Skip to main content

Advertisement

SpringerLink
Log in

Personality disorders are important risk factors for disability pensioning

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether personality disorders (PDs) are associated with increased risk of disability pensioning in young adults, independent of other common mental disorders.

Methods

2,770 young adults from the general population were assessed for PDs by the Structured Interview for DSM-IV Personality, and for common mental disorders by the Composite of International Diagnostic Interview. These data were linked to the Norwegian National Insurance Administration’s recordings of disability benefits for a 10-year period. Logistic regression analyses were applied to investigate the association between PDs and disability pensioning. The analyses were conducted for three types of PD measures: categorical diagnoses (any PD), dimensional scores of individual PDs and higher order components retrieved by principal component analyses.

Results

Having any PD was strongly associated with disability pensioning, regardless of disability diagnosis. The estimated odds ratio (OR) was substantially higher for PDs [OR 4.69 (95 % confidence interval (CI) 2.6–8.5)] than for mood disorders [OR 1.3 (CI 0.7–2.3)] and anxiety disorders [OR 2.3 (CI 1.3–4.3)]. Measured dimensionally, all PD traits except antisocial traits were significantly associated with disability pensioning. After adjusting for co-occurring traits of other PDs, only schizoid, dependent and borderline PD traits showed a significant positive association with disability pension, while antisocial traits showed a significant negative association. The principal component analyses showed that negative affectivity, psychoticism, and detachment was associated with an increased risk of disability pensioning, while antagonism/disinhibition and obsessivity were not.

Conclusions

PDs are strongly associated with disability pensioning in young adults, and might be more important predictors of work disability than anxiety and depressive disorders. Certain aspects of pathologic personalities are particularly important predictors of disability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

OR:

Odds ratio

CI:

Confidence interval

PD:

Personality disorder

SES:

Socioeconomic status

NIA:

(The Norwegian) National Insurance Administration

OCD:

Obsessive–compulsive disorder

PTSD:

Post traumatic stress disorder

References

  1. OECD (2003) Disability programmes in need of reform—a policy brief. OECD Publishing, Paris

    Google Scholar 

  2. OECD (2010) Sickness, disability and work: breaking the barriers. OECD Publishing, Paris

    Google Scholar 

  3. Gjesdal S, Ringdal PR, Haug K, Maeland JG (2008) Long-term sickness absence and disability pension with psychiatric diagnoses: a population-based cohort study. Nord J Psychiatry 62:294–301

    Article  PubMed  Google Scholar 

  4. Karpansalo M, Kauhanen J, Lakka TA, Manninen P, Kaplan GA, Salonen JT (2005) Depression and early retirement: prospective population based study in middle aged men. J Epidemiol Community Health 59:70–74

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Knudsen AK, Overland S, Aakvaag HF, Harvey SB, Hotopf M, Mykletun A (2010) Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res 69:59–67

    Article  PubMed  Google Scholar 

  6. Mykletun A, Heradstveit O, Eriksen K, Glozier N, Overland S, Maeland JG, Wilhelmsen I (2009) Health anxiety and disability pension award: the HUSK study. Psychosom Med 71:353–360

    Article  PubMed  Google Scholar 

  7. Mykletun A, Knudsen AK (2009) Tapte arbeidsår ved uførepensjonering for psykiske lidelser. Norwegian institute of public health, Norway

    Google Scholar 

  8. Mykletun A, Overland S, Dahl AA, Krokstad S, Bjerkeset O, Glozier N, Aaro LE, Prince M (2006) A population-based cohort study of the effect of common mental disorders on disability pension awards. Am J Psychiatry 163:1412–1418

    Article  PubMed  Google Scholar 

  9. Huang Y, Kotov R, de GG, Preti A, Angermeyer M, Benjet C, Demyttenaere K, de GR, Gureje O, Karam AN, Lee S, Lepine JP, Matschinger H, Posada-Villa J, Suliman S, Vilagut G, Kessler RC (2009) DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry 195:46–53

    Article  PubMed Central  PubMed  Google Scholar 

  10. Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJV (2008) The economic burden of personality disorders in mental health care. J Clin Psychiatry 69:259–265

    Article  PubMed  Google Scholar 

  11. Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B (2010) Personality disorder: a new global perspective. World Psychiatry 9:56–60

    PubMed Central  PubMed  Google Scholar 

  12. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders DSM-IV-TR. American Psychiatric Association, Washington

    Google Scholar 

  13. Ansell EB, Sanislow CA, McGlashan TH, Grilo CM (2007) Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Compr Psychiatry 48:329–336

    Article  PubMed  Google Scholar 

  14. Dimeff LA, McDavid J, Linehan MM (1999) Pharmacotherapy for borderline personality disorder: a review of the literature and recommendations for treatment. J Clin Psychol Med Settings 6:113–138

    Article  Google Scholar 

  15. Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A (2012) The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res 36:427–440

    Article  Google Scholar 

  16. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011) Borderline personality disorder. Lancet 377:74–84

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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 65:948–958

    Article  PubMed  Google Scholar 

  19. 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 49:327–335

    Article  PubMed  Google Scholar 

  20. Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ (2011) Personality disorder types proposed for DSM-5. J Pers Disord 25:136–169

    Article  PubMed  Google Scholar 

  21. Knudsen AK, Skogen JC, Harvey SB, Stewart R, Hotopf M, Moran P (2012) Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity. Psychol Med 42:1–10

    Article  Google Scholar 

  22. Markon KE, Krueger RF, Watson D (2005) Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. J Pers Soc Psychol 88:139–157

    Article  PubMed Central  PubMed  Google Scholar 

  23. Harris JR, Magnus P, Tambs K (2002) The Norwegian Institute of Public Health Twin Panel: a description of the sample and program of research. Twin Res 5:415–423

    Article  PubMed  Google Scholar 

  24. Akselsen A, Lien S, Sandnes T (2003) FD-trygd dokumentasjonsrapport. Pensjoner. Grunn og hjelpestønader 1992–2001. Rikstrygdeverket, Norway

    Google Scholar 

  25. Pfohl BB, Zimmerman M (1995) Structured interview for dsm-iv personality (sidp-iv). University of Iowa, Department of Psychiatry, Iowa City

    Google Scholar 

  26. World Health Organization (1997) Composite of international diagnostic interview

  27. Dobson AJ (2002) An introduction to generalized linear models. Chapman & Hall/CRC, USA

    Google Scholar 

  28. Oldham JM, Skodol AE (2000) Charting the future of Axis II. J Pers Disord 14:17–29

    Article  CAS  PubMed  Google Scholar 

  29. Oldham JM, Skodol AE, Kellman HD, Hyler SE, Rosnick L, Davies M (1992) Diagnosis of Dsm-Iii-R personality-disorders by 2 structured interviews—patterns of comorbidity. Am J Psychiatry 149:213–220

    CAS  PubMed  Google Scholar 

  30. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders DSM-5. American Psychiatric Association, Washington

    Google Scholar 

  31. Andrew T, Hart DJ, Snieder H, de LM, Spector TD, MacGregor AJ (2001) Are twins and singletons comparable? A study of disease-related and lifestyle characteristics in adult women. Twin Res 4:464–477

    Article  CAS  PubMed  Google Scholar 

  32. Johnson W, Krueger RF, Bouchard TJ Jr, McGue M (2002) The personalities of twins: just ordinary folks. Twin Res 5:125–131

    Article  PubMed  Google Scholar 

  33. Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH (2007) Comparison of alternative models for personality disorders. Psychol Med 37:983–994

    Article  PubMed  Google Scholar 

  34. Tambs K, Ronning T, Prescott CA, Kendler KS, Reichborn-Kjennerud T, Torgersen S, Harris JR (2009) The Norwegian Institute of Public Health twin study of mental health: examining recruitment and attrition bias. Twin Res Hum Genet 12:158–168

    Article  PubMed Central  PubMed  Google Scholar 

  35. 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 69:533–545

    Article  PubMed Central  PubMed  Google Scholar 

  36. Reichborn-Kjennerud T, Czajkowski N, Roysamb E, Orstavik RE, Neale MC, Torgersen S, Kendler KS (2010) Major depression and dimensional representations of DSM-IV personality disorders: a population-based twin study. Psychol Med 40:1475–1484

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69:1033–1045

    Article  PubMed Central  PubMed  Google Scholar 

  38. Vilaplana M, McKenney K, Riesco MD, Autonell J, Cervilla JA (2010) Depressive comorbidity in personality disorders. Revista de Psiquiatria y Salud Mental 3:4–12

    PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by grants from the Sickness Absence Research Programme of The Norwegian Research Council. The work was also partly supported by National Institutes of Health Grant MH-068643.

Ethical standard

The interview was based on informed, written consent from all participants. The study protocol and the linking of health data with the registries of NIA was approved by the Regional Ethical Committee.

Conflict of interest

All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years no other relationships or activities that could appear to have influenced the submitted work.

Author information

Authors and Affiliations

  1. Department of Mental Health, Norwegian Institute of Public Health, Nydalen, Box 4404, 0403, Oslo, Norway

    Kristian Amundsen Østby, Nikolai Czajkowski, Gun Peggy Knudsen, Eivind Ystrom, Line C. Gjerde, Ragnhild E. Ørstavik & Ted Reichborn-Kjennerud

  2. Department of Psychology, University of Oslo, Oslo, Norway

    Nikolai Czajkowski & Ted Reichborn-Kjennerud

  3. Departments of Psychiatry and Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA

    Kenneth S. Kendler

  4. Department of Epidemiology, Columbia University, New York, NY, USA

    Ted Reichborn-Kjennerud

Authors
  1. Kristian Amundsen Østby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolai Czajkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gun Peggy Knudsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eivind Ystrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Line C. Gjerde
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth S. Kendler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ragnhild E. Ørstavik
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ted Reichborn-Kjennerud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristian Amundsen Østby.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Østby, K.A., Czajkowski, N., Knudsen, G.P. et al. Personality disorders are important risk factors for disability pensioning. Soc Psychiatry Psychiatr Epidemiol 49, 2003–2011 (2014). https://doi.org/10.1007/s00127-014-0878-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-014-0878-0

Keywords

Search

Navigation