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Am J Psychiatry 1995; 152:571-578
Copyright © 1995 by American Psychiatric Association
Comorbidity of axis I and axis II disorders
JM Oldham, AE Skodol, HD Kellman, SE Hyler, N Doidge, L Rosnick and PE Gallaher
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York.
OBJECTIVE: In light of continuing controversies concerning the DSM-III- R
system for diagnosing personality disorders, their construct validity, and
the assignment of disorders to a particular axis, the authors studied
patterns of axis I-axis II comorbidity. METHOD: Semistructured interviews
were used to assess axis I and axis II disorders in 200 inpatients and
outpatients. Odds ratios were calculated to determine significant
comorbidity between classes of current axis I disorders and axis II
personality disorders diagnosed according to two methods and defined at two
diagnostic thresholds. Distributions of personality disorder traits were
also compared in patients with and without axis I disorders. RESULTS:
Significantly elevated odds ratios were found for co-occurrence of current
mood disorders with avoidant and dependent personality disorders; anxiety
disorders with borderline, avoidant, and dependent personality disorders;
psychotic disorders with schizotypal, borderline, and dependent personality
disorders; psychoactive substance use disorders with borderline and
histrionic personality disorders; and eating disorders with schizotypal,
borderline, and avoidant personality disorders. These results held when
conservative and liberal definitions of personality disorders were used.
Non-specific axis I and axis II associations were confirmed for
distributions of personality disorder traits. CONCLUSIONS: Significant
associations occurred between most axis I classes of disorders and axis II
disorders and traits in more than one cluster. All axis I classes of
disorders except mood disorders co-occurred with borderline personality
disorder; however, patients with mood disorders had elevated levels of
borderline traits. When any personality disorder was present, there were
significant odds that a mood, anxiety, psychotic, or eating disorder would
also be present; psychoactive substance use disorders, in contrast,
significantly co- occurred with borderline and histrionic personality
disorders.
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