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Am J Psychiatry 1993; 150:1237-1243
Copyright © 1993 by American Psychiatric Association
Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents
DP Bernstein, P Cohen, CN Velez, M Schwab-Stone, LJ Siever and L Shinsato
Department of Psychiatry, Bronx Veterans Affairs Medical Center, NY 10468.
OBJECTIVE: The purpose of this study was to estimate the prevalence,
concurrent validity, and stability of DSM-III-R personality disorders in a
large community-based sample of adolescents. METHOD: A randomly selected
community sample of 733 youths ranging in age from 9 to 19 years was
followed over a 2-year period. The protocol consisted of structured
interviews with the adolescents and their mothers and self- report
questionnaires. Algorithms for 10 DSM-III-R axis II disorders were
developed to produce diagnoses at two levels of severity; these were
validated against multiple indicators of distress and functional
impairment. RESULTS: The overall prevalence of personality disorders peaked
at age 12 in boys and at age 13 in girls and declined thereafter.
Obsessive-compulsive personality disorder was the most prevalent moderate
axis II disorder, narcissistic personality disorder the most prevalent
severe disorder, and schizotypal personality disorder the least prevalent
axis II disorder, based on both moderate and severe diagnostic thresholds.
All moderate axis II disorders were associated with significantly greater
odds for at least five of 12 diagnostic validators. Longitudinal follow-up
revealed that although most axis II disorders did not persist over a 2-year
period, subjects with disorders identified earlier remained at elevated
risk for receiving a diagnosis again at follow-up. CONCLUSIONS: These
findings suggest that a substantial minority of adolescents who are not in
treatment qualify for DSM-III-R personality disorder diagnoses and that
these diagnoses are associated with increased risk of psychological
distress and functional impairment.
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