The total burden of personality disorder psychopathology is closely related to correlates of an adverse outcome of bipolar disorder, according to a longitudinal study published in the Journal of Nervous and Mental Disease.

More than 782 outpatients with bipolar disorder self-rated using the Personality Disorder Questionnaire, Version 4 (PDQ4), and rated 6 poor prognosis factors while depressed or euthymic. The relationship of poor prognosis factors to the total PDQ4 score was then analyzed, using a linear regression.

Researchers found that a history of child abuse, early age of onset, an anxiety disorder comorbidity, rapid cycling, and a history of 20 or more previous episodes was significantly related to PDQ4, even after correcting for higher PDQ4 scores when depressed. Substance abuse, however, was not significantly related. Poor prognosis factors predicted total PDQ scores, severity of depression, and all 3 personality clusters: odd/eccentric, dramatic/emotional, and anxious/fearful.

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The limitations of the research include a reliance on a self-rated instrument rather than a systematic clinical review, use of cluster scores rather than specific disorders, and the exclusion of patients with severe substance use requiring treatment in another facility.

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The total burden of personality disorder pathology experienced by outpatients with bipolar disorder is strongly related to factors predicting or reflecting a difficult course of bipolar illness. According to researchers, these data may lead to a more nuanced understanding of bipolar disorder and “to a better definition of the effectiveness of interventions directed at treating both the personality disorder and bipolar illness burden.”


Post R M, McElroy S, Kupka R, et al. Axis II personality disorders are linked to an adverse course of bipolar disorder. J Nerv Ment Dis. 2018;206(6):469-472.

This article originally appeared on Psychiatry Advisor