INTENSITY OF PERSONALITY DISORDER AND BORDERLINE SPECIFICITIES IN PERSONS WITH NEUROTIC AND DEPRESSIVE DISORDERS
Keywords:
intensity of personality disorders, borderline pattern, neurotic disorders, anxiety, depressive disordersAbstract
Introduction: The intensity of personality disorders conditioned by the degree of self and/or interpersonal functionality is the basic diagnostic criterion for personality disorders according to ICD 11. There is a high prevalence and association of personality disorders with other psychiatric entities, as well as with neurotic and depressive disorders. The aims of this study were to determine the prevalence of personality disorder in neurotic and depressive patients, as well as the correlation with the borderline pattern.
Materials and methods: The study was designed as a monocentric, analytical observational cross-sectional study. It included 108 participants divided in three groups – people with neurotic and/or depressive disorders according to ICD 10 (60 participants), a control group (30 participants), and a group of people with personality disorders according to ICD 10 (18 participants). Scales were used to assess anxiety, depression, severity of personality disorders according to ICD 11 and the borderline pattern scale.
Results: A high prevalence of personality disorders was found in individuals with neurotic and/or depressive disorders; a high correlation of anxiety and depression with the severity of personality disorder, as well as a high correlation between the borderline pattern and the intensity of personality dysfunction.
Conclusion: The study demonstrated a significant difference in personality functionality among the examined groups, which had clinical implications.
References
Volkert J, Gablonski TC, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. Br J Psychiatry 2018; 213(6): 709-715. doi: 10.1192/bjp.2018.202.
Beckwith H, Moran PF, Reilly J. Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personal Ment Health 2014; 8(2): 91-101. doi: 10.1002/pmh.1252.
Geddes, John R., Nancy C. Andreasen, and Guy M. Goodwin (eds), New Oxford Textbook of Psychiatry, 3 edn, Oxford Textbook (Oxford, 2020; online edn, Oxford Academic, 1 Mar. 2020), available from
https://doi.org/10.1093/med/9780198713005.001.0001
ICD-11 for Mortality and Morbidity Statistics (who.int) available from https://icd.who.int/browse/2024-01/mms/en
Tyrer P, Mulder R, Kim YR, Crawford MJ. The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics. Annu Rev Clin Psychol 2019; 15: 481-502. doi: 10.1146/annurev-clinpsy-050718-095736.
Skodol AE, Geier T, Grant BF, Hasin DS. Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depress Anxiety 2014; 31(9): 721-728. doi: 10.1002/da.22287.
Tyrer P, Seivewright H, Johnson T. The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder. Psychol Med 2004; 34(8): 1385-1394. doi: 10.1017/s0033291704002569.
Middeldorp CM, Cath DC, Van Dyck R, Boomsma DI. The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychol Med 2005; 35(5): 611-624. doi: 10.1017/s003329170400412x.
Tyrer P, Tyrer H, Johnson T, Yang M. Thirty-year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial. Psychol Med 2021: 12:1-10. doi: 10.1017/S0033291721000878.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23(1): 56-62. doi: 10.1136/jnnp.23.1.56.
Hamilton M. The Assessment of Anxiety States by Rating. 32 Br J Med Psychol 50-55.1959
Weekers LC, Hutsebaut J, Kamphuis JH. The Level of Personality Functioning Scale-Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personal Ment Health 2019; 13(1): 3-14. doi: 10.1002/pmh.1434.
Weekers LC, Sellbom M, Hutsebaut J, Simonsen S, Bach B. Normative data for the LPFS-BF 2.0 derived from the Danish general population and relationship with psychosocial impairment. Personal Ment Health 2023; 17(2): 157-164. doi: 10.1002/pmh.1570.
Bach B, Brown TA, Mulder RT, Newton-Howes G, Simonsen E, Sellbom M. Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11. Personal Ment Health 2021; 15(3): 223-236. doi: 10.1002/pmh.1510.
Bach B, Simonsen E, Kongerslev MT, Bo S, Hastrup LH, Simonsen S, Sellbom M. ICD-11 personality disorder features in the danish general population: Cut-offs and prevalence rates for severity levels. Psychiatry Res 2023; 328:115484. doi: 10.1016/j.psychres.2023.115484.
