Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study
It is not yet clear whether chronic fatigue syndrome (CFS) is associated with elevated levels of personality disorders.
This study aims to determine the prevalence of DSM-IV axis II personality disorders among patients with CFS.
We examined the prevalence of personality disorders in a sample of 92 female CFS patients and in two well-matched control groups, i.e., normal community individuals (N = 92) and psychiatric patients (N = 92). Participants completed the assessment of DSM-IV personality disorders questionnaire (ADP-IV), which yields a categorical and dimensional evaluation of personality disorder features.
The prevalence of personality disorders in CFS patients (16.3 %) was significantly lower than in psychiatric patients (58.7 %) and was similar to that in the community sample (16.3 %). Similar results were found for dimensional and pseudodimensional scores, except for the Depressive (DE) and Obsessive–Compulsive Personality Disorder (O-C) subscales. Patients with CFS had significantly higher levels of DE features compared to normal controls and similar dimensional scores on the O-C scale compared to psychiatric controls.
Although the CFS sample was characterized by depressive and obsessive–compulsive personality features, this study provides no evidence for the assumption that these patients generally show a higher prevalence of axis II pathology. Given the conflicting findings in this area, future studies using multiple measures to assess personality disorders in CFS are needed to substantiate these findings.
- Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953–9. CrossRef
- Carruthers BM, van de Sande MI, De Meirleir KL, et al. Myalgic encephalomyelitis: International Consensus Criteria. J Intern Med. 2011;270:327–38. CrossRef
- Van Houdenhove B, Kempke S, Luyten P. Psychiatric aspects of chronic fatigue syndrome and fibromyalgia. Curr Psychiatr Rep. 2010;12:208–14. CrossRef
- Van Houdenhove B, Luyten P. Chronic fatigue syndrome reflects loss of adaptability. J Intern Med. 2010;268:249–51. CrossRef
- Luyten P, Kempke S, Van Wambeke P, Claes S, Blatt SJ, Van Houdenhove B. Self-critical perfectionism, stress generation, and stress sensitivity in patients with chronic fatigue syndrome: relationship with severity of depression. Psychiatry. 2011;74:21–30.
- Van Den Eede F, Moorkens G, Van Houdenhove B, Cosyns P, Claes SJ. Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. Neuropsychobiology. 2007;55:112–20. CrossRef
- Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a ‘crash’ in the stress system? Med Hypotheses. 2009;72:701–5. CrossRef
- Dittner AJ, Rimes K, Thorpe S. Negative perfectionism increases the risk of fatigue following a period of stress. Psychol Health. 2011;26:253–68. CrossRef
- Deary V, Chalder T. Personality and perfectionism in chronic fatigue syndrome: a closer look. Psychol Health. 2010;25:465–75. CrossRef
- Fukuda S, Kuratsune H, Tajima S, et al. Premorbid personality in chronic fatigue syndrome as determined by the Temperament and Character Inventory. Compr Psychiatr. 2010;51:78–85. CrossRef
- Kempke S, Van Houdenhove B, Luyten P, Goossens L, Bekaert P, Van Wambeke P. Unraveling the role of perfectionism in chronic fatigue syndrome: is there a distinction between adaptive and maladaptive perfectionism? Psychiatr Res. 2011;186:373–7. CrossRef
- Kempke S, Luyten P, Van Houdenhove B, Goossens L, Bekaert P, Van Wambeke P. Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome. Clin Rheumatol. 2011;30:1543–8. CrossRef
- Luyten P, Van Houdenhove B, Cosyns N, Van den Broeck A-L. Are patients with chronic fatigue syndrome perfectionistic-or were they? A case–control study. Pers Indiv Differ. 2006;40:1473–83. CrossRef
- Moss-Morris R, Spence MJ, Hou R. The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychol Med. 2011;41:1099–107. CrossRef
- Van Campen E, Van Den Eede F, Moorkens G, et al. Use of the Temperament and Character Inventory (TCI) for assessment of personality in chronic fatigue syndrome. Psychosomatics. 2009;50:147–54. CrossRef
- Van Houdenhove B, Bruyninckx K, Luyten P. In search of a new balance. Can high “action-proneness” in patients with chronic fatigue syndrome be changed by a multidisciplinary group treatment? J Psychosom Res. 2006;60:623–5. CrossRef
- van Geelen SM, Sinnema G, Hermans HJ, Kuis W. Personality and chronic fatigue syndrome: methodological and conceptual issues. Clin Psychol Rev. 2007;27:885–903. CrossRef
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA; 1994.
- Ciccone DS, Busichio K, Vickroy M, Natelson BH. Psychiatric morbidity in the chronic fatigue syndrome: are patients with personality disorder more physically impaired? J Psychosom Res. 2003;54:445–52. CrossRef
- Millon C, Salvato F, Blaney N, et al. A psychological assessment of chronic fatigue syndrome/chronic Epstein–Barr virus patients. Psychol Health. 1989;3:131–41. CrossRef
- Johnson SK, DeLuca J, Natelson BH. Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression. J Psychiatr Res. 1996;30:9–20. CrossRef
- Henderson M, Tannock C. Objective assessment of personality disorder in chronic fatigue syndrome. J Psychosom Res. 2004;56:251–4. CrossRef
- Nater UM, Jones JF, Lin JM, Maloney E, Reeves WC, Heim C. Personality features and personality disorders in chronic fatigue syndrome: a population-based study. Psychother Psychosom. 2010;79:312–8. CrossRef
- Hyler SE, Rieder RO. PDQ-R: Personality Diagnostic Questionnaire-Revised. New York: State Psychiatric Institute; 1987.
