Prevalence of Specific Dsmiii Dsmiiir or Dsmiv Personality Disorders

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In this section, each of the personality disorders will be presented, starting with the essential features of the disorder according to the DSM-IV criteria published by the American Psychiatric Association in 1994. Available data about prevalence in clinical and nonclinical populations will be presented. For several personality disorders, such as antisocial personality disorder, there are a number of studies that have reported prevalence. For many of the personality disorders, however, there have been very few reports of true prevalence. The length of each section is somewhat proportional to the amount of epidemiological data that is available about the disorder. In some cases a single study provided data on a number of individual personality disorders. To avoid redundancy, the methodology of the study is mentioned only once.

Paranoid Personality Disorder. The essential feature of paranoid personality disorder is a "pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent'' (American Psychiatric Association, 1994). All four nonclinical studies of paranoid personality disorder reported prevalence rates less than 2.0%. The rates in clinical samples reported in Widiger (1991) ranged from 1.0% to 36% with a median prevalence of 6.0%. Reich (1987a) found an excess of paranoid personality disorder among males compared to females in an outpatient sample. The DSM-IV reports rates in the general population to be between 0.5% to 2.5%, in inpatient psychiatric settings 10% to 30%, and in outpatient mental health clinics 2.5% to 10% (APA, 1994).

Schizoid Personality Disorder:. The essential feature of this disorder is a "pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings'' (APA, 1994). In general, schizoid personality disorder has been a very infrequent diagnosis in clinical settings. For example, Zanarini et al. (1987) found no cases in a clinical sample of 97 patients and Koenigsberg et al. (1985) reported no cases on the basis of chart review in a sample of 2,462 patients. The prevalences in nonclinical samples reported in Table 2 are 1.0% or lower. The rates in clinical samples reported in Widiger (1991) ranged from 0.0% to 8% with a median prevalence of 1.0%. Comparison studies using DSM-III-R criteria report higher prevalence rates than DSM-III criteria. Morey (1988) compared the two sets of criteria on the same group of patients; rates were substantially higher using the DSM-III-R criteria. Individuals with schizoid personality disorder may be less likely to seek treatment as a function of their disorder. It may also be that the diagnosis of schizotypal personality disorder is applied to a number of individuals that might have been characterized as schizoid before DSM-III or that the current criteria are inadequate (Zanarini et al., 1987).

TABLE 2. Prevalence of Cluster A Personality Disorders

Authors (year)

Population

Instrument

Prevalence (%)

Comments

Paranoid PD

Zimmerman and Coryell (1989)

Reich et al.

Lyons and Jerskey

Schizoid PD

Zimmerman and Coryell (1989)

Casey and Tyrer (1986)

Reich et al.

Lyons and Jerskey

Schizotypal PD

Zimmerman and Coryell (1989)

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

235 community residents, selected randomly

452 probands and relatives from randomly wselected families in Germany

693 male twins from the Vietnam Era Twin Registry

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

200 urban and rural residents, selected randomly

235 community residents, selected randomly

452 probands and relatives from randomly selected families in Germany

693 male twins from the Vietnam Era Twin Registry

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

DSM-III by SIDP

telephone 72.9%

face-to-face

Personality Diagnostic Questionnaire, DSM-III

DSM-III-R by SCID

DSM-IV by SIDP

DSM-III by SIDP:

telephone 72.9%

face-to-face

Personality Assessment Schedule, ICD

Personality Diagnostic Questionnaire, DSM-III

DSM-III-R by SCID

DSM-IV by SIDP

DSM-III by SIDP; telephone 72.9% face-to-face 27.1%

Sample limits generalizability

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-R

exclusionary criteria

Males only

Sample limits generalizability

Not DSM

based

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-R

exclusionary criteria

Males only

Sample limits generalizability

(Continued)

TABLE 2. (Continued)

Authors (year)

Population

Instrument

Prevalence (%)

Comments

Schizotypal

Baron et al.

376 relatives of

DSM-III by

2.2

Adjustment for

(1985)

control subjects

Schedule for

sensitivity of

in a

Interviewing

family history

family study

Borderlines; 70% interviews 30% family history

method

Reich et al.

235 community

Personality

5.1

Required criteria

(1989)

residents,

Diagnostic

plus impairment/

selected

Questionnaire,

distress for

randomly

DSM-III

diagnosis

Maier et al.

