The stability of DSM personality disorders over twelve to eighteen years.
BACKGROUND
Stability of personality disorders is assumed in most nomenclatures; however, the evidence for this is limited and inconsistent. The aim of this study is to investigate the stability of DSM-III personality disorders in a community sample of eastern Baltimore residents unselected for treatment.


METHODS
Two hundred ninety four participants were examined on two occasions by psychiatrists using the same standardized examination twelve to eighteen years apart. All the DSM-III criteria for personality disorders were assessed. Item-response analysis was adapted into two approaches to assess the agreement between the personality measures on the two occasions. The first approach estimated stability in the underlying disorder, correcting for error in trait measurement, and the second approach estimated stability in the measured disorder, without correcting for item unreliability.


RESULTS
Five of the ten personality disorders exhibited moderate stability in individuals: antisocial, avoidant, borderline, histrionic, and schizotypal. Associated estimated ICCs for stability of underlying disorder over time ranged between approximately 0.4 and 0.7-0.8. A sixth disorder, OCPD, exhibited appreciable stability with estimated ICC of approximately 0.2-0.3. Dependent, narcissistic, paranoid, and schizoid disorders were not demonstrably stable.


CONCLUSIONS
The findings suggest that six of the DSM personality disorder constructs themselves are stable, but that specific traits within the DSM categories are both of lesser importance than the constructs themselves and require additional specification.
Nestadt
Gerald
G
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Meyer 113, Baltimore, Maryland 21287, USA. gnestadt@jhmi.edu
Di
Chongzhi
C
Samuels
J F
JF
Bienvenu
O J
OJ
Reti
I M
IM
Costa
P
P
Eaton
William W
WW
Bandeen-Roche
Karen
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D012111:Residence Characteristics; D012189:Retrospective Studies; D055815:Young Adult