Longitudinal Effects of Personality Disorders on Psychosocial Functioning of Patients With Major Depressive Disorder

John C. Markowitz, M.D.; Andrew E. Skodol, M.D.; Eva Petkova, Ph.D.; Jianfeng Cheng, Ph.D.; Charles A. Sanislow, Ph.D.; Carlos M. Grilo, Ph.D.; John G. Gunderson, M.D.; and Thomas H. McGlashan, M.D.

Objective: No previous research has focused on psychosocial functioning in understanding how personality disorders compound the impairment caused by major depressive disorder over time. This report describes the effects of persistent and remitting comorbid personality disorders on the depressive status and functioning of patients with major depressive disorder over the course of 2 years.

Method: Longitudinal data on functioning from the first 2 years of the Collaborative Longitudinal Personality Disorders Study were evaluated for 3 groups of subjects with major depressive disorder: subjects with major depressive disorder alone (N = 103), those with persistent comorbid personality disorders (N = 164), and those with comorbid personality disorders that remitted (N = 69). DSM-IV criteria were used for mood and personality disorder diagnoses. The data were gathered from September 1996 to August 2000 and from September 2001 to September 2004.

Results: Subjects whose personality disorders remitted were more likely than those with persisting personality disorders to have major depressive disorder remit. Social functioning, as measured by the Longitudinal Interval Follow-up Evaluation and the Global Assessment of Functioning, improved across a range of domains over time, with most gains occurring in the first 6 months of follow-up and with differential improvement by group. As hypothesized, subjects whose personality disorders remitted fared nearly as well as did subjects without personality disorders, whereas subjects whose personality disorders persisted functioned most poorly.

Conclusions: Outcome research on major depressive disorder has often ignored Axis II disorders. Our data indicate that the longitudinal course of personality psychopathology meaningfully influences depressive outcome and psychosocial functioning in patients with major depressive disorder. The findings indicate the need to target both symptom relief and psychosocial functioning and to treat both personality and mood disorders in comorbid patients.

(J Clin Psychiatry 2007;68:186-193)

Received April 13, 2006; accepted June 26, 2006. From the Department of Personality Studies (Drs. Markowitz and Skodol) and the Department of Biostatistics (Drs. Petkova and Cheng), New York State Psychiatric Institute, New York; the Yale Psychiatric Research Institute and Yale University, New Haven, Conn. (Drs. Sanislow, Grilo, and McGlashan); and the Department of Psychiatry, Harvard Medical School, Cambridge, Mass. (Dr. Gunderson).

Supported in part by an Independent Investigator Award from the National Alliance for Research on Schizophrenia and Depression (Dr. Markowitz) and National Institute of Mental Health grant numbers R01 MH 01654, 50837, 50838, 50839, 50840, 50850, and 73708.

The authors report no additional financial or other relationship relevant to the subject of this article.

This manuscript has been reviewed and approved for submission by the Publications Committee of the Collaborative Longitudinal Personality Disorder Study.

Corresponding author and reprints: John C. Markowitz, M.D., Department of Personality Studies, New York State Psychiatric Institute, 1051 Riverside Dr., Unit #129, New York, NY 10032 (e-mail: jcm42@columbia.edu).