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Personality Disorder and Cardiovascular Disease: Results From a National Household Survey. [CME]

J Clin Psychiatry 2007;68:69-74

Objective: Little is known about the physical health of personality-disordered people. This study investigated associations between personality disorder and cardiovascular disease in a large, nationally representative sample from Great Britain.

Method: A random sample of 8580 adults aged 16 to 74 years, living in England, Wales, and Scotland in 2000 was screened for the presence of personality disorders using the screening questionnaire of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Self-reported stroke or ischemic heart disease was ascertained. Age, sex, social class (by occupation), self-reported hypertension or diabetes, smoking history, and alcoholism were entered into regression models as potential confounding/mediating factors.

Results: Participants screening positive for any personality disorder were more likely to report experiencing a stroke and ischemic heart disease (age- and sex-adjusted odds ratios [ORs] were 2.1 [95% CI, 1.2 to 3.8] and 1.5 [95% CI, 1.1 to 2.1], respectively). After adjusting for potential confounders, significant associations were found between any personality disorder and stroke (OR = 1.9; 95% CI, 1.0 to 3.5) and any personality disorder and ischemic heart disease (OR = 1.4; 95% CI, 1.0 to 1.9). After adjustment, avoidant (OR = 4.0; 95% CI, 1.2 to 13.3), obsessive-compulsive (OR = 2.9; 95% CI, 1.3 to 6.6), and borderline personality disorders (OR = 8.5; 95% CI, 1.0 to 72.8) were significantly associated with stroke. Ischemic heart disease was significantly associated with avoidant (OR = 2.2; 95% CI, 1.1 to 4.5), paranoid (OR = 2.1; 95% CI, 1.0 to 4.3), schizotypal (OR = 3.6; 95% CI, 1.5 to 8.6), schizoid (OR = 1.6; 95% CI, 1.1 to 2.4), and borderline personality disorders (OR = 7.2; 95% CI, 2.1 to 24.3).

Conclusion: People at risk for personality disorder are also at increased risk for cardiovascular disease. This increased risk is not explained by differences in socioeconomic status or lifestyle. Dysfunctional personality traits may have a direct role in the etiology of cardiovascular disease.