- Hyler SE. Personality Diagnostic Questionnaire-4+ (PDQ-4+). New York: State Psychiatric Institute; 1994.
- First M, Spitzer R, Gibbon M, Williams J, editors. Structured Clinical Interview for DSM-III-R personality disorders (SCID-III). Washington, DC: American Psychiatric Press; 1987.
- Courjaret J, Schotte CK, Wijnants H, Moorkens G, Cosyns P. Chronic fatigue syndrome and DSM-IV personality disorders. J Psychosom Res. 2009;66:13–20. CrossRef
- Schotte CK, de Doncker D, Vankerckhoven C, Vertommen H, Cosyns P. Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV. Psychol Med. 1998;28:1179–88. CrossRef
- Reus RJ, Berg JF, Emmelkamp PM. Personality Diagnostic Questionnaire 4+ is not useful as a Screener in Clinical Practice 2012. Clin Psychol Psychother (in press)
- Wilberg T, Dammen T, Friis S. Comparing Personality Diagnostic questionnaire-4+ with Longitudinal, Expert, All Data (LEAD) standard diagnoses in a sample with a high prevalence of axis I and axis II disorders. Compr Psychiatr. 2000;41:295–302. CrossRef
- Kay JH, Altshuler LL, Ventura J, Mintz J. Prevalence of axis II comorbidity in bipolar patients with and without alcohol use disorders. Ann Clin Psychiatr. 1999;11:187–95. CrossRef
- Schotte CK, De Doncker DA, Dmitruk D, Van Mulders I, D'Haenen H, Cosyns P. The ADP-IV questionnaire: differential validity and concordance with the semi-structured interview. J Pers Disord. 2004;18:405–19.
- Jason LA, Richman JA, Rademaker AW, et al. A community-based study of chronic fatigue syndrome. Arch Intern Med. 1999;159:2129–37. CrossRef
- Doering S, Renn D, Hofer S, et al. Validation of the “Assessment of DSM-IV Personality Disorders (ADP-IV)” Questionnaire. Z Psychosom Med Psychother. 2007;53:111–28.
- Bastiaansen L, Rossi G, Schotte C, De Fruyt F. The structure of personality disorders: comparing the DSM-IV-TR Axis II classification with the five-factor model framework using structural equation modeling. J Pers Disord. 2011;25:378–96. CrossRef
- Schotte CKW. New instruments for diagnosing personality disorders. Curr Opin Psychiatr. 2000;13:605–9. CrossRef
- Schotte C, De Doncker D. Assessment of DSM-IV Personality Disorders questionnaire (ADP-IV). Edegem (Antwerp): UZA; 1994.
- First M, Gibbon M, Spitzer R, Williams J, editors. User's guide for the structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, D.C.: APA; 1997.
- Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum; 1988.
- Grant BF, Hasin DS, Stinson FS, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatr. 2004;65:948–58. CrossRef
- Ekselius L, Tillfors M, Furmark T, Fredrikson M. Personality disorders in the general population: DSM-IV and ICD-10 defined prevalence as related to sociodemographic profile. Pers Indiv Differ. 2001;30:311–20. CrossRef
- Lerman SF, Shahar G, Rudich Z. Self-criticism interacts with the affective component of pain to predict depressive symptoms in female patients. Eur J Pain. 2012;16:115–22. CrossRef
- Uguz F, Cicek E, Salli A, et al. Axis I and Axis II psychiatric disorders in patients with fibromyalgia. Gen Hosp Psychiatr. 2010;32:105–7. CrossRef
- Wessely S, White PD. There is only one functional somatic syndrome. Br J Psychiatry. 2004;185:95–6. CrossRef
- Pae CU, Luyten P, Marks DM, et al. The relationship between fibromyalgia and major depressive disorder: a comprehensive review. Curr Med Res Opin. 2008;24:2359–71. CrossRef
- Arnold LM. Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics. 2008;49:185–90. CrossRef
- Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P. Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord. 2010;126:174–9. CrossRef
- Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. 2003;160:221–36. CrossRef
- Reyes M, Nisenbaum R, Hoaglin DC, et al. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med. 2003;163:1530–6. CrossRef
- Luyten P, Blatt SJ. Integrating theory-driven and empirically-derived models of personality development and psychopathology: a proposal for DSM V. Clin Psychol Rev. 2011;31:52–68. CrossRef
- Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study
International Journal of Behavioral Medicine
Volume 20, Issue 2 , pp 219-228
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Chronic fatigue
- Personality disorders
- Functional somatic syndromes
- Author Affiliations
- 1. Department of Psychology, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium
- 2. Department of Psychiatry, Antwerp University Hospital, Edegem, Antwerp, Belgium
- 3. Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- 4. Department of Clinical Psychology, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussels, Belgium
- 5. Department of Clinical and Lifespan Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- 6. Department of Psychiatry, University Hospitals Leuven, University of Leuven, Leuven, Belgium
- 7. Chronic Fatigue Syndrome Reference Center, University Hospitals Leuven, University of Leuven, Pellenberg, Belgium
- 8. Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, University of Leuven, Leuven, Belgium
- 9. Research Department of Clinical, Educational and Health Psychology, University College London, London, UK