Ljh Personality Disorder


Table 6.1 (Continued)

Axis II Personality Disorders



Axis I Clinical Syndromes

Schizophrenia and other

Psychotic Disorders Mood Disorders Anxiety Disorders

Mood Disorders Somatoform Disorders Anxiety Disorders

Axis II Personality Disorders

Paranoid Schizoid

Passive-Aggressive Self-Defeating Avoidant Borderline







Avoidant years), we found that depression (as measured by Beck's Depression Inventory) and anxiety (as measured by Spiel-berger's State-Trait Anxiety Scale) were highly comorbid with personality disorders as an aggregate. We found that 18% of the sample met the criteria for at least one personality disorder (self-report form of the CATI), 25% were mildly, moderately, or severely depressed, and 16% were moderately to severely anxious (trait anxiety). We concluded that there is a danger for clinicians to focus their diagnoses on symptoms that can be medicated or treated in a short course of psychotherapy instead of on the more chronic manifestations of personality disorders, the latter of which are more likely to have a pervasive effect on the individual's functioning and remain unabated if not targeted directly.

In other clinical studies, Kunik et al. (1993) evaluated depressed older adult inpatients and found that 24% also had a comorbid personality disorder diagnosis. Similarly, Thompson, Gallagher, and Czirr (1988) reported that 33% of depressed older adults participating in a psychotherapy outcome study were comorbidly diagnosed with a personality disorder. Moli-nari and Marmion (1995) used a structured personality disorder scale to assess personality disorders in elderly patients with mood disorders, reporting a 63% comorbidity rate. Similarly, personality disorders were commonly comorbid among older (58%) and younger (66%) adults suffering with a chronic mental illness (Coolidge, Segal, Pointer, et al., 2000). In one of the few studies of personality disorders among older persons with clinically significant anxiety, Coolidge, Segal, Hook, and Stewart (2000) found that 61% met criteria for at least one personality disorder. This latter finding converges with Sadavoy's (1999) impression that because personality disordered individuals likely have difficulty modulating their worry, intense anxiety can be triggered. The primary effect of a comorbid personality disorder in a patient with diverse types of clinical disorders is that treatment will be more complicated, longer, and less effective than in similar patients without personality disorder pathology. We examine this issue more fully later in this book.

Regarding the comorbidity of personality disorders with other personality disorders, our study (Coolidge et al., 2006) of community-dwelling people over 60 years of age (total N = 114) demonstrated that those with at least one clinical personality disorder elevation, 27% (4 of 11 participants) had two or more personality disorders. In contrast, the younger sample (N = 512; age range = 18 to 50) had a 20% prevalence rate (104 out of 512 participants) of at least one clinically elevated personality disorder scale. Approximately 47% (53 of 114 participants) of those with at least one clinically elevated personality disorder scale had two or more personality disorder scales. Many studies have recorded the comorbidity of personality with other personality disorders in younger populations (e.g., McGlashan et al., 2000; Oldham et al., 1992), and there is no reason to think this pattern will change dramatically as a mere function of growing older. It is even possible for the comorbid-ity to become worse in later life, especially in cases in which previously adaptive styles and behaviors become maladaptive over time and vulnerabilities, previously hidden, become un-

covered. The presence of a dementing illness in individuals with a personality disorder warrants other special considerations.

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