Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis

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Abstract

Background

Personality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous rates.

Aims

We aimed to conduct a meta-analysis on the prevalence of personality disorders in adult populations and examine potential moderators that affect heterogeneity.

Method

We searched PsycINFO, PSYNDEX and Medline for studies that used standardised diagnostics (DSM-IV/-5, ICD-10) to report prