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Relationship of Personality Disorders to the Course of Major Depressive Disorder in a Nationally Representative Sample
Open accessAbstract
OBJECTIVE: The purpose of this study was to examine the effects of specific personality disorder comorbidity on the course of major depressive disorder in a nationally representative sample. METHOD: Data were drawn from 1,996 participants in a national survey. Participants who met criteria for major depressive disorder at baseline in face-to-face interviews (in 2001-2002) were reinterviewed 3 years later (in 2004-2005) to determine persistence and recurrence. Predictors included all DSM-IV personality disorders. Control variables included demographic characteristics, other axis I disorders, family and treatment histories, and previously established predictors of the course of major depressive disorder. RESULTS: A total of 15.1% of participants had persistent major depressive disorder, and 7.3% of those who remitted had a recurrence. Univariate analyses indicated that avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal personality disorders all elevated the risk for persistence. With axis I comorbidity controlled, all personality disorders except histrionic personality disorder remained significant. With all other personality disorders controlled, borderline and schizotypal disorders remained significant predictors. In final, multivariate analyses that controlled for age at onset of major depressive disorder, the number of previous episodes, duration of the current episode, family history, and treatment, borderline personality disorder remained a robust predictor of major depressive disorder persistence. Neither personality disorders nor other clinical variables predicted recurrence. CONCLUSIONS: In this nationally representative sample of adults with major depressive disorder, borderline personality disorder robustly predicted persistence, a finding that converges with recent clinical studies. Personality psychopathology, particularly borderline personality disorder, should be assessed in all patients with major depressive disorder, considered in prognosis, and addressed in treatment.
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“Major depressive disorder was associated with other psychiatric disorders, especially generalized anxiety disorder and borderline personality disorder, associations found in previous studies.5,[46][47][48][49]”
From Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [48]
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Self-citationGrant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., Dawson, D. S., Pulay, A. J., Pickering, R. P., et al. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0404 · Cited by 1,618
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Self-citationRecurrence after recovery from major depressive disorder during 15 years of observational follow-up
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Prevention of Relapse following cognitive therapy vs medications in moderate to severe depression.
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., et al. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.4.417 · Cited by 735
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- Grilo CM, J Clin Psychiatry
- Pulay AJ, J Clin Psychiatry
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Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.4602 · Cited by 1,737
Self-citationBorderline personality disorder
Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S. O., & Zanarini, M. C. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2018.29 · Cited by 511
Self-citationHasin, D. S., & Grant, B. F. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1088-0 · Cited by 452
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Friborg, O., Martinsen, E. W., Martinussen, M., Kaiser, S., Øvergård, K. T., & Rosenvinge, J. H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.08.023 · Cited by 242
Metadata
- Authors
- Skodol, A. E., Grilo, C. M., Keyes, K. M., Geier, T., Grant, B. F., & Hasin, D. S.
- Affiliations
- New York State Psychiatric Institute (US)
- Venue
- American Journal of Psychiatry
- Published
- 2011-03
- Volume
- 168
- Issue
- 3
- Pages
- 257-264
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3202962
- OpenAlex
- W2158522650
- Cited by
- 225
- References
- 40
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 12 · 2023: 6 · 2022: 19 · 2021: 20 · 2020: 12 · 2019: 13 · 2018: 18 · 2017: 18 · 2016: 14 · 2015: 14 · 2014: 23 · 2013: 17 · 2012: 12
- FWCI
- 21.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Alcohol Abuse and Alcoholism (Z01AA000449, U01AA018111, K05AA014223)
- 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
- major depressive disorder, personality disorders, borderline personality disorder, schizotypal personality disorder, disease persistence, recurrence, comorbidities, prognosis, DSM-IV personality disorders, avoidant personality disorder, histrionic personality disorder, paranoid personality disorder, schizoid personality disorder
- MeSH terms
- Adult, Depressive Disorder, Major, Major Depressive Disorder, Female, Health Surveys, Humans, Male, Middle Aged, Personality Disorders, Prognosis, Recurrence, Risk Factors, Comorbidity
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