If your everyday struggle with an anxiety disorder is impairing your social life, career, or education, you are not alone. There are an estimated 40 million people affected with an anxiety disorder in the US alone, and anxiety disorders are quite often “chronic,” or persistent over time, suggesting an ongoing burden for those who suffer from them.
Because of this, researchers have focused on identifying the factors that can contribute to a chronic anxiety disorder so they may be able to improve diagnosis and better determine recommended treatment. One thing they’ve discovered is that among individuals with anxiety disorders, co-occurring personality disorders are known to increase the severity of anxiety symptoms and decrease one’s ability to function effectively or cope with anxiety.
Less has been discovered or studied, however, about how personality disorders influence the course of anxiety disorders over time. This is what my team and I recently attempted to figure out, and what our research study aimed to understand.
Personality Disorders are Strong Predictors of Anxiety Disorder Persistence
Over the course of three years, my colleagues and I examined the effect of personality disorders on the persistence of four DSM-IV anxiety disorders in a national sample of 34,653 participants.2 Participants in the study had been previously diagnosed with Generalized Anxiety Disorder (GAD), social anxiety disorder, specific phobias, or panic disorder. In order to determine predictors of persistence we analyzed participant’s DSM-IV personality disorders, along with other factors such as age and treatment history.
What we found was that the persistence of all four anxiety disorders was predicted by the presence of at least one of the following factors:
- any personality disorder
- two or more personality disorders
- borderline personality disorder
- schizotypal personality disorder
- the mean number of personality disorders diagnosed
- the mean number of personality disorder criteria being met
Schizoid and avoidant personality disorders were shown to predict the persistence of GAD. Narcissistic personality disorder predicted the persistence of both GAD and of panic disorder. Finally, avoidant personality disorder strongly predicted the persistence of social phobia.
Overall, we found that personality disorders were far stronger predictors for the persistence of anxiety than any of the other factors we examined. These other factors included demographics, age at onset of the anxiety disorder, number of prior episodes of the anxiety disorder, duration of the current episode, and treatment history.
Treating Your Personality Disorder May Help Your Anxiety
What we’ve concluded is that if you are suffering persistently from GAD, social phobia, a specific phobia, or panic disorder, and you are not responding to the usual treatments for these disorders (either through medicine or psychotherapy), the problem might be a co-occurring personality disorder.
This means, first of all, that all patients with anxiety disorders should be assessed for personality pathology. Personality disorders are often over-looked, even by mental health practitioners, and are rarely the concern of busy general medical doctors who may prescribe medications for a person with an anxiety disorder.
An untreated person who thinks they may be suffering from co-occurring anxiety and personality disorders should seek help from a mental health practitioner, while a patient in treatment might ask his or her therapist or doctor for a referral to a mental health professional that specializes in personality disorders. Research has also shown that several effective treatments for personality pathology exist (cognitive-behavioral, psychodynamic, and others), and that appropriate psychotherapy treatment could result in a much better treatment outcome for people with chronic anxiety disorders due to personality pathology.
Sources
1Anxiety and Depression Association of America. (n.d.) Facts and Statistics. Retrieved from https://www.adaa.org/about-adaa/press-room/facts-st…
2Skodol AE, Geier T, Grant BF, Hasin DS: Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depress Anxiety 2014; 31(9):721-728. doi: 10.1007/s11920-014-0480-x
Andrew E. Skodol, M.D. is Research Professor of Psychiatry at the University of Arizona, College of Medicine and Adjunct Professor of Psychiatry at the Columbia University College of Physicians and Surgeons. He was a Member of the Task Force for DSM-5 and Chair of its Personality and Personality Disorders Work Group. He has been Chair of the Steering Committee and one the Principal Investigators of the multi-site, NIMH-funded Collaborative Longitudinal Personality Disorders Study (CLPS). He has published extensively on the topics of clinical psychiatric diagnosis, the assessment of stress and psychosocial functioning, and personality disorders. He was in private practice in New York City for 31 years.
Dr. Skodol is a graduate of Yale University and the University of Pennsylvania, School of Medicine. He received his psychiatric training at the Albert Einstein College of Medicine, where he continued as Assistant Professor until joining the Columbia faculty in 1979. He was a Research Psychiatrist in the Biometrics Research and Social Psychiatry Departments at the New York State Psychiatric Institute, the Director of the Department of Personality Studies from 1997 to 2007, and the Deputy Director of the Institute from 2000 through 2003. He became Professor of Clinical Psychiatry at Columbia in 1995, a position he held until 2007, when he moved to Arizona. He was President of the Institute for Mental Health Research in Arizona in 2007-2008 and led the non-profit Sunbelt Collaborative in 2008-2011.
Dr. Skodol is certified by the American Board of Psychiatry and Neurology. He is a Distinguished Life Fellow of the American Psychiatric Association; Fellow and President Elect of the American Psychopathological Association; Member of the American College of Psychiatrists; Member of the Section on Classification, Diagnostic Assessment, and Nomenclature of the World Psychiatric Association; and Past President of the Association for Research on Personality Disorders.
