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Outcomes 20 Years Later

Thomas N. Crawford, PhD; Patricia Cohen, PhD; Michael B. First, MD; Andrew E. Skodol, MD; Jeffrey G. Johnson, PhD; Stephanie Kasen, PhD

Arch Gen Psychiatry. 2008;65(6):641-648.

Context  Although Axis II personality disorders in adolescence have been linked to psychopathology and psychosocial impairment in early adulthood, little is known about their effects over longer periods.

Objectives  To evaluate and compare long-term prognoses of adolescent personality disorders and co-occurring Axis I disorders.

Design  Population-based longitudinal study.

Setting  Upstate New York.

Participants  A community sample of 629 adolescents interviewed at a mean age of 13.8 years and again at a mean age of 33.2 years.

Main Outcome Measures  Clinically assessed psychiatric disorders and self-reported attainment and function.

Results  Axis I (mood, anxiety, disruptive behavior, and substance use disorders) and Axis II disorders in adolescence showed risks for negative prognoses lasting 20 years. Co-occurring Axis I and Axis II disorders consistently presented the highest risk, often approximating the sum of the axis-associated risk or even several times the risk of disorders in either axis alone.

Conclusions  Long-term prognoses of Axis I and Axis II disorders are of comparable magnitude and often additive when comorbid. These findings are highly relevant to the current debate over how personality disorders should be handled in DSM-V.

Author Affiliations: New York State Psychiatric Institute (Drs Crawford, Cohen, First, Skodol, Johnson, and Kasen) and Columbia University (Drs Crawford, Cohen, First, Johnson, and Kasen), New York, New York; and Institute for Mental Health Research, Phoenix, Arizona (Dr Skodol).

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