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Are Personality Disorders Set in Stone?

Apparently not, according to this 4-year prospective study of a young, nonclinical population.

Personality disorders are defined as enduring maladaptive patterns of behavior and thought. To determine whether these diagnoses are stable over time (see Journal Watch Psychiatry October 24, 2002), researchers analyzed 4 years of findings from the Longitudinal Study of Personality Disorders, which began in 1990. Clinicians used semistructured questionnaires and diagnostic interviews to evaluate 250 college students for DSM-IIIR personality-disorder diagnoses during their first, second, and fourth years of college. In this paper, the investigators examined changes within individuals over time.

About half of the sample (n=129) met criteria for a personality-disorder diagnosis in the first year. However, specific personality-disorder criteria decreased by an average of 1.4 items per year (yearly mean decreases by cluster: cluster A criteria, 0.35; cluster B criteria, 0.65; cluster C criteria, 0.40). The decline in personality-disorder symptoms was statistically significant and moderately important for total personality-disorder features; for clusters A, B, and C; and for all diagnoses except antisocial, schizotypal, passive-aggressive, and schizoid (median effect size, 0.26).

Comment: These results suggest that a personality disorder diagnosed at one point may be less severe or even no longer present later in life. However, using a young, nonclinical population, especially college students, may have skewed the results, which seems likely given the large number of personality-disorder diagnoses in the first year. Nevertheless, we can take comfort from the notion that psychological growth does not stop in adolescence and that even the most deeply entrenched traits may change with time, experience, and, of course, treatment.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry November 18, 2004

Citation(s):

Lenzenweger MF et al. Individual growth curve analysis illuminates stability and change in personality disorder features: The longitudinal study of personality disorders. Arch Gen Psychiatry 2004 Oct; 61:1015-24.

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