Untitled

Abstract

The literature pertaining to the stability and course of personality disorders is briefly reviewed. Available data suggest that PD diagnoses demonstrate only moderate stability and that--although generally associated with a plethora of negative outcomes--they can show improvement over time. This paper highlights the pervasiveness of diagnostic co-occurrence and its implications for continued investigation of the question of PD stability. In addition to examining the stability (and outcome) of PDs, longitudinal studies need to consider continuities between diagnoses. The Collaborative Longitudinal Personality Disorder Study (CLPS) is described briefly vis-a-vis some of these major issues.

Exploring Personality Diagnosis Stability Following Acute Psychotherapy for Chronic Posttraumatic Stress Disorder

“…In 1980, DSM-III codified these categories as Axis I disorders and Axis II personality disorders. They frequently co-occur (2,3), and seeming distinctions between Axis I “state” episodes and persisting Axis II “trait” PDs quickly blur. The passive, anxious, socially-withdrawn “state” of major depressive disorder, for example, overlaps Axis II cluster C “trait” diagnoses such as dependent or avoidant PD (4).…”

“…Nor did we hypothesize that PD diagnoses would worsen PTSD treatment outcome, another area of comorbidity controversy (2). …”

Identifying latent trajectories of personality disorder symptom change: Growth mixture modeling in the longitudinal study of personality disorders.

“…That said, even among symptomatic individuals, only Antisocial, Obsessive-Compulsive, and Passive-Aggressive PDs included a latent trajectory with stable, persistent symptoms, suggesting that previous research on mean-level declines in PD symptoms presents a reasonably accurate picture of the modal course of personality pathology. Clinically, our findings underscore the importance of assessing for comorbid Axis I and II disorders when diagnosing PDs (Grilo et al, 2000; Loranger et al, 1991; Morey et al, 2010; Zanarini, Frankenburg, Vujanovic, et al, 2004; Zimmerman et al, 2005) and also point to the incremental utility of considering personality dimensions when formulating treatment plans (Harkness & Lilienfeld, 1997). …”

“…To explore the stability of PD diagnoses and symptoms over time, several research groups undertook major longitudinal studies in the 1990s (Grilo, McGlashan, & Skodol, 2000; Lenzenweger, 1999; Paris, Brown, & Nowlis, 1987; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2006). Accumulating evidence from these studies indicates that the mean number of symptoms for nearly all PDs declines over time and that these disorders are much less stable than previously thought (Lenzenweger, Johnson, & Willett, 2004; Skodol et al, 2005).…”

“…Personality disorders are often comorbid with each other and with Axis I psychopathology (Grilo et al, 2000; Zimmerman & Mattia, 1999), and greater comorbidity is associated with functional impairment and poor treatment response (Fournier et al, 2008; Newton-Howes et al, 2006). Moreover, personality traits may represent a common substrate that is related to many forms of psychopathology (Krueger, 2005; Krueger & Markon, 2006; Lahey, 2009).…”