Am J Psychiatry 1996; 153:1308-1312
Copyright © 1996 by American Psychiatric Association
Patterns of personality disorder comorbidity in early-onset versus late- onset major depression
M Fava, JE Alpert, JS Borus, AA Nierenberg, JA Pava and JF Rosenbaum
Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
OBJECTIVE: This study tested the hypothesis that in a population of adult
outpatients with major depression, those with an early onset of depression
would have a greater prevalence of personality disorders than those with a
late onset of depression. METHOD: The 404 subjects were patients
participating in depression treatment studies at the Massachusetts General
Hospital. They were administered the Structured Clinical Interview for
DSM-III-R-Patient Version to assess the current presence of major
depression and the age at onset of the initial depressive episode. The
subjects were then divided into two groups: those with early onset (before
18 years of age) and those with late onset (at age 18 or later). The
prevalence of personality disorders was determined through use of the
physician-rated Structured Clinical Interview for DSM-III-R Personality
Disorders (SCID-II) and the patient- rated Personality Diagnostic
Questionnaire-Revised (PDQ-R). RESULTS: The patients with early onset of
major depression had a significantly higher prevalence of avoidant,
histrionic, narcissistic, and borderline personality disorders according to
the SCID-II. The PDQ-R scores indicated that avoidant, dependent,
passive-aggressive, histrionic, narcissistic, borderline, and antisocial
personality disorders were significantly more prevalent among the patients
with early onset of major depression. CONCLUSIONS: Overall, the results are
consistent with the view that early-onset depressive illness is
distinguished from late- onset major depression by more frequent
association with persistent disturbances in behaviors and attitudes.
