Personality disorders and quality of life. A population study
Introduction
A number of studies have examined the quality of life of individuals with anxiety disorders [1], [2], affective disorders [3], and schizophrenia [4]. In contrast, only one Australian population study [5] and one Italian study of individuals contacting community mental health services have included personality disorder (PD) in their study of quality of life and mental disorders [6]. However, their assessment of PDs was based on diagnostic rating and brief screening, and they did not distinguish between different PDs.
Subjective report of dysfunction, disability, and impairment are to some extent the reverse of quality of life, because impairment usually encompasses poor qualities in interpersonal relations. Some investigators have studied how PDs are associated with impaired functioning. Andreoli et al [7] found that patients with PDs had poorer work and interpersonal relationships. Levy et al [8] observed that youth in a psychiatric ward with PDs had lower GAF score than other adolescent patients. A number of studies have found that having a PD in addition to a symptom disorder reduces social functioning. Klass et al [9] found a lower GAF among those who had a PD in addition to anxiety disorder. Noyes et al [10] observed that PD in addition to panic disorder reduced work adjustment, social relationships, and family and marriage functioning. Skodol et al [11] found correspondingly that PDs added to drug disorders reduced the Global Assessment of Functioning (GAF) score.
Some studies have investigated specific PDs. van Velzen et al [12] found that those with avoidant PD in addition to social phobia had poorer social and occupational adjustment.
Most studies have investigated borderline PDs. Pope et al [13] found that those with borderline PD had poorer social and occupational adjustment, compared with patients with bipolar and schizoaffective disorders. Tucker et al [14] observed an improvement in friendship and family relations parallel with an improvement in borderline PD features. Daley et al [15] observed that patients with borderline features experienced more stress and conflicts and were less satisfied than other patients over a 4-year period. However, when they included other PDs in the analyses, they found that histrionic and paranoid features were better predictors of conflicts, and schizotypal and narcissistic traits were almost just as good predictors of “romantic” problems as borderline traits.
Shea et al [16] observed that the eccentric and the dramatic, not the fearful, cluster was related to poor social adjustment, but not to poor occupational adjustment. Torgersen [17], however, observed that those with borderline and with schizotypal PD had poorer social as well as occupational adjustment.
Two recent studies have investigated a larger number of PDs. Skodol et al [18] found dysfunction in relation to parents, sibs, and friends among patients with schizotypal, borderline, or avoidant PD; occupational dysfunction among those with schizotypal or borderline PD; and dysfunction in relation to more distant family members among those with schizotypal PD. Those with obsessive-compulsive PD were rather well functioning, compared with controls who were depressive patients without PDs. Fossati et al [19] studied aspects of close relationships: confidence, discomfort with closeness, relationships as secondary, need for approval, and preoccupation with relationships among patients with different PDs. Strongest dysfunction was observed among those with avoidant PD, followed by paranoid, depressive, borderline, schizotypal, dependent, and histrionic PDs.
In contrast to the few studies of PDs, a number of studies have demonstrated the relationship between personality traits and dimensions, and subjective well-being [20]. Subjective well-being correlated negatively with the so-called Big Five factor neuroticism and positively with the factors extraversion, agreeableness, conscientiousness, and openness to experience in descending magnitude in 2 American studies [21], [22].
Based on Saulsman and Page [23], metaanalysis of Big Five and PDs, those with avoidant PD will then be expected to have most strongly deficiency in quality of life, followed by borderline, schizotypal, dependent, paranoid, schizoid, and antisocial PD. Those with obsessive-compulsive PD should not have a poor quality of life, and those with histrionic and narcissistic PD a good quality of life.
However, subjective well-being is not the only important aspect of quality of life. Also, a number of subjective relational aspects of life are important, as well as broad aspects of the good life [24], [25], [26]. Consequently, in the present study, we have included in the concept of quality of life also relation to friends, family and neighbors, self-realization, social support, and absence of negative life events.
The aim of the present study was to investigate whether PDs are related to broad aspects of quality of life, whether our prediction from the studies of personality dimensions are confirmed, and what specific relationships exist between specific PDs and specific aspects of quality of life. To our knowledge, this is the first study of quality of life and specific PDs.
Section snippets
Subjects
The study was approved by the Regional Ethical Committee. Written informed consent was obtained after the study had been fully explained. The sample is described more in detail in previous articles [27], [28]. Briefly, the basis was 3590 individuals between 18 and 65 years old registered in the National Population Register in Oslo in 1994. All known individuals supposed to live in Oslo are included in the Register. The 3590 individuals were drawn by chance. It turned out that only 2693 actually
Results
Table 1 presents the mean standard scores for individuals with different PDs. The means of those with a specific PD (for instance paranoid PD) are compared with the means of those without any PD whatsoever and the means of those with another PD than the specific PD (for instance schizotypal and avoidant PD).
Subjective well-being and self-realization is poorer for those with almost all types of specific PDs and also most strongly reduced for those with any PD. Poorer neighborhood quality is
Discussion
The present study demonstrates in a relatively unselected population that having PDs implies poor quality of life and impairment in functioning. The deficiency in quality of life is adding to the reduction caused by unfavorable sociodemographic conditions, as shown in previous studies [5], [6], and axis I disorders, also shown in previous studies of disability [9], [10], [11].
The deficiency, when the specific PDs are taken into account, is strongest for contact with friends and self-realization
Acknowledgments
This study was supported by grants from the Council of Mental Health, the Foundation for Health and Rehabilitation, Norway, and the Norwegian Council for Research, Department of Mental Health, Norway.
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