Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions
- 506 Downloads
There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, arthritis and gastrointestinal disease (GI)] in a nationally representative survey of adults from the United States.
This study utilized pooled data (n = 34,653; ≥20 years) from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. PDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Physical conditions were based on self-reports of being diagnosed by a health professional. Unadjusted and adjusted logistic regressions examined the relationship between PDs and physical conditions.
After adjustment (sociodemographic factors, past-year mood, anxiety and substance use disorders), Clusters A, B and C PDs were each associated with physical conditions (all p ≤ 0.01). Of the individual PDs, schizoid, schizotypal, narcissistic, borderline and obsessive–compulsive PDs were associated with CVD (all p ≤ 0.01) among younger adults. Paranoid, antisocial, borderline and avoidant PDs and younger adults with schizoid, schizotypal and obsessive–compulsive PDs were each associated with arthritis (all p ≤ 0.01). Significant associations were seen between paranoid, schizoid and schizotypal PDs and diabetes (all p ≤ 0.01). Finally, schizotypal, antisocial, borderline and narcissistic PDs were associated with GI conditions (all p ≤ 0.01).
PDs were consistently associated with physical conditions. Investigation of PDs and their relationship with physical health outcomes warrant further research attention as these findings have important clinical implications.
KeywordsPersonality disorders Comorbidity Physical conditions NESARC
Shae E Quirk is supported by a National Health and Medical Research Council (NHMRC of Australia) Postgraduate Scholarship (GNT1076347). Renée El-Gabalawy has received a Manitoba Graduate Scholarship, and a Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research. Sharon Brennan has received Grant/Research support from The University of Melbourne, and is supported by an Early Career Research Fellowship from the NHMRC (GNT1012472). James Bolton has received Grant/Research support from the Canadian Institutes of Health Research, and the Manitoba Health Research Council. Michael Berk has received Grant/Research Support from the National Institute of Health (USA), Simons Foundation, CRC for Mental Health, Stanley Medical Research Institute, Medical Benefits Fund, National Health and Medical Research Council (NHMRC of Australia), Beyond Blue, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Organon, Novartis, Mayne Pharma, Servier and Astra Zeneca. He has been a paid consultant for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck and Pfizer and a paid speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Organon, Pfizer, Sanofi Synthelabo, Solvay and Wyeth and is supported by a NHMRC Senior Principal Research Fellowship (GNT1059660). Andrew Chanen has received research funding from the National Health and Medical Research Council (NHMRC of Australia), Australian Research Council, Colonial Foundation, The University of Melbourne, and the New South Wales Department of Health. Lana Williams has received Grant/Research support from Eli Lilly, Pfizer, The University of Melbourne, Deakin University and the National Health and Medical Research Council (NHMRC of Australia), is supported by a NHMRC Career Development Fellowship (GNT1064272).
Conflict of interest
The authors have no conflict of interest to declare.
The US Census Bureau and the US Office of Management and Budget reviewed the research protocol and provided full ethical approval and therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 1.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
- 6.Jackson HJ, Burgess PM (2002) Personality disorders in the community: results from the Australian National Survey of Mental Health and Wellbeing Part II. Relationships between personality disorder, axis I mental disorders and physical conditions with disability and health consultations. Soc Psychiatry Psychiatr Epidemiol 37(6):251–260CrossRefPubMedGoogle Scholar
- 7.Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69(4):533–545CrossRefPubMedCentralPubMedGoogle Scholar
- 8.Hengartner MP, Muller M, Rodgers S, Rossler W, Ajdacic-Gross V (2014) Occupational functioning and work impairment in association with personality disorder trait-scores. Soc Psychiatry Psychiatr Epidemiol 49(2):327–335Google Scholar
- 11.Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, Benjet C, Bromet E, de Girolamo G, de Graaf R, Gasquet I, Gureje O, Haro JM, He Y, Kessler RC, Levinson D, Mneimneh ZN, Oakley Browne MA, Posada-Villa J, Stein DJ, Takeshima T, Von Korff M (2007) Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. J Affect Disord 103(1–3):113–120CrossRefPubMedGoogle Scholar
- 17.Goldstein RB, Dawson DA, Chou SP, Ruan WJ, Saha TD, Pickering RP, Stinson FS, Grant BF (2008) Antisocial behavioral syndromes and past-year physical health among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69(3):368–380CrossRefPubMedCentralPubMedGoogle Scholar
- 20.Lee HB, Bienvenu OJ, Cho SJ, Ramsey CM, Bandeen-Roche K, Eaton WW, Nestadt G (2010) Personality disorders and traits as predictors of incident cardiovascular disease: findings from the 23-year follow-up of the Baltimore ECA study. Psychosomatics 51(4):289–296CrossRefPubMedCentralPubMedGoogle Scholar
- 26.Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP (2004) Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 65(7):948–958CrossRefPubMedGoogle Scholar
- 27.Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, Pickering RP, Kaplan K (2004) Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 61(8):807–816CrossRefPubMedGoogle Scholar
- 28.Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71(1):7–16CrossRefPubMedGoogle Scholar
- 29.Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP, Dawson DA, Huang B, Stinson FS, Grant BF (2008) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADISIV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend 92(1–3):27–36CrossRefPubMedCentralPubMedGoogle Scholar
- 30.Cox BJ, Clara IP, Worobec LM, Grant BF (2012) An empirical evaluation of the structure of DSM-IV personality disorders in a nationally representative sample: results of confirmatory factor analysis in the National Epidemiologic Survey on Alcohol and Related Conditions waves 1 and 2. J Pers Disord 26(6):890–901CrossRefPubMedGoogle Scholar
- 31.Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2012) Physical health conditions associated with posttraumatic stress disorder in US older adults: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Am Geriatr Soc 60(2):296–303CrossRefPubMedCentralPubMedGoogle Scholar
- 33.Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W, Lopez Ridaura R, Maximova T, Arokiasamy P, Phaswana-Mafuya N, Williams S, Snodgrass JJ, Minicuci N, D’Este C, Peltzer K, Boerma JT, SAGE Collaborators (2012) Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol 41(6):1639–1649CrossRefPubMedCentralPubMedGoogle Scholar
- 34.Simning A, Conwell Y, Mohile SG, van Wijngaarden E (2013) The moderating effect of age on the 12-month prevalence of anxiety and depressive disorders in adults with a lifetime history of cancer. Am J Geriatr Psychiatry. doi: 10.1016/j.jagp.2013.08.003
- 39.Shah BV, Barnswell BG, Bieler GS (2009) SUDAAN User’s manual: release 10.0. Research Triangle Institute, Research Triangle ParkGoogle Scholar
- 40.Levy PS, Lemeshow S (1999) Sampling of populations. John Wiley & Sons, New YorkGoogle Scholar
- 41.Grant BF, Kaplan K, Moore T, Kimball J (2007) 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions: Source and Accuracy Statement. National Institute on Alcohol Abuse and Alcoholism, BethesdaGoogle Scholar
- 46.World Health Organization (2011) Noncommunicable diseases country profiles. WHO Press, GenevaGoogle Scholar
- 50.Maes M, Ruckoanich P, Chang YS, Mahanonda N, Berk M (2011) Multiple aberrations in shared inflammatory and oxidative & nitrosative stress (IO&NS) pathways explain the co-association of depression and cardiovascular disorder (CVD), and the increased risk for CVD and due mortality in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 35(3):769–783CrossRefPubMedGoogle Scholar