Estimated 30.8 million American adults meet standard diagnostic criteria for at least one personality disorder

Aug 3 2004

An estimated 30.8 million American adults (14.8 percent) meet standard diagnostic criteria for at least one personality disorder as defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), according to the results of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Sponsored by the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, the NESARC is a representative survey of the U.S. civilian noninstitutionalized population aged 18 years and older. More than 43,000 American adults participated in the survey. Designed to assess prevalence and comorbidity, or co-occurrence, of multiple mental health disorders, the NESARC is the first national survey conducted in the United States to estimate the prevalence of personality disorders--stable patterns of inner experience and behavior that are inflexible and maladaptive that begin in early adulthood and are displayed in a variety of contexts.

The NESARC found that personality disorders are pervasive in the general population: In 2001- 2002, fully 16.4 million individuals (7.9 percent of all adults) had obsessive-compulsive personality disorder; 9.2 million (4.4 percent) had paranoid personality disorder; 7.6 million (3.6 percent) had antisocial personality disorder; 6.5 million (3.1 percent) had schizoid personality disorder; 4.9 million (2.4 percent) had avoidant personality disorder; 3.8 million (1.8 percent) had histrionic personality disorder; and 1.0 million (0.5 percent) had dependent personality disorder.

The researchers found that risk of having avoidant, dependent, and paranoid personality disorders is greater for females than males, whereas risk of having antisocial personality disorder is greater for males than females. They found no gender differences in the risk of having obsessive-compulsive, schizoid, or histrionic personality disorders. In general, other risk factors for personality disorders included being Native American or Black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. With the exception of histrionic personality disorder, all the personality disorders assessed in the survey were associated with considerable emotional disability and impairment in social and occupational functioning.

"The first-time availability of prevalence information on personality disorders at the national level is critically important," said Dr. Ting-Kai Li, M.D., Director, National Institute on Alcohol Abuse and Alcoholism. "Personality disorders consistently have been associated with substantial impairment and decreased psychological functioning among alcohol and drug abusers."

"The NESARC was crucial in determining the scope of personality disorders confronting the nation and in identifying important subgroups of the population in greatest need of prevention efforts," said lead author Bridget F. Grant, Ph.D., Ph.D., Chief, Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, NIAAA.