Developmental Issues

Personality disorder diagnoses may be applied to children or adolescents in those unusual instances in which the maladaptive traits appear to be pervasive, persistent and unlikely to be limited to a particular developmental stage. However, it should be recognized that traits that appear in childhood may not persist into later adulthood (American Psychiatric Association, 1994). For diagnosis, the features of the personality disorder must be present for at least one year, with the exception of antisocial personality disorder, which cannot be diagnosed until after the age of eighteen.

To investigate longevity of personality disorders diagnosis in childhood, Bernstein and colleagues (1993) performed a cross-sectional prevalence analysis across the age span from late childhood to early adulthood, as well as a longitudinal assessment of the stability of personality disorder diagnoses. Subjects were a random sample of children from families in two upstate counties in New York. A single child was selected from each of the 976 families that agreed to participate in the study, after which an interview with the mother of the child was conducted. Follow-up assessments were conducted on the families that were located eight and ten years later (n = 724 and n = 733). The findings suggested that there is a high proportion of adolescents not referred for treatment that meet DSM-III-R criteria for a personality disorder diagnosis. Longitudinal data revealed substantial stability. However, less then half the subjects receive the same diagnosis at follow-up.

Johnson et al. (2000) reported three different kinds of information about the development and course of personality disorders in adolescents. First, they reported that significant declines (28%) in personality disorder traits were observed between early adolescence and early adulthood. They also found that stability in these traits ranged from low to moderate over a six-year interval that began in middle adolescence. Finally, they reported that adolescents with diagnoses of personality disorders tended to have elevated disordered traits in their early adult years. It is important to recognize that diagnostic criteria were originally designed to diagnose personality disorders in adults and not younger populations. Further investigation may be warranted to see if modifications of the criteria are needed to appropriately assess younger individuals.

On the other end of the developmental continuum, Abrams and Horowitz (1996) performed a meta-analysis of the literature concerning the frequency and distribution of personality disorders in older adults. Their review of eleven articles

TABLE 1. Post-DSM-III Community Studies of Prevalence of Any Personality Disorder

Instrument and

Prevalence (%)

Authors (year)

Population

DX System

of any PD

Comments

Nestadt et al.

810 subjects from

DSM-III by SPE

5.9

(1993)

the Clinical

administered

(definite)

Reappraisal at

by psychiatrist

9.3 (definite

Baltimore ECA site

plus provisional)

Zimmerman

797 nonpatient

DSM-III by SIDP

17.9

Sample limits

and

relatives of normal

generalizability

Coryell

controls and probands

telephone 72.9

(1989)

with schizophrenia and depression

face-to-face 27.1

Casey and

200 urban and rural

Personality

13.0

Not DSM

Tyrer

residents, selected

Assessment

based

(1986)

randomly

Schedule, ICD

Reich et al.

235 community

Personality

11.0

Required criteria

(1989)

residents, selected

Diagnostic

plus impairment/

randomly

Questionnaire, DSM-III

distress for diagnosis

Maier et al.

452 probands and

DSM-III-R

10.0

Did not use

(1992)

relatives from randomly selected families in Germany

by SCID

exclusionary criteria

Bernstein

733 adolescences and

Ten diagnostic

31.2

Not all criteria

et al. (1993)

their mothers selected

scales combined

moderate)

were matched

randomly

including

17.2

by protocol

structured

(severe)

items

interviews and

self-report

questionnaires

Abrams and

meta-analysis of eleven

Structured interviews, 10.0

Settings of subjects

Horowitz

studies, samples ranging

clinician consensus,

varied

(1996)

from 30-547 (SD = 214.53)

and chart review

Lenzenweger

1646 college students

DSM-III-R by

6.7

Results are estimated

et al.

International

(definite)

from a two-stage

(1997)

Personality

11.0

case identification

Disorder

(definite +

procedure

Examination

probable)

Lyons and

693 male twins from the

DSM-IV by

7.6

Males only

Jerskey

Vietnam Era Twin Registry

SIDP

published from 1980 through 1994 found that the overall prevalence for that age group of 50 years and older was 10%. However, the prevalences ranged from 6% to 33% based upon the setting in which participants were recruited (e.g., senior citizen center, psychiatric inpatients, psychiatric outpatients) and methods of assessment (e.g., structured interviews, consensus of clinicians, and retrospective chart reviews).

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