Functional Impairment in Patients With Schizotypal, Borderline, Avoidant, or Obsessive-Compulsive Personality Disorder

TLDR

The study aimed to compare psychosocial functioning among patients with schizotypal, borderline, avoidant, or obsessive‑compulsive personality disorders to those with major depressive disorder without a personality disorder. Using data from 668 participants recruited across four sites of the Collaborative Longitudinal Personality Disorders Study, the authors compared psychosocial functioning domains measured by the Longitudinal Interval Follow‑Up Evaluation–Baseline Version and the Social Adjustment Scale. Schizotypal and borderline personality disorders exhibited markedly greater impairment in work, social relationships, and leisure than obsessive‑compulsive personality disorder or major depressive disorder, with avoidant personality disorder intermediate; these differences persisted across assessment modalities and after adjusting for demographics and comorbid axis I psychopathology, underscoring that personality disorders contribute more functional morbidity than major depressive disorder alone.

Abstract

OBJECTIVE: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder and patients with major depressive disorder and no personality disorder. METHOD: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation—Baseline Version and the Social Adjustment Scale. RESULTS: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with obsessive-compulsive personality disorder or major depressive disorder; patients with avoidant personality disorder were intermediate. These differences were found across assessment modalities and remained significant after covarying for demographic differences and comorbid axis I psychopathology. CONCLUSIONS: Personality disorders are a significant source of psychiatric morbidity, accounting for more impairment in functioning than major depressive disorder alone.