Olajide K, Munjiza J, Moran P, O'Connell L, Newton-Howes G, Bassett P, Akintomide G, Ng N, Tyrer P, Mulder R, Crawford MJ. Development and Psychometric Properties of the Standardized Assessment of Severity of Personality Disorder (SASPD). J Pers Disord 2018; 32(1): 44-56. doi: 10.1521/pedi_2017_31_285.
Oltmanns JR, Widiger TA. Evaluating the assessment of the ICD-11 personality disorder diagnostic system. Psychol Assess 2019; 31(5): 674-684. doi: 10.1037/pas0000693.
Bach B, Anderson JL. Patient-Reported ICD-11 Personality Disorder Severity and DSM-5 Level of Personality Functioning. J Pers Disord 2020; 34(2): 231-249. doi: 10.1521/pedi_2018_32_393.
Friborg O, Martinsen EW, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. Comorbidity of personality disorders in mood disorders: a meta-analytic review of 122 studies from 1988 to 2010. J Affect Disord 2014; 152-154: 1-11. doi: 10.1016/j.jad.2013.08.023.
Asp M, Lindqvist D, Fernström J, Ambrus L, Tuninger E, Reis M, Westrin Å. Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care. PLoS One 2020; 15(1): e0227364. doi: 10.1371/journal.pone.0227364.
Friborg O, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. J Affect Disord 2013; 145(2): 143-155. doi: 10.1016/j.jad.2012.07.004.
Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry 2005; 162(10): 1911-1918. doi: 10.1176/appi.ajp.162.10.1911.
Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet 2015; 385(9969): 717-726. doi: 10.1016/S0140-6736(14)61995-4.
Latas M, Milovanovic S. Personality disorders and anxiety disorders: what is the relationship? Curr Opin Psychiatry 2014; 27(1): 57-61. doi: 10.1097/YCO.000000 0000000025.
Vittengl JR, Jarrett RB, Ro E, Clark LA. How can the DSM-5 alternative model of personality disorders advance understanding of depression? J Affect Disord 2023; 320: 254-262. doi: 10.1016/j.jad.2022.09.146.
di Giacomo E, Colmegna F, Biagi E, Zappa L, Caslini M, Dakanalis A, Clerici M; UnimibPsychiatricResearch-Group (Martina Tremolada,‡ Giulia Gamba,‡ Francesca Pescatore,‡ Rodolfo Pessina,‡ Valeria Placenti,∗ Jacopo Santambrogio,‡ Francesca Costantini‡). Anxiety and Depression: A Key to Understanding the Complete Expression of Personality Disorders. J Nerv Ment Dis. 2021;209(3):188-195. doi: 10.1097/NMD.0000000000001279. PMID: 33273394.
Mulder RT, Horwood LJ, Tyrer P. The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: A redundant addition to classification. Aust N Z J Psychiatry 2020; 54(11): 1095-1100. doi: 10.1177/0004867420951608.
Clark LA, Nuzum H, Ro E. Manifestations of personality impairment severity: comorbidity, course/prognosis, psychosocial dysfunction, and 'borderline' personality features. Curr Opin Psychol 2018; 21: 117-121. doi: 10.1016/j.copsyc.2017.12.004.
Sharp C, Wright AG, Fowler JC, Frueh BC, Allen JG, Oldham J, Clark LA. The structure of personality pathology: Both general ('g') and specific ('s') factors? J Abnorm Psychol 2015; 124(2): 387-398. doi: 10.1037/abn0000033.
Sloan E, Hall K, Moulding R, Bryce S, Mildred H, Staiger PK. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clin Psychol Rev 2017; 57: 141-163. doi: 10.1016/j.cpr.2017.09.002.
Paulus DJ, Vanwoerden S, Norton PJ, Sharp C. Emotion dysregulation, psychological inflexibility, and shame as explanatory factors between neuroticism and depression. J Affect Disord 2016; 190: 376-385. doi: 10.1016/j.jad.2015.10.014.