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The association of personality disorders with the prospective 7-year course of anxiety disorders

Published online by Cambridge University Press:  14 September 2010

E. B. Ansell ,
A. Pinto ,
M. O. Edelen ,
J. C. Markowitz ,
C. A. Sanislow ,
S. Yen ,
M. Zanarini ,
A. E. Skodol ,
M. T. Shea  and
L. C. Morey
...Show all authors
E. B. Ansell*
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
A. Pinto
Affiliation:
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York State Psychiatric Institute, New York, NY, USA
M. O. Edelen
Affiliation:
Rand Corporation, Santa Monica, CA, USA
J. C. Markowitz
Affiliation:
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York State Psychiatric Institute, New York, NY, USA
C. A. Sanislow
Affiliation:
Department of Psychology, Wesleyan University, Middletown, CT, USA
S. Yen
Affiliation:
Department of Veterans Affairs, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
M. Zanarini
Affiliation:
Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
A. E. Skodol
Affiliation:
University of Arizona School of Medicine and the Sunbelt Collaborative, Tucson, AZ, USA
M. T. Shea
Affiliation:
Department of Veterans Affairs, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
L. C. Morey
Affiliation:
Department of Psychology, Texas A&M University, College Station, TX, USA
J. G. Gunderson
Affiliation:
Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
T. H. McGlashan
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
C. M. Grilo
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
*
*Address for correspondence: E. B. Ansell, Ph.D., Yale University School of Medicine, 2 Church Street South, Suite 209, New Haven, CT 06519, USA. (Email: [email protected])
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Abstract

Background

This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.

Method

Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.

Results

Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.

Conclusions

Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.

Keywords

Chronicityanxiety disorderspersonality disordersrelapseremission
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 5 , May 2011 , pp. 1019 - 1028
Copyright
Copyright © Cambridge University Press 2010

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