Personality disorder and depression

Beck, Deborah Lynne (1991) Personality disorder and depression. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

The purpose of this study was to investigate the relationship between personality disorder and depression, the focus being upon the frequency and type of personality disorder, its relationship to the type of depression and its effect upon outcome. -- A random sample of 67 depressed psychiatric inpatients was assessed for the presence of personality disorder using the original Personality Disorder Examination (PDE). Criteria for entry into the study were that the subjects on admission to hospital had a depressed mood, with a Beck Depression Inventory score greater than 18 and were in the age range 18 to 45. There were 27 males and 40 females in the study with a mean age of 3 2.8 years. The initial assessment, made within 72 hours, included the Beck Depression Inventory, Hamilton Rating Scale for Depression, the Eysenck Personality Inventory and the Diagnostic Melancholia Scale. The major assessment was done when their depression had remitted (Montgomery-Asberg Depression Scale Score < 9). This included the PDE, Socialization Scale, Alexithymia Scale, the Global Assessment of Functioning Scale as well as historical and demographic data that included Life Events. Finally, a DSM-III-R clinical diagnosis, arrived at Ill by the psychiatric team at a discharge diagnosis meeting, was used. -- There were 44 subjects, 19 male and 25 female diagnosed by the PDE as personality disorders. Only 14 (32%) had a diagnosis of a single personality disorder. The most frequent diagnosis (68%) was Borderline Personality Disorder. Compared to the normal subjects group, the personality disorder group were younger, had lower Socialization scores and reported more undesirable life events and concerns about employment and health. -- When the subjects were grouped according to their type of depression, Major Depressive Disorder (28), Adjustment Disorder Depression (20) and Secondary Depression (19), personality disorders were not significantly associated with a particular type of depression except for Antisocial Personality Disorder with Secondary Depression. Differences between personality disorder and normal subjects within each type of depression group were largely not specific to the type of depression, nor were there many significant differences between the types of depression when analysis was restricted to the personality disorder subjects in each group. -- The high frequency of Borderline Personality Disorder led to a post hoc analysis of these subjects. They viewed themselves as subjectively more depressed, had lower Socialization Scores, higher Scale A Alexithymia scores, and were younger than normal subjects. Compared to other personality disorders, those with Borderline Personality had longer hospital stays, worse current levels of functioning, higher Alexithymia C scores, and greater frequency of marital problems. -- Differences between subjects with personality disorder and those with normal personalities were found in all divisions of the data and have been reported and discussed. The PDE identified a higher proportion of subjects with personality disorder (66%) than psychiatrists' clinical diagnoses (21%). The reasons for this are discussed as is the relationship of Borderline Personality Disorder to the development of depression in general.

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