Abstract
Purpose
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.
Methods
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.
Results
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).
Conclusions
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.
Similar content being viewed by others
References
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC
Jackson HJ, Burgess PM (2000) Personality disorders in the community: a report from the Australian National Survey of Mental Health and Wellbeing. Soc Psychiatry Psychiatr Epidemiol 35(12):531–538
Torgersen S, Kringlen E, Cramer V (2001) The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 58(6):590–596
Coid J, Yang M, Tyrer P, Roberts A, Ullrich S (2006) Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 188:423–431
Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007) DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry 62(6):553–564
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):251–260
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):533–545
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):327–335
Yu R, Geddes JR, Fazel S (2012) Personality disorders, violence, and antisocial behavior: a systematic review and meta-regression analysis. J Pers Disord 26(5):775–792
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370(9590):851–858
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):113–120
Roy-Byrne PP, Davidson KW, Kessler RC, Asmundson GJ, Goodwin RD, Kubzansky L, Lydiard RB, Massie MJ, Katon W, Laden SK, Stein MB (2008) Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 30(3):208–225
Chou SP, Huang B, Goldstein R, Grant BF (2013) Temporal associations between physical illnesses and mental disorders–results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Compr Psychiatry 54(6):627–638
Moreno C, Nuevo R, Chatterji S, Verdes E, Arango C, Ayuso-Mateos JL (2013) Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis: results from the WHO World Health Survey. World Psychiatry 12(3):251–257
Sanna L, Stuart AL, Pasco JA, Kotowicz MA, Berk M, Girardi P, Brennan SL, Williams LJ (2013) Physical comorbidities in men with mood and anxiety disorders: a population-based study. BMC Med 11:110
Moran P, Stewart R, Brugha T, Bebbington P, Bhugra D, Jenkins R, Coid JW (2007) Personality disorder and cardiovascular disease: results from a national household survey. J Clin Psychiatry 68(1):69–74
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):368–380
McWilliams LA, Clara IP, Murphy PD, Cox BJ, Sareen J (2008) Associations between arthritis and a broad range of psychiatric disorders: findings from a nationally representative sample. J Pain 9(1):37–44
El-Gabalawy R, Katz LY, Sareen J (2010) Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosom Med 72(7):641–647
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):289–296
Becoña E, Del Río EF, López-Durán A, Piñeiro B, Martínez U (2013) Axis II disorders and cigarette smoking among adults from the general population. J Pers Disord 27(3):411–424
Stewart DW, Cohen AS, Copeland AL (2010) Cigarette smoking across the schizotypy spectrum. Psychiatry Res 179(1):113–115
Powers AD, Oltmanns TF (2013) Borderline personality pathology and chronic health problems in later adulthood: the mediating role of obesity. Personal Disord 4(2):152–159
Van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A (2007) Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 22(7):613–626
El-Gabalawy R, Mackenzie CS, Shooshtari S, Sareen J (2011) Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults. Gen Hosp Psychiatry 33(6):556–564
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):948–958
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):807–816
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):7–16
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):27–36
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):890–901
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):296–303
Baumeister H, Kriston L, Bengel J, Harter M (2010) High agreement of self-report and physician diagnosed somatic conditions yields limited bias in examining mental-physical comorbidity. J Clin Epidemiol 63(5):558–565
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):1639–1649
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
Sareen J, Afifi TO, McMillan KA, Asmundson GJ (2011) Relationship between household income and mental disorders: findings from a population-based longitudinal study. Arch Gen Psychiatry 68(4):419–427
Mackenzie CS, Pagura J, Sareen J (2010) Correlates of perceived need for and use of mental health services by older adults in the collaborative psychiatric epidemiology surveys. Am J Geriatr Psychiatry 18(12):1103–1115
Mackenzie CS, Scott T, Mather A, Sareen J (2008) Older adults’ help-seeking attitudes and treatment beliefs concerning mental health problems. Am J Geriatr Psychiatry 16(12):1010–1019
Cairney J, McCabe L, Veldhuizen S, Corna LM, Streiner D, Herrmann N (2007) Epidemiology of social phobia in later life. Am J Geriatr Psychiatry 15(3):224–233
Shah BV, Barnswell BG, Bieler GS (2009) SUDAAN User’s manual: release 10.0. Research Triangle Institute, Research Triangle Park
Levy PS, Lemeshow S (1999) Sampling of populations. John Wiley & Sons, New York
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, Bethesda
Chanen AM, Jovev M, Jackson HJ (2007) Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. J Clin Psychiatry 68(2):297–306
McWilliams LA, Higgins KS (2013) Associations between pain conditions and borderline personality disorder symptoms: findings from the national comorbidity survey replication. Clin J Pain 29(6):527–532
Nuevo R, Chatterji S, Fraguas D, Verdes E, Naidoo N, Arango C, Ayuso-Mateos JL (2011) Increased risk of diabetes mellitus among persons with psychotic symptoms: results from the WHO World Health Survey. J Clin Psychiatry 72(12):1592–1599
Ryan MC, Collins P, Thakore JH (2003) Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry 160(2):284–289
World Health Organization (2011) Noncommunicable diseases country profiles. WHO Press, Geneva
Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, Kazis L, Gale DR (2001) The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 134(7):541–549
Kelly-Irving M, Lepage B, Dedieu D, Bartley M, Blane D, Grosclaude P, Lang T, Delpierre C (2013) Adverse childhood experiences and premature all-cause mortality. Eur J Epidemiol 28(9):721–734
Su S, Wang X, Kapuku GK, Treiber FA, Pollock DM, Harshfield GA, McCall WV, Pollock JS (2014) Adverse childhood experiences are associated with detrimental hemodynamics and elevated circulating endothelin-1 in adolescents and young adults. Hypertension 64(1):201–207
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):769–783
Anderson G, Maes M, Berk M (2012) Inflammation-related disorders in the tryptophan catabolite pathway in depression and somatization. Adv Protein Chem Struct Biol 88:27–48
Moylan S, Jacka FN, Pasco JA, Berk M (2013) How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain Behav 3(3):302–326
Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmacher T (2003) Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 37(3):193–220
Pompili M, Venturini P, Palermo M, Stefani H, Seretti ME, Lamis DA, Serafini G, Amore M, Girardi P (2013) Mood disorders medications: predictors of nonadherence: review of the current literature. Expert Rev Neurother 13(7):809–825
Fazel S, Khosla V, Doll H, Geddes J (2008) The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med 5(12):e225
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K (2011) Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 155(2):97–107
Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ (2010) Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord 24(4):412–426
Acknowledgments
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.
Ethical standard
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Quirk, S.E., El-Gabalawy, R., Brennan, S.L. et al. Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol 50, 807–820 (2015). https://doi.org/10.1007/s00127-014-0974-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-014-0974-1