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Does the diagnosis of multiple Axis II disorders have clinical significance?

Mark Zimmerman, MD

Department of Psychiatry and Human Behavior, Brown Medical School, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

Janine N. Galione, BS

Department of Psychiatry and Human Behavior, Brown Medical School, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

Iwona Chelminski, PhD

Department of Psychiatry and Human Behavior, Brown Medical School, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

Diane Young, PhD

Department of Psychiatry and Human Behavior, Brown Medical School, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

Kristy Dalrymple, PhD

Department of Psychiatry and Human Behavior, Brown Medical School, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

Theresa A. Morgan, MPhil

Department of Psychiatry and Human Behavior, Brown Medical School, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

BACKGROUND: A stated goal of the DSM-5 Work Group on Personality and Personality Disorders (PDs) has been to reduce the high rate of comorbidity among PDs. Few studies have examined whether the diagnosis of multiple PDs has clinical significance. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we tested the hypothesis that patients with >1 DSM-IV PD would have more severe forms of psychopathology than patients who were diagnosed with only 1 DSM-IV PD.

METHODS: A total of 2,150 psychiatric outpatients were evaluated with semi-structured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity.

RESULTS: For 8 of the 10 PDs, the majority of patients had at least 1 additional PD, although at least 20% of patients diagnosed with each PD were diagnosed with only 1 PD. Compared with patients with 1 PD, patients with ≥2 PDs had significantly more psychosocial morbidity.

CONCLUSIONS: The co-occurrence of PDs conveys clinically significant information. Moreover, despite high levels of comorbidity, each PD also existed as a stand-alone entity. These findings raise questions about the DSM-5 Work Group’s emphasis on reducing comorbidity in Axis II.

KEYWORDS: personality disorder, comorbidity, DSM-5

ANNALS OF CLINICAL PSYCHIATRY 2012;24(3):195-201

CORRESPONDENCE: Mark Zimmerman, MD Bayside Medical Center 235 Plain Street Providence, RI 02905 USA E-MAIL: mzimmerman@lifespan.org
Annals of Clinical Psychiatry ©2012 Quadrant HealthCom Inc.

 
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