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Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation

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Abstract

Objective

To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients.

Method

3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview.

Results

The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive–compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders.

Conclusions

PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.

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Acknowledgments

This study was presented in part at Fogarty International Center Implementation Science and Global Health 2010 Satellite Meeting for implementation science research, Bethesda, March 17, 2010. This study was supported by the funds from National High Technology Research and Development Program of China (2007AA02Z420) and by an NIH Fogarty International Center grant (5D43TW05809) awarded to Byron J. Good, P.I., in the Department of Global Health and Social Medicine, Harvard Medical School. We highly appreciate the help of Shanghai Mental Health Center doctors for their cooperation during the research process.

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Authors and Affiliations

  1. Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, People’s Republic of China

    Tianhong Zhang, Lanlan Wang, Yunfei Dai, Junhan Yu, Haiyin Zhang & Zeping Xiao

  2. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Mary-Jo D. Good & Byron J. Good

  3. School of Psychology, Deakin University, Melbourne, Australia

    Annabelle Chow

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  1. Tianhong Zhang
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Correspondence to Zeping Xiao.

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Zhang, T., Wang, L., Good, MJ.D. et al. Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation. Soc Psychiatry Psychiatr Epidemiol 47, 1409–1417 (2012). https://doi.org/10.1007/s00127-011-0445-x

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  • DOI: https://doi.org/10.1007/s00127-011-0445-x

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