The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.
The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients
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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“In these analyses, NPD formed part of an antagonism factor comprising narcissistic, antisocial, histrionic, and paranoid PDs (see Zimmerman et al. 2005).”
From Controversies in Narcissism (2017) · cites this paper as Zimmerman et al. 2005
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“Longitudinal studies show that this association is bidirectional, 241,242 but with a stronger time-lagged association of marital discord predicting depressive symptoms than viceversa. 243”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [241]
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“Approximately a quarter of patients in mental health centers and 45% of outpatients meet the minimum criteria for a personality disorders (PDs)(1, 2).”
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“The fact that more than 50% of patients diagnosed with a PD also receives the diagnosis of another PD (Clark, 2007; Zimmerman et al., 2005) is a problem which has troubled the debate in the field of Personality Disorders for at least two decades.”
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ResultA network analysis of DSM-5 avoidant personality disorder diagnostic criteria
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“Epidemiological studies documented high prevalence of PDs (ranging from 30 to 45%) among psychiatric outpatients (Zimmerman et al., 2005).”
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“Furthermore, the current categorical approaches to diagnosis a PD have been criticized due to their high within-PD overlapping rates as reported by many studies [12, 13].”
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“These delays include trialling multiple antidepressant medications and/or electroconvulsive therapy, or the use of psychotherapeutic approaches that have little efficacy for treating people with BPD.18 The frequent use of the K10 in primary health services was evident in the proportions of study participants prescribe…”
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“, 2001; Mattia and Zimmerman, 2001) and moderately higher than in general psychiatric populations (rates of 40–45%) (Zimmerman et al., 2005; Newton-Howes et al., 2009), including samples of patients with bipolar disorder (rates of 40–45%) (Keown et al.”
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“The frequency of personality disorders in our sample (13%) is less than that usually reported by outpatient psychiatric clinics (30– 45%) (Zimmerman et al., 2005) and approximates the prevalence found in the general population (between 9% and 15%) (Torgersen et al.”
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“BPD sufferers are overrepresented in treatment settings and make up an estimated 15%−20% of psychiatric inpatient samples, 10% of outpatient samples, and 10-15% of all emergency room visits (Chaput & Lebel, 2007; Tomko et al., 2014; Zimmerman et al., 2005; Zimmerman et al., 2008).”
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“Studies of the frequency and correlates of PDs should be replicated in clinical populations where the disorder and comorbidity rates are higher to provide the clinicians with information that has more direct clinical uses [15, 16].”
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Hopwood, C. J., Fox, S. E., Bender, D. S., & Zimmermann, J. (2021) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190092689.013.5 · Cited by 4
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Self-citationCo-occurrence of borderline and schizotypal personality disorders: a scoping review
Meisner, M. W., Lenzenweger, M. F., Storebø, O. J., Petersen, L. S., Bach, B., & Simonsen, E. H. (2023) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2023.2254299 · Cited by 6
“…2.3% of 431 admitted patients were diagnosed with brief/NOS psychotics disorder [32], SPD was significantly stronger associated with schizophrenia spectrum disorders [31], and in the full sample of 859 patients, 0.5% were diagnosed with schizophrenia and 0.5% with schizoaffective disorder [37].”
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“This is consistent with considerable work showing high rates of comorbidity among these diagnostic categories in later adolescence and adult-hood (Watson & Clark, 2023; Zimmerman et al., 2005).”
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“report questionnaires are more prone to this bias [22].”
BackgroundThe alliance-outcome association in borderline and obsessive-compulsive personality disorder
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“BPD and OCPD appear particularly suitable for this differential analysis of personality disorders as they belong to different DSM-5 clusters of personality disorders and are among the most common personality disorders in outpatient groups (27).”
BackgroundMood Disorders and Personality Disorders: Simplicity and Complexity
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The concurrent validity of a Web‐based self‐report assessment for personality disorders
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“The inter-rater reliability of the diagnoses in the MIDAS study is adequate (18,19) with a previously reported kappa coefficient, κ= .”
MethodSelf-citationDiagnosing alcohol abuse in alcohol dependent individuals: Diagnostic and clinical implications
Ray, L. A., Hutchison, K. E., Leventhal, A. M., Miranda, R., Francione, C., Chelminski, I., Young, D., & Zimmerman, M. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.03.028 · Cited by 6
Self-citationTijdig herkennen en behandelen van borderlineproblematiek bij jongeren met MBT-early
Hutsebaut, J., Feenstra, D., Keur, E., Schäfer, B., & Bales, D. (2017) · Tijdschrift voor Psychotherapie · doi:10.1007/s12485-017-0216-6 · Cited by 5
Juul, S., Jakobsen, J., Hestbaek, E., Kamp, C., Olsen, M. H., Rishede, M., Frandsen, F., Bo, S., Poulsen, S., Sørensen, P., et al. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000544934 · Cited by 4
Tepper, D., Sellar, B., Shipley, S., Smith, R. A., & Murray, C. M. (2025) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674251393159 · Cited by 5
“People diagnosed with BPD are prevalent in psychiatric settings (Zimmerman et al., 2005) and frequently seek support from emergency and mental health services during periods of crisis (Warrender et al., 2020).”
Munawar, K., Aqeel, M., Rehna, T., Shuja, K. H., Bakrin, F. S., & Choudhry, F. R. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.533526 · Cited by 11
Hein, K. E., Glass, I. V., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.11.075 · Cited by 5
Managing challenging residents
Bettles, S., Rich, B., & Bourne, R. (2015) · Probation Journal · doi:10.1177/0264550515620692 · Cited by 5
Diagnostic validity of millon clinical multiaxial inventory-IV (MCMI-IV)
Mohammadi, M. R., Hooshyari, Z., Delāvar, A., Amanat, M., Mohammadi, A., Abasi, I., & Salehi, M. (2022) · Current Psychology · doi:10.1007/s12144-022-02972-9 · Cited by 6
“, 1994) to over 45% (Zimmerman et al., 2005) of people with psychiatric disorders were diagnosed with personality disorders.”
BackgroundBiases in Affective Forecasting and Recall as a Function of Borderline Personality Disorder Features
Hughes, C. D., & Rizvi, S. L. (2019) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2019.38.2.200 · Cited by 5
Zimmerman, M. A., Dalrymple, K. L., Young, D., Chelminski, I., & Martinez, J. H. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.6.880 · Cited by 5
Self-citationPersonality Disorders and Addiction Disorders
Szerman, N., & Peris, L. (2014) · Springer eBooks · doi:10.1007/978-88-470-5322-9_120 · Cited by 5
Carvalho, L. D. F., Sette, C. P., & Miguel, F. K. (2018) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2017-0038 · Cited by 5
“Items must be answered using a Likert scale of four points, ranging from “it has nothing to do with me” (1) to “it has a lot to do with me” (4).”
MethodMamdouh, R., Magd, S., Rakhawy, M., & Shaheen, S. H. (2019) · Egyptian Journal of Psychiatry · doi:10.4103/ejpsy.ejpsy_16_18 · Cited by 5
Metadata
- Authors
- Zimmerman, M., Rothschild, L., & Chelminski, I.
- Affiliations
- Lifespan (US)
- Venue
- American Journal of Psychiatry
- Published
- 2005-10-01
- Volume
- 162
- Issue
- 10
- Pages
- 1911-1918
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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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