The impact of comorbid dysthymic disorder on outcome in personality disorders
published online 08 January 2010.
Abstract
Objective
The goal of our study was to investigate the impact of dysthymic disorder (DD), a form of chronic depression, on naturalistic outcome in individuals with personality disorders (PDs).
Method
The Collaborative Longitudinal Personality Disorders Study is a cohort initially including 573 subjects with 4 targeted PDs (borderline, avoidant, schizotypal, and obsessive-compulsive) and 95 subjects with major depression but no PD. At baseline, 115 subjects were diagnosed with coexisting DD, of whom 109 (94.8%) were PD subjects. Regression analyses were performed to predict 3 classes of broad clinical outcome after 2 years of prospective follow-up. We hypothesized that DD diagnosis at baseline would be associated with worse outcome on (1) persistence of a PD diagnosis, (2) impairment in psychosocial functioning (as measured by the Longitudinal Interval Follow-up Evaluation), and (3) crisis-related treatment utilization.
Results
Baseline DD diagnosis was associated with persistence of PD diagnosis at 2 years, particularly for borderline and avoidant PDs. It was associated with worse outcome on global social adjustment, life satisfaction, recreation, and friendships, but not employment or relationship with spouse. Contrary to expectation, DD did not increase suicide attempts, emergency room visits, or psychiatric hospitalizations.
Conclusions
Comorbidity of DD is associated with persistence of PD diagnosis and with worse outcome on many, but not all, measures of psychosocial functioning.
aNew York State Psychiatric Institute, New York, NY 10032, USA
bCollege of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
cDepartment of Epidemiology and Biostatistics, University of Illinois, Chicago, IL 60612, USA
dWeill Medical College of Cornell University, New York, NY 10021, USA
eBrown University Department of Psychiatry and Human Behavior, Providence, RI 02912, USA
fHarvard Medical School and McLean Hospital, Belmont, MA 02478, USA
gYale-New Haven Psychiatric Hospital, New Haven, CT 06510, USA
hYale University School of Medicine, New Haven, CT 06510, USA
Corresponding author. New York State Psychiatric Institute, New York, NY 10032, USA .Tel.: +1 212 543 5743; fax: +1 212 43 5326.
ABSTRACT