Strong Axis I comorbidity raises questions about the somewhat arbitrary separation of PDs from Axis I disorders in the DSM nomenclature. The impairment findings suggest that the main public health significance of PDs lies in their effects on Axis I disorders rather than in their effects on functioning.

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It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

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If these results can be replicated in a more representative community sample, this 2-stage method might substantially reduce the number of persons who needed to be interviewed in a major epidemiological study of PDs, with little or no loss in diagnostic accuracy, while presumably lowering the cost of such an investigation.

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