Future Directions

In comparison to the major axis I disorders, there is considerably less epidemiolog-ical information about the personality disorders. There are a number of factors that have contributed to this state of affairs. Before DSM-III was published in 1980, there was less of a consensus about how to define the individual personality disorders (as well as disagreement about which disorders to include under the heading) than there was for the major axis I disorders. The most ambitious studies of true prevalence, the ECA study and the NCS, included most of the important axis I disorders, but only antisocial personality disorder was included from axis II. There is good evidence that personality disorders are strongly associated with use of mental health services, use of medical services (Reich et al., 1989), prognosis and responsiveness to treatment of axis I disorders (Reich and Green, 1991), and substantial impairment in functioning and subjective distress. There are important questions that remain unanswered about the true prevalence of most of these disorders, about the stability of these disorders, their natural course, as well as risk and protective factors for their development.

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