A Strategy to Address High Comorbidity of Personality Disorders in a Chinese Population: A Principal and Subordinate Diagnostic Model

Psychiatry. 2019 Fall;82(3):272-282. doi: 10.1080/00332747.2019.1600218. Epub 2019 Apr 24.

Abstract

Objective: Multiple and overlapping diagnoses of personality disorders (PDs) have been a major obstacle in clinical practice and research. This study aims to investigate the comorbidity of PDs in a sample of a high-risk clinical population. We propose a diagnostic model to address this critical issue. Methods: The sample population included 982 PD patients. The PD diagnoses were concluded based on self-reported and face-to-face interviews. To address the issue of overlapping PD diagnoses, we defined the criteria for clinically distinguishing principal and subordinate PDs, and determined the frequency of each condition. Results: Diagnostic overlap among PDs was quite common across all categories. Of all 982 PD patients, 436 (44.4%) met the criteria for more than one PD. In terms of specific PD diagnoses, the comorbidity rate of each PD was nearly 47.1-74.7%. The principal and subordinate PDs were distinguished accordingly. Avoidant, obsessive-compulsive, and borderline PD remain the most prevalent types of principal PD in this clinical population. Conclusions: The principal/subordinate model may be one strategy of resolving the issue of PD comorbidity in Chinese clinical settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Asian People / psychology*
  • China / epidemiology
  • Comorbidity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Psychological
  • Personality Disorders / diagnosis*
  • Personality Disorders / epidemiology*
  • Prevalence
  • Self Report
  • Young Adult