoms in Alcohol-Dependent and Cocaine-Dependent Patients
Boog, M., van Hest, K. M., Drescher, T., Verschuur, M., & Franken, I. (2018) · European Addiction Research · doi:10.1159/000493644 · Cited by 17
Personality Functioning and Mentalizing in Patients With Subthreshold or Diagnosed Borderline Personality Disorder: Implications for ICD-11
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“Specifically, in ICD-11, the severity of PDs is determined by: “(1) Impairments in self-functioning, (2) impairments in interpersonal functioning, (3) the pervasiveness, severity, and chronicity of emotional, cognitive, and behavioral manifestations of the personality dysfunction, (4) the extent to which the personali…”
Background
Group schema therapy for cluster‐C personality disorders: A multicentre open pilot study
Wibbelink, C. J. M., Venhuizen, A. S. M., Grasman, R. P. P. P., Bachrach, N., van den Hengel, C., Hudepohl, S., Kunst, L. E., de Lange, H., Louter, M. A., Matthijssen, S. J. M. A., et al. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2903 · Cited by 23
Confronting Myths and Stereotypes About Borderline Personality Disorder
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Characterizing DSM-5 and ICD-11 personality disorder features in psychiatric inpatients at scale using electronic health records
Barroilhet, S. A., Pellegrini, A. M., McCoy, T. H., & Perlis, R. H. (2019) · Psychological Medicine · doi:10.1017/s0033291719002320 · Cited by 20
“Studies using structured diagnostic interviews have identified a PD diagnosis in 40–82% of psychiatric outpatient populations (Zimmerman et al., 2005; Newton-Howes et al., 2010; Beckwith et al., 2014) and in 64–74% of psychiatric inpatient populations (Grilo et al.”
Method
The Italian Version of the Inventory of Interpersonal Problems Personality Disorders Scales (IIP-47): Psychometric Properties and Clinical Usefulness as a Screening Measure
Ubbiali, A., Chiorri, C., & Donati, D. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.4.528 · Cited by 20
“, 1997) to all the subjects, after the remission of acute DSM-IV Axis I symptoms confirmed by the clinical judgment of a psychiatrist (Zimmerman et al., 2005).”
BackgroundMethodInfluential
Clinically useful screen for borderline personality disorder in psychiatric out-patients
Zimmerman, M. A., Multach, M. D., Dalrymple, K. L., & Chelminski, I. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.116.182121 · Cited by 20
Self-citation
Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N)
Diamond, D., Yeomans, F., & Keefe, J. R. (2021) · Psychodynamic Psychiatry · doi:10.1521/pdps.2021.49.2.244 · Cited by 19
Age and remission of personality pathology in the psychotic disorders compared to mood and/or anxiety disorders
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“Though many related studies [1-4] report different concrete rates, the conclusions reached by most studies hold that PD and Axis I diagnosis have quite high comorbidity.”
BackgroundResult
DSM-IV personality disorders and associations with externalizing and internalizing disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
Harford, T. C., Chen, C. M., Saha, T. D., Smith, S. M. R., Ruan, W. J., & Grant, B. F. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.07.016 · Cited by 20
Borderline personality disorder subscale (Chinese version) of the structured clinical interview for DSM-IV axis II personality disorders: a validation study in Cantonese-speaking Hong Kong Chinese.
Wong, H. M., & Chow, L. Y. (2011) · PubMed · Cited by 19
The DSM-5 Level of Personality Functioning Scale
Zimmermann, J., Hopwood, C. J., & Krueger, R. F. (2023) · Oxford University Press eBooks · doi:10.1093/med-psych/9780197542521.003.0025 · Cited by 21
Impact of the COVID-19 pandemic on patients with pre-existing mood disorders
McLoughlin, J., O’Grady, M., & Hallahan, B. P. (2021) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2021.38 · Cited by 19
“Emotionally unstable personality disorder (EUPD) has a reported point prevalence in the population of approximately 1% (Samuels et al. 2002, Coid et al. 2006) with rates amongst patients attending secondary mental health services of approximately 10% (Zimmerman et al. 2005).”
Diagnostic orphans for alcohol use disorders in a treatment-seeking psychiatric sample
Ray, L. A., Miranda, R., Chelminski, I., Young, D., & Zimmerman, M. A. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.03.002 · Cited by 19
Self-citation
Comorbidity Between Narcissistic Personality Disorder and Axis I Diagnoses
Simonsen, S., & Simonsen, E. H. (2011) · Wiley eBooks · doi:10.1002/9781118093108.ch21 · Cited by 19
The Association Between Childhood Trauma and Attachment Functioning in Patients With Personality Disorders
Voestermans, D., Eikelenboom, M., Rullmann, J., Wolters-Geerdink, M., Draijer, N., Smit, J. H., Thomaes, K., & van Marle, H. J. F. (2021) · Journal of Personality Disorders · doi:10.1521/pedi_2020_34_474 · Cited by 19
Are DSM-IV-TR Borderline Personality Disorder, ICD-10 Emotionally Unstable Personality Disorder, and CCMD-III Impulsive Personality Disorder Analogous Diagnostic Categories Across Psychiatric Nomenclatures?
Lai, C. M., Leung, F. Y. K., You, J., & Cheung, F. M. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.4.551 · Cited by 18

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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