High personality disorder comorbidity rates identified in anxiety

Oct 9 2012

By Ingrid Grasmo, medwireNews Reporter

A meta-analysis covering 30 years of research has identified high rates of comorbid personality disorders across a number of anxiety disorder (AD) subtypes.

Of interest, the research findings published in the Journal of Affective Disorders found that a substantial proportion of patients with AD also presented with an avoidant personality disorder.

Oddgeir Friborg (University of Tromsø, Norway) and co-authors say this finding should be addressed in the routine clinical assessment and treatment of AD patients.

They note that large heterogeneity in post-traumatic stress disorder (PTSD) comorbidity observed in the study supports several of the proposed changes in the forthcoming DSM-V, notably moving PTSD from AD to a new cluster called "Trauma and Stressor-Related Disorders."

The researchers identified 125 research papers published during 1980 to 2010 on patients with panic disorders, social phobia, generalized anxiety, obsessive-compulsive disorder (OCD), and PTSD, which revealed a high rate of comorbid personality disorders across all ADs (ranging from 35% for PTSD to 52% for OCD).

The comorbidity rate for patients with cluster C personality disorders (avoidant, dependent, and compulsive types) was significantly higher than for cluster B (dramatic, borderline, and antisocial types) and cluster A (schizoid, schizotypal, and paranoid types) types, at 39% versus 19% and 13%.

The highest comorbidity rate of a specific personality disorder was for social phobia, which occurred most frequently with the avoidant subtype (46%), followed by PTSD, which showed an elevated comorbid pattern across a number of personality disorders, including paranoid, avoidant, borderline, and OCD (ranging from 22 to 26%).

"Clearly, PTSD stands out as clinically more heterogeneous in nature compared with the other ADs," say Friborg and team, noting that this finding is in line with other research and may be explained by the large variety in the nature and impact of traumatic exposures and unresolved core features of the disorder.

Patients with OCD and AD did not have a significantly higher occurrence of comorbid OCD personality disorder compared with other cluster C types, which stands in contrast to other findings.

In addition, an earlier age of axis I AD onset predicted an increased risk for personality disorder comorbidity for social phobia only, thus highlighting the importance of early detection and treatment, according to the researchers.

"Further comorbidity studies are needed in view of the substantial changes in how personality disorders will be diagnosed," they conclude.

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