452 probands and

DSM-III-R

0.7

Did not use

(1992)

relatives from randomly selected families in Germany

by SCID

exclusionary criteria

Lyons and

693 male twins from

DSM-IV by

0.3

Males only

Jerskey

the Vietnam Era Twin Registry

SIDP

Schizotypal Personality Disorder:. The essential feature of schizotypal personality disorder is a ''pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior'' (APA, 1994). These characteristics must be present by early adulthood in various contexts. The symptoms must not be severe enough to warrant a diagnosis of schizophrenia. The DSM-III diagnostic criteria for schizotypal personality disorder were drawn from the definition for the diagnosis of borderline schizophrenia in the Danish Adoption study (Kety et al., 1978). A number of studies have indicated a familial relationship between schizotypal personality disorder and schizophrenia. However, a number of studies have failed to find an excess risk for schizophrenia among the relatives of schizotypal probands.

Baron et al. (1985) conducted a family study of the transmission of schizotypal and borderline personality disorder. They identified a control group of 90 subjects and subsequently included 376 of their relatives. Their findings on the relatives of controls is relevant for inferring prevalence in a nonclinical sample. Seventy percent of the relatives of controls were personally interviewed by mental health professionals using the Schedule for Affective Disorders and Schizophrenia (Spitzer and Endicott, 1978) for axis I and with the Schedule for Interviewing Borderlines (Gunderson, 1982) which yields diagnoses for DSM-III schizotypal and borderline personality disorders. Data were obtained on 30% of the relatives using a family history version of the Schedule for Interviewing Borderlines (the family history method refers to obtaining information from an informant rather than through a direct interview). Seventy-five percent of the relatives of controls were studied blind to the diagnostic status of the proband. Baron and colleagues did not find differences in outcome between subjects rated in the blind versus nonblind conditions. The risk to relatives was age corrected using the Stromgren method for schizotypal but not for borderline personality disorder. The authors also adjusted the morbidity risks to compensate for the inferior sensitivity of the family history method compared to direct interview. Although this procedure applied across all relative groups in their study may help the comparison of relatives of different types of probands, it also makes epidemiological inferences from these data somewhat tentative.

In a small study of consecutive outpatient admissions, Bornstein et al. (1988) reported that patients with schizotypal personality disorder were more likely to receive a diagnosis of substance abuse or dependence and major affective disorder than nonschizotypal patients in their series. The prevalences in nonclinical samples reported in Table 2 range from 0.3% to 5.1% with a median value of about 3.0%. The rates in clinical samples reported in Widiger (1991) ranged from 2.0% to 64% with a median prevalence of 17.5%.

Antisocial Personality Disorder:. The essential feature of antisocial personality disorder is a ''pervasive pattern of disregard for and violation of the rights of others'' (APA, 1994). The DSM-III and DSM-III-R criteria were heavily influenced by the work of Robins (1984) and place an emphasis on antisocial and criminal behavior. In prison populations the prevalence of DSM-III-R antisocial personality disorder may be over 50%. Reich (1987a) found an excess of males with antisocial personality disorder among an outpatient sample.

Antisocial personality disorder was one of the DSM-III personality disorders about which Nestadt and his coworkers reported results. They found a positive association between the number of criteria for antisocial PD and the risk for an alcohol use disorder diagnosis. Swanson and colleagues (1994) found that 90.4% of their sample of individuals with antisocial personality disorder had at least one other DSM-III lifetime psychiatric diagnosis. Moran (1999a, b) found several sociodemographic predictors of antisocial personality disorder. Males outnumbered females by as much as 8:1 and younger age groups and people with limited education were at higher risk. In a follow-up study of 500 psychiatric outpatients, Martin et al. (1985) found that the mortality rates for patients with antisocial personality disorder was almost four times greater than the comparison population.

Using DSM-I criteria, Leighton et al. (1963) reported a prevalence of 11% in men and 5% for women for a sociopathic diagnosis. Weissman et al. (1978) reported results from a systematic survey of households in New Haven, Connecticut. Their diagnostic data were collected in an eight-year follow-up of the sample. The original sample was 1,095 individuals; the diagnostic sample included 511 of the original sample. The follow-up sample differed from the original sample on the basis of race and class; the follow-up included a higher proportion of whites and a lower proportion of the lowest social class. Diagnostic data were collected with the SADS and diagnoses were based on the Research Diagnostic Criteria. The rate of current antisocial personality disorder was 0.2%.

Antisocial personality disorder was the only personality disorder included in the ECA study and the National Comorbidity Survey (Kessler et al., 1994). Data are presented in Table 3. Compton et al. (1991) applied the methodology of the ECA study to a community-based sample in Taiwan. The prevalences in nonclinical

TABLE 3. Prevalence of Cluster B Personality Disorder

Authors (year)

Population

Instrument

Prevalence (%)

Comments

Antisocial PD

Robins et al. (1984)

Compton et al. (1991)

Zimmerman and Coryell (1989)

Casey and Tyrer (1986)

Nestadt et al. (1990)

Weissman et al.

Reich et al.

Oakley-Browne

Swanson et al. (1994)

Kessler et al. (1994)

Lyons and Jerskey

9,543 subjects strict probability sampling at 3 sites

11,004 community residents in Taiwan; strict probability sample

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

200 urban and rural residents, selected randomly

810 subjects from the Clinical Reappraisal at Baltimore ECA site

511 systematically identified community residents

235 community residents, selected randomly

1,498 New Zealand

452 probands and relatives from randomly selected families in Germany

3258 (Edmonton,

Canada)

8098 Strict probability sample

693 male twins from the Vietnam Era Twin Registry

DIS 2.5

DIS 0.2

DSM-III by 3.3

SIDP

telephone 72.9%

face-to-face

Personality 6.0

Assessment Schedule, ICD

DSM-III by SPE 1.5

administered by psychiatrist

Research 0.2

Diagnostic Criteria; RDC

Personality 0.4

Diagnostic Questionnaire, DSM-III

DIS 3.1

by SCID

DIS 3.7

DSM-III-R 3.5 by CIDI

DSM-IV byz 0.9 SIDP

Very rigorous sampling

Very rigorous sampling and methodology

Sample limits generalizability

(included explosive personality) not DSM based

Significant sample attrition is a problem

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-R

exclusionary criteria

Weighted prevalence rate

National Comorbidity Survey

Males only

TABLE 3. (Continued)

Authors (year)

Population

Instrument

Prevalence (%)

Comments

Borderline

Zimmerman and Coryell (1989)

Reich et al.

Swartz et al. (199G)

Lyons and Jerskey

Histrionic PD

Zimmermanand Coryell (1989)

Nestadt et al. (199G)

Reich et al.

Lyons and Jerskey

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

376 relatives of control subjects in a family study

235 community residents, selected randomly

1,541 community residents from the Duke ECA site

452 probands and relatives from randomly selected families in in Germany

693 male twins from the Vietnam Era Twin Registry

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

810 subjects from the Clinical Reappraisal at Baltimore ECA site

235 community residents, selected randomly

452 probands and relatives from randomly selected families in Germany

693 male twins from the Vietnam Era Twin Registry

DSM-III by SIDP

telephone 72.9% face-to-face 27.1% DSM-III by Schedule for Interviewing Borderlines; 70% interviews 30% family history

Personality Diagnostic Questionnaire, DSM-III

DIS/Borderline Index, DSM-III

DSM-III-R by SCID

DSM-IV by SIDP

DSM-III by SIDP

telephone 72.9% face-to-face 27.1% DSM-III by SPE

administered by psychiatrist Personality Diagnostic Questionnaire, DSM-III

DSM-III-R by SCID

DSM-IV by SIDP

Sample limits generalizability

Unorthodox adjustment for sensitivity of family history method

Required criteria plus impairment/ distress for diagnosis

Included subjects between ages 19 and 55

Did not use DSM-III-R

exclusionary criteria

Males only

Sample limits generalizability

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-R

exclusionary criteria

Males only

(Continued)

TABLE 3. (Continued)

Authors (year)

Population

Instrument

Prevalence (%)

Comments

Narcissistic PD

Zimmerman and

797 nonpatient

DSM-III by

0.0

Sample limits

Coryell

relatives of normal

SIDP

generalizability

(1989)

controls and probands with schizophrenia and depression

telephone 72.9,% face-to-face 27.1%

Reich et al.

235 community

Personality

0.4

Required criteria

(1989)

residents,

Diagnostic

plus impairment/

selected

Questionnaire,

distress for

randomly

DSM-III

diagnosis

Maier et al.

452 probands and

DSM-III-R

0.0

Did not use

(1992)

relatives from randomly selected families in in Germany

by SCID

exclusionary criteria

Lyons and

693 male twins from

DSM-IV by

0.9

Males only

Jerskey

the Vietnam Era Twin Registry

SID

samples reported in Table 3 range from 0.2% in a Taiwanese population to over 3% with a median value of about 2.0%. The rates in clinical samples reported in Widiger (1991) ranged from 0.0% to 37% with a median prevalence of 7%. DSM-IV reports prevalence estimates in clinical settings ranging from 3% to 30% depending on the predominant characteristics of the populations that are sampled, with higher rates being associated with substance abuse treatment settings and prison and forensic settings (APA, 1994).

Borderline Personality Disorder. The essential feature of borderline personality disorder is a ''pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses'' (APA, 1994). Swartz et al. (1990) derived a diagnostic algorithm for diagnosing BPD from the Diagnostic Interview Schedule (Robins et al., 1981). Using a cutoff of 11 items from their 24-item index, they classified 1.8% of their sample (from the Duke site of the ECA study) between ages 19 and 55 as having borderline personality disorder. Merikangas and Weissman (1986) estimated the prevalence of borderline personality disorder to be between 1.7% and 2.0% based on community studies carried out before the diagnostic criteria for borderline personality disorder were codified in DSM-III.

Borderline personality disorder is the most common personality disorder seen in most psychiatric settings and is overrepresented in clinical populations because of the tendency toward help-seeking (Galenberg, 1987). Nurnberg et al. (1991) found that 82% of patients with a diagnosis of borderline personality disorder received at least one other axis II diagnosis, among a sample of outpatients with personality disorder and no concurrent axis I disorder. They concluded that borderline personality disorder characterizes a general personality disorder construct.

Widiger and Weissman (1991) and Widiger and Trull (1992) reviewed the epidemiology of borderline personality disorder. They reported an average prevalence of 8.0% in studies of outpatients and 15% in studies of inpatients. Among studies of patients with personality disorder, the average prevalence among outpatients was 27% and among inpatients, 51%. These authors concluded that BPD is the most common personality disorder diagnosis given in clinical samples, with prevalence rates of up to 70% found among inpatient samples (Standage and Ladha, 1988).

Akhtar, Byrne, and Doghramji (1986) reviewed 23 studies of borderline personality disorder to investigate associations between borderline personality disorder and demographic characteristics. All of the studies that they reviewed used clinical samples, mostly inpatients. They only included studies that utilized one of several widely used criteria sets to define the disorder. They pooled data across the samples of borderlines and compared these data to pooled comparison group data from the same studies. They found that patients receiving a diagnosis of borderline personality disorder tended to be young, with a mean age in the mid-twenties. A significantly higher percentage of borderline patients (77%) were female. The samples of borderline patients were disproportionally white; the mean percentage of blacks in the borderline samples was 10%, while the mean percentage of blacks in the comparison samples was 20%, a statistically significant difference. Reich (1987a) did not find an excess of borderline personality disorder among female outpatients.

The prevalences in nonclinical samples reported in Table 3 range from 0.4% to 1.8% with a median value of about 1.6%. The rates in clinical samples reported in Widiger (1991) ranged from 11% to 70% with a median prevalence of 31%.

Histrionic Personality Disorder. The essential feature of histrionic personality disorder is a ''pervasive pattern of excessive emotionality and attention-seeking'' (APA, 1994). The term ''hysterical personality'' has been used in other classifications. There has been relatively little empirical work done on histrionic personality disorder (Pfohl, 1991). When structured diagnostic assessments have been utilized, no sex difference in histrionic personality disorder has been observed, however, there is some suggestion that clinicians may more frequently apply the diagnosis to females (Pfohl, 1991).

Histrionic personality disorder was one of the DSM-III Personality disorders about which Nestadt and his coworkers (described above) reported results from the Clinical Reappraisal of the ECA Baltimore site. There were no differences in prevalence by sex (males, 2.2%; females, 2.1%), race, or education. The prevalence declined with age in males but not in females. There was a higher rate of histrionic personality disorder among separated and divorced subjects than among married subjects. There was also an increase in depressive disorder, suicide attempts, and the occurrence of three or more unexplained medical symptoms in females associated with histrionic personality disorder. In males there was an increase in substance use disorders associated with histrionic personality disorder. Subjects with histrionic personality disorder were significantly more likely to seek medical and psychiatric treatment than subjects without.

The prevalences in nonclinical samples reported in Table 3 range from 0.0% to 3.0% with a median value of about 2.2%. The rates in clinical samples reported in

Widiger (1991) ranged from 2.0% to 45% with a median prevalence of 19%. Rates in inpatient and outpatient mental health settings have been reported to be between 10% to 15% when a structured assessment has been conducted (APA, 1994).

Narcissistic Personality Disorder. The essential feature of this disorder is a ''pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy'' (APA, 1994). There has not been a great deal of empirical work done on narcissistic personality disorder in general, and very little epidemiological work in particular. Although there is considerable clinical interest in the disorder, it has only recently been included in official nomenclatures. Narcissistic personality disorder became part of the American nomenclature in 1980 with DSM-III and there is no counterpart to it in ICD-10.

Gunderson et al. (1991b) reviewed several studies that reported the prevalence of DSM-III-R narcissistic personality disorder in clinical populations (Dahl, 1986; Frances et al., 1984; Skodol, 1989; Zanarini et al., 1987) and reported prevalence rates ranging from 2.0% to 16%. The prevalences in nonclinical samples reported in Table 3 range from 0.0% to 0.4% with a median value of about 0.2%. The rates in clinical samples reported in Widiger (1991) ranged from 2.0% to 35% with a median prevalence of 6.0%.

Avoidant Personality Disorder. The essential feature of avoidant personality disorder is a ''pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation'' (APA, 1994). An important issue in the epidemiology of avoidant personality disorder is its potential overlap with an axis I disorder: generalized social phobia. Turner et al. (1991) studied axis II comorbidity in a sample of individuals with social phobias. Avoidant personality disorder was present in 22.1% of the sample and an additional 52.9% of the sample had avoidant features that fell short of meeting the diagnostic threshold. Schneier et al. (1991) studied a sample of 50 patients with social phobias. They found that 70% of patients with social phobia met criteria for avoidant personality disorder and 89% of patients with generalized social phobia received a diagnosis of avoidant personality disorder. Herbert et al. (1992) found that 61% of patients in their series with generalized social phobia also met criteria for avoidant personality disorder. Holt et al. (1992) found that 50% of their sample with generalized social phobia met criteria for avoidant personality disorder. Schneier et al. (1991) suggested that generalized social phobia and avoidant personality disorder may define a single psychopathological entity.

The prevalences in nonclinical samples reported in Table 4 range from 0.0% to 2.3% with a median value of about 1.1%. The rates in clinical samples reported in Widiger (1991) ranged from 5.0% to 55% with a median prevalence of 16%.

Dependent Personality Disorder. The essential feature of dependent personality disorder is a ''pervasive and excessive need to be taken care of, leading to submissive and clinging behaviors and fears of separation'' (APA, 1994). Dependent personality disorder was recently reviewed by Hirschfeld et al. (1991). They pointed out that dependent personality disorder derives from psychoanalytic theory, social psychological theory, and ethological theory. The construct of dependent personality disorder overlaps with borderline, avoidant, and histrionic personality disorders. In studies of clinical samples reviewed by Hirschfeld et al. (1991),

TABLE 4. Prevalence of Cluster C Personality Disorders

Authors (year) Population

Instrument Prevalence (%)

Comments

Avoidant PD

Zimmerman 797 nonpatient and Coryell relatives of normal (1989) controls and probands with schizophrenia and depression

Reich et al. 235 community (1989) residents, selected randomly

DSM-III by SIDP:

telephone 72.9%, face-to-face 27.1%

Personality Diagnostic Questionnaire, DSM-III

DSM-III-R by SCID

Maier et al. 452 probands and (1992) relatives from randomly selected families in Germany

Lyons and 693 male twins from DSM-IV by Jerskey the Vietnam Era SIDP

Twin Registry

Dependent PD

Zimmerman and Coryell (1989)

Lyons and Jerskey

797 nonpatient relatives of normal controls and probands with schizophrenia and depression

235 community residents, selected randomly

452 probands and relatives from randomly selected families in Germany

DSM-III by SID:

telephone 72.9% face-to-face 27.1%

Personality Diagnostic Questionnaire, DSM-III

DSM-III-R by SCID exclusionary criteria

693 male twins from DSM-IV by the Vietnam Era SIDP Twin Registry

Sample limits generalizability

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-R exclusionary criteria

Males only

Sample limits generalizability

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-R

Males only

( Continued)

TABLE 4. (Continued)

Authors (year) Population

Instrument Prevalence (%)

Comments

Obsessive-Compulsive PD

Zimmerman 797 nonpatient and Coryell (1989)

relatives of normal controls and probands with schizophrenia and depression

Nestadt et al. 810 subjects from

the Clinical Reappraisal at Baltimore ECA site

DSM-III by SIDP:

telephone 72.9%, face-to-face 27.1%

DSM-III by

administrated by psychiatrist

Sample limits generalizability

Male rate 5 times female rate

Reich et al. 235 community Personality 6.4

(1989) residents, selected Diagnostic randomly Questionnaire,

DSM-III

Maier et al. 452 probands and DSM-III-R 2.2

(1992) relatives from by SCID

randomly selected families in Germany

Lyons and 693 male twins from DSM-IV by 2.3

Jerskey Vietnam Era SIDP

Twin Registry

Required criteria plus impairment/ distress for diagnosis

Did not use DSM-III-exclusionary criteria

Males only substantial overlap with other personality disorders was reported. The greatest degree of overlap was with borderline personality disorder (over 50 in most studies), followed by avoidant, histrionic, and schizotypal personality disorders. Hirschfeld and associates discussed the issues of sex differences and possible sex bias in the diagnosis of dependent personality disorder. They pointed out that dependent personality disorder was diagnosed more frequently in females when assessment was not carried out using standardized instruments. When standard -ized instruments were used, males and females did not differ in the frequency of the diagnosis. This suggests that clinicians, rather than the standardized diagnostic criteria, may be responsible for observed differences in male and female rates. Individuals with a depressive disorder may be more likely to display dependent personality traits (Overholser, 1991). According to the DSM-IV, dependent personality is among the most frequently reported of the personality disorders encountered in mental health clinics (APA, 1994).

The prevalences of dependent personality disorder in nonclinical samples reported in Table 4 range from 0.1% to 5.1% with a median value of about 1.8%. The rates in clinical samples reported in Widiger (1991) ranged from 2.0% to 55% with a median prevalence of 20%.

Obsessive-Compulsive Personality Disorder:. The essential feature of obsessive -compulsive personality disorder is a ''pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency'' (APA, 1994). Compulsive personality disorder was one of the DSM-III personality disorders about which Nestadt and his coworkers (described above) reported results from the Clinical Reappraisal of the ECA Baltimore site. Males had a significantly higher prevalence (3.0%) than females (0.6%). White respondents had a significantly higher prevalence than black respondents. There was no association between age and risk of the disorder. The diagnosis of compulsive personality disorder was associated with higher education, greater likelihood of being employed, and greater likelihood of being married as against being widowed, separated, divorced, or never married. Subjects with compulsive personality disorder had a higher income than those without after correcting for age and sex. Nestadt et al. (1992) found that compulsive traits were associated with greater risk of generalized anxiety disorder and simple phobia and lower risk of alcohol use disorder.

Turner et al. (1991) studied axis II comorbidity in a sample of individuals with social phobias. Obsessive-compulsive personality disorder was present in 13.2% of the sample and an additional 48.5% of the sample had obsessive - compulsive traits that fell short of meeting the diagnostic threshold. Baer et al. (1990) studied 96 patients with obsessive - compulsive disorder (OCD), which is an anxiety disorder recorded on axis I. Only 6% of the patients received a diagnosis of obsessive-compulsive personality disorder; of the six patients receiving the obsessive - compulsive personality disorder diagnosis, five had onset of obsessive-compulsive symptoms before age 10. Pfohl et al. (1990) found that among patients with OCD, 30% met criteria for obsessive-compulsive personality disorder. (To put this finding in context, in the same study they found dependent personality disorder in 46% of their OCD subjects and passive - aggressive personality disorder in 49%.) Reich (1987a) found an excess of males with obsessive-compulsive personality disorder among an outpatient sample in comparison to females.

The prevalences in nonclinical samples reported in Table 4 range from 1.7% to 6.4% with a median value of about 2.0%. The rates in clinical samples reported in Widiger (1991) ranged from 1.0% to 20% with a median prevalence of 9%.

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