Comorbid Axis I and Axis II disorders in early adolescence: outcomes 20 years later.
BACKGROUND
Although Axis II personality disorders in adolescence have been linked to psychopathology and psychosocial impairment in early adulthood, little is known about their effects over longer periods.


OBJECTIVE
To evaluate and compare long-term prognoses of adolescent personality disorders and co-occurring Axis I disorders.


METHODS
Population-based longitudinal study.


METHODS
Upstate New York.


METHODS
A community sample of 629 adolescents interviewed at a mean age of 13.8 years and again at a mean age of 33.2 years.


METHODS
Clinically assessed psychiatric disorders and self-reported attainment and function.


RESULTS
Axis I (mood, anxiety, disruptive behavior, and substance use disorders) and Axis II disorders in adolescence showed risks for negative prognoses lasting 20 years. Co-occurring Axis I and Axis II disorders consistently presented the highest risk, often approximating the sum of the axis-associated risk or even several times the risk of disorders in either axis alone.


CONCLUSIONS
Long-term prognoses of Axis I and Axis II disorders are of comparable magnitude and often additive when comorbid. These findings are highly relevant to the current debate over how personality disorders should be handled in DSM-V.
Crawford
Thomas N
TN
Children in the Community Study, 100 Haven Ave, Ste 31F, New York, NY 10032, USA. crawfor@pi.cpmc.columbia.edu
Cohen
Patricia
P
First
Michael B
MB
Skodol
Andrew E
AE
Johnson
Jeffrey G
JG
Kasen
Stephanie
S
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D009518:New York; D010342:Patient Acceptance of Health Care; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011379:Prognosis; D018570:Risk Assessment; D012917:Social Adjustment; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology