A recent e-mail news release from the American Academy of Family Physicians caught my attention. A landmark survey has reported the prevalence of personality disorders in the United States. According to the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) has shown that an estimated 14.9 percent of Americans 18 years or older (30.8 million persons) meet standard diagnostic criteria for at least one personality disorder, as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). The news release on the survey is available online at http://www.niaaa.nih.gov/press/2004/landmark.htm.
The NESARC is a representative survey of noninstitutionalized U.S. civilians aged 18 years and older; more than 43,000 American adults participated in the survey. Designed to assess prevalence and comorbidity, or co-occurrence, of multiple mental health disorders, the NESARC was the first national survey conducted in the United States to estimate the prevalence of personality disorders. Results of the survey are reported in the Journal of Clinical Psychiatry (2004;65:948–58) and are available to subscribers at http://www.psychiatrist.com/.
Findings of the survey are significant: The most prevalent disorder in the United States is obsessive-compulsive personality disorder, which affects 7.9 percent of adults (representing approximately 16.4 million persons). Approximately 4.4 percent (9.2 million) have paranoid personality disorder; 3.6 percent (7.6 million) have antisocial personality disorder; 3.1 percent (6.5 million) have schizoid personality disorder; 2.4 percent (4.9 million) have avoidant personality disorder; 1.8 percent (3.8 million) have histrionic personality disorder; and 0.5 percent (1.0 million) have dependent personality disorder.
The survey found no gender differences in the prevalence of obsessive-compulsive, schizoid, or histrionic personality disorders. The prevalence of avoidant, dependent, and paranoid personality disorders is greater in women than in men, whereas the prevalence of antisocial personality disorder is greater in men than in women. In general, other risk factors for personality disorders included being Native American or black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. With the exception of histrionic personality disorder, all of the personality disorders assessed in the survey were associated with considerable emotional disability and impairment in social and occupational functioning.
Given the significance of personality disorders in the general population, you may want to read the article in this issue on the assessment and management of personality disorders, by Randy K. Ward, M.D. (see page 1505). Dr. Ward notes that caring for patients with personality disorders can be problematic and frustrating, and often leads to dysfunctional physician-patient relationships that complicate the task of diagnosing and managing medical and psychiatric conditions. Physicians must try to develop a working relationship with these patients to help them receive the best possible care despite their chronic difficulties in interacting with the health care system.