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Personality Change After Treatment

To the Editor: I would like to provide some background from the literature for the report by David J. Hellerstein, M.D., et al. (1). Although the authors’ finding appears to be solid and valid, it is not new. There is literature going back decades regarding how treatment of an axis I disorder can reduce measured personality dysfunction in both anxiety and depression (2–4). There is also literature indicating that these personality changes have clinical significance (5). Finally, there is also a growing literature on the effects of pharmacology on personality; an example is a review by Soloff (6).

A review of the literature shows the discussion moving forward from replicated findings to the meanings of the findings themselves. There is the question of whether the findings are measurement artifacts, treatment responses secondary to the treatment of an axis I disorder, or responses secondary to direct treatment of personality symptoms themselves. These are the more interesting questions. There was an empirical report (7) containing the suggestion that there may be an entity called a "stress-induced personality disorder," which, under the stress of an axis I illness, appears similar to a personality disorder but remits with the treatment of the axis I disorder. I applaud Dr. Hellerstein et al. for moving this topic into a useful area of research. I hope they find the previous literature helpful in their future endeavors.

References

1. Hellerstein DJ, Kocsis JH, Chapman D, Stewart JW, Harrison W: Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: effects on personality. Am J Psychiatry 2000; 157:1436-1444[Abstract/Free Full Text]
2. Hirschfeld RM, Klerman GL, Clayton PJ, Keller MB, McDonald-Scott P, Larkin BH: Assessing personality: effects of the depressive state on trait measurement. Am J Psychiatry 1983; 140: 695-699
3. Reich J, Noyes R Jr, Hirschfeld R, Coryell W, O’Gorman T: State and personality in depressed and panic patients. Am J Psychiatry 1987; 144:181-187[Abstract/Free Full Text]
4. Reich J: State versus trait in mental disorders (letter). Am J Psychiatry 1989; 146:568-569[CrossRef][Medline]
5. Reich J, Vasile R: The effect of personality disorders on the treatment outcome of axis I conditions: an update. J Nerv Ment Dis 1993; 181:475-484[CrossRef][Medline]
6. Soloff PH: Algorithms for pharmacological treatment of personality dimensions: symptom-specific treatments for cognitive-perceptual, affective, and impulsive-behavioral dysregulation. Bull Menninger Clin 1998; 62:195-214[Medline]
7. Reich J: Empirical evidence for "stress-induced" personality disorders. Psychiatr Ann 1999; 29:701-706

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