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This chapter addresses the complex inter relationships between anxiety disorders (ADs) and personality disorders (PDs), including diagnostic controversies, patterns of comorbidity, and prognostic implications for treatment. The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) created five axes for diagnostic classification, including Axis I for illnesses such as ADs and Axis II for PDs. The presence of an Axis I state disorder may confound diagnosis of Axis II trait. The biopsychosocial model suggests that illness arises from the interplay of genetic, trait, and environmental influences. PDs are less prevalent than ADs. Limited information exists on the comorbidity between ADs and PDs in the general population. Available data suggest that PD comorbidity among ADs is common, except in the case of specific phobia. Current evidence yields more questions than answers, due in part to the complexity of assessing PDs and the labor and expense of large-scale, longitudinal studies.
Analyses of co-morbidity patterns among common mental disorders have repeatedly indicated that relationships among disorders can be understood in terms of broad superordinate dimensions. However, these analyses have been based on syndromal-level indicators, which are often heterogeneous, rather than on symptoms, which are presumably more homogeneous.
Method
Symptom-level exploratory and confirmatory analyses were used to explore the joint hierarchical organization of Axis I and II psychopathology, using data on 8405 individuals from the 2000 British Psychiatric Morbidity Survey.
Results
Analyses indicated that 20 identified subordinate dimensions of psychopathology could be organized into four broad superordinate dimensions: Internalizing, Externalizing, Thought Disorder, and Pathological Introversion.
Conclusions
These results extend existing model frameworks ‘downward’ as well as ‘outward’, by analyzing symptoms rather than diagnoses, and by integrating symptoms from Axis I and II disorders in a common framework. This model demonstrates the importance of hierarchy in psychopathology structure, comprises replicable features of psychopathology structure, and has important implications for understanding the nature and organization of mental disorders.
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