Comprehensive Psychiatry
Volume 51, Issue 5 , Pages 449-457 , September 2010

The impact of comorbid dysthymic disorder on outcome in personality disorders

  • David J. Hellerstein

      Affiliations

    • New York State Psychiatric Institute, New York, NY 10032, USA
    • College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    • Corresponding Author InformationCorresponding author. New York State Psychiatric Institute, New York, NY 10032, USA .Tel.: +1 212 543 5743; fax: +1 212 43 5326.
    • ,
  • Andrew E. Skodol

      Affiliations

    • New York State Psychiatric Institute, New York, NY 10032, USA
    • College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    • ,
  • Eva Petkova

      Affiliations

    • New York State Psychiatric Institute, New York, NY 10032, USA
    • College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    • ,
  • Hui Xie

      Affiliations

    • New York State Psychiatric Institute, New York, NY 10032, USA
    • College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    • Department of Epidemiology and Biostatistics, University of Illinois, Chicago, IL 60612, USA
    • ,
  • John C. Markowitz

      Affiliations

    • New York State Psychiatric Institute, New York, NY 10032, USA
    • College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    • Weill Medical College of Cornell University, New York, NY 10021, USA
    • ,
  • Shirley Yen

      Affiliations

    • Brown University Department of Psychiatry and Human Behavior, Providence, RI 02912, USA
    • ,
  • John Gunderson

      Affiliations

    • Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA
    • ,
  • Carlos Grilo

      Affiliations

    • Yale-New Haven Psychiatric Hospital, New Haven, CT 06510, USA
    • ,
  • Maria T. Daversa

      Affiliations

    • Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA
    • ,
  • Thomas H. McGlashan

      Affiliations

    • Yale University School of Medicine, New Haven, CT 06510, USA

References 

  1. Dysthymia in clinical practice. The WPA Dysthymia Working Group. Br J Psychiatry. 1995;166:174–183
  2. Keller MB. Dysthymia in clinical practice:course, outcome and impact on the community. Acta Psychiatr Scand Suppl. 1994;89(s383):24–34
  3. Katon W, Russo J, Frank E, Barrett J, Williams JW, Oxman T, et al. Predictors of nonresponse to treatment in primary care patients with dysthymia. Gen Hosp Psychiatry. 2002;24(1):20–27
  4. Klein DN, Shankman SA, Rose S. Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry. 2006;163(5):872–880
  5. Mulder RT. Personality pathology and treatment outcome in major depression: a review. Am J Psychiatry. 2002;159(3):359–371
  6. Pilkonis PA, Frank E. Personality pathology in recurrent depression: nature, prevalence, and relationship to treatment response. Am J Psychiatry. 1988;145(4):435–441
  7. Grilo CMS, Sanislow CA, Shea TM, Skodol AE, Stout RL, Gunderson JG, et al. Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. J Consult Clin Psychol. 2005;73(1):78–85
  8. Klein DN, Santiago NJ. Dysthymia and chronic depression: Introduction, classification, risk factors, and course. J Clin Psychol. 2003;59(8):807–816
  9. Klein DN, Schwartz JE. The relation between depressive symptoms and borderline personality disorder features over time in dysthymic disorder. J Personal Disord. 2002;16(6):523–535
  10. Kool S, Dekker J, Duijsens IJ, de Jonghe F. Major depression, double depression and personality disorders. J Personal Disord. 2000;14(3):274–281
  11. Paris J, Zweig-Frank H. A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2001;42(6):482–487
  12. Horwitz AV, Widom CS, McLaughlin J, White HR. The impact of childhood abuse and neglect on adult mental health: a prospective study. J Health Soc Behav. 2001;42(2):184–201
  13. Shea MT, Stout R, Gunderson J, Morey LC, Grilo CM, McGlashan T, et al. Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. Am J Psychiatry. 2002;159(12):2036–2041
  14. Grilo CM, Sanislow CA, Gunderson JG, Pagano ME, Yen S, Zanarini MC, et al. Two-year stability and change of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. J Consult Clin Psychol. 2004;72(5):767–775
  15. Lenzenweger MF. Stability and change in personality disorder features: the longitudinal study of personality disorders. Arch Gen Psychiatry. 1999;56(11):1009–1015
  16. Zanarini MC, Frankenburg FR, Hennen J, Silk KR. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry. 2003;160(2):274–283
  17. Skodol AE, Stout RL, McGlashan TH, Grilo CM, Gunderson JG, Shea MT, et al. Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS). Depress Anxiety. 1999;10(4):175–182
  18. Klein DN, Norden KA, Ferro T, Leader JB, Kasch KL, Klein LM, et al. Thirty-month naturalistic follow-up study of early-onset dysthymic disorder: course, diagnostic stability, and prediction of outcome. J Abnorm Psychol. 1998;107(2):338–348
  19. Klein DN, Schwartz JE, Rose S, Leader JB. Five-year course and outcome of dysthymic disorder: a prospective, naturalistic follow-up study. Am J Psychiatry. 2000;157(6):931–939
  20. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, Morey LC, et al. The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatr Scand. 2000;102(4):256–264
  21. Akiskal HS, Hirschfeld RM, Yerevanian BI. The relationship of personality to affective disorders. Arch Gen Psychiatry. 1983;40(7):801–810
  22. Shea MT, Stout RL, Yen S, Pagano ME, Skodol AE, Morey LC, et al. Associations in the course of personality disorders and Axis I disorders over time. J Abnorm Psychol. 2004;113(4):499–508
  23. Oldham JM, Skodol AE, Kellman HD, Hyler SE, Doidge N, Rosnick L, et al. Comorbidity of axis I and axis II disorders. Am J Psychiatry. 1995;152(4):571–578
  24. Gunderson JG, Shea MT, Skodol AE, McGlashan TH, Morey LC, Stout RL, et al. The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics. J Personal Disord. 2000;14(4):300–315
  25. Zanarini MC, Skodol AE, Bender D, Dolan R, Sanislow C, Schaefer E, et al. The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses. J Personal Disord. 2000;14(4):291–299
  26. First MB, Gibbon M, Spitzer RL, Williams JB. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Version (SCID-IP). New York, NY: New York State Psychiatric Institute; 1996;
  27. Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald-Scott P, et al. The LONGITUDINAL INTERVAL FOLLOW-UP EVALUATION. A comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry. 1987;44(6):540–548
  28. Zanarini MC, Frankenburg FR, Sickel AE, Yong L. The Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Belmont (Ma): McLean Hospital, Laboratory for the Study of Adult Development; 1996;
  29. Kovacs M, Obrosky DS, Gatsonis C, Richards C. First-episode major depressive and dysthymic disorder in childhood: clinical and sociodemographic factors in recovery. J Am Acad Child Adolesc Psychiatry. 1997;36(6):777–784
  30. Kasen S, Cohen P, Skodol AE, Johnson JG, Smailes E, Brook JS. Childhood depression and adult personality disorder: alternative pathways of continuity. Arch Gen Psychiatry. 2001;58(3):231–236
  31. Johnson JG, Cohen P, Skodol AE, Oldham JM, Kasen S, Brook JS. Personality disorders in adolescence and risk of major mental disorders and suicidality during adulthood. Arch Gen Psychiatry. 1999;56(9):805–811
  32. Garyfallos G, Adamopoulou A, Karastergiou A, Voikli M, Sotiropoulou A, Donias S, et al. Personality disorders in dysthymia and major depression. Acta Psychiatr Scand. 1999;99(5):332–340
  33. Shea MT, Leon AC, Mueller TI, Solomon DA, Warshaw MG, Keller MB. Does major depression result in lasting personality change?. Am J Psychiatry. 1996;153(11):1404–1410
  34. Sanderson WC, Wetzler S, Beck AT, Betz F. Prevalence of personality disorders in patients with major depression and dysthymia. Psychiatry Res. 1992;42(1):93–99
  35. Devanand DP, Turret N, Moody BJ, Fitzsimons L, Peyser S, Mickle K, et al. Personality disorders in elderly patients with dysthymic disorder.. Am J Geriatr Psychiatry. 2000;8(3):188–195
  36. Bellino S, Patria L, Ziero S, Rocca G, Bogetto F. Clinical features of dysthymia and age: a clinical investigation. Psychiatry Res. 2001;103(2-3):219–228
  37. Frank E, Thase ME. Natural history and preventative treatment of recurrent mood disorders. Annu Rev Med. 1999;50:453–468
  38. Griffiths J, Ravindran AV, Merali Z, Anisman H. Dysthymia: a review of pharmacological and behavioral factors. Mol Psychiatry. 2000;5(3):242–261
  39. Howland RH, Thase ME. Biological studies of dysthymia. Biol Psychiatry. 1991;30(3):283–304
  40. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry. 1998;55(8):694–700
  41. Hirschfeld RM. Personality disorders and depression: comorbidity. Depress Anxiety. 1999;10(4):142–146
  42. Koenigsberg HW, Anwunah I, New AS, Mitropoulou V, Schopick F, Siever LJ. Relationship between depression and borderline personality disorder. Depress Anxiety. 1999;10(4):158–167
  43. Shea MT, Pilkonis PA, Beckham E, Collins JF, Elkin I, Sotsky SM, et al. Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry. 1990;147(6):711–718
  44. Shea MT, Widiger TA, Klein MH. Comorbidity of personality disorders and depression: implications for treatment. J Consult Clin Psychol. 1992;60(6):857–868
  45. Durbin CE, Klein DN. Ten-year stability of personality disorders among outpatients with mood disorders. J Abnorm Psychol. 2006;115(1):75–84
  46. Gunderson JG, Morey LC, Stout RL, Skodol AE, Shea MT, McGlashan TH, et al. Major depressive disorder and borderline personality disorder revisited: longitudinal interactions. J Clin Psychiatry. 2004;65(8):1049–1056
  47. Gunderson JG, Daversa MT, Grilo CM, McGlashan TH, Zanarini MC, Shea MT, et al. Predictors of 2-year outcome for patients with borderline personality disorder. Am J Psychiatry. 2006;163(5):822–826
  48. Black KJ, Sheline YI. Personality disorder scores improve with effective pharmacotherapy of depression. J Affect Disord. 1997;43(1):11–18
  49. Hirschfeld RM, Russell JM, Delgado PL, Fawcett J, Friedman RA, Harrison WM, et al. Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine. J Clin Psychiatry. 1998;59(12):669–675
  50. Yen S, Shea MT, Pagano M, Sanislow CA, Grilo CM, McGlashan TH, et al. Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study. J Abnorm Psychol. 2003;112(3):375–381

PII: S0010-440X(09)00133-3

doi: 10.1016/j.comppsych.2009.11.002

Comprehensive Psychiatry
Volume 51, Issue 5 , Pages 449-457 , September 2010

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