title: Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation.
abstract: OBJECTIVE
  To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients.
  
  
  METHODS
  3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview.
  
  
  RESULTS
  The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders.
  
  
  CONCLUSIONS
  PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, People's Republic of China.
authors.forename: Tianhong
authors.initials: T
authors.lastname: Zhang
authors.forename: Lanlan
authors.initials: L
authors.lastname: Wang
authors.forename: Mary-Jo D
authors.initials: MJ
authors.lastname: Good
authors.forename: Byron J
authors.initials: BJ
authors.lastname: Good
authors.forename: Annabelle
authors.initials: A
authors.lastname: Chow
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Dai
authors.forename: Junhan
authors.initials: J
authors.lastname: Yu
authors.forename: Haiyin
authors.initials: H
authors.lastname: Zhang
authors.forename: Zeping
authors.initials: Z
authors.lastname: Xiao
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D044466:Asian People / Q000523:psychology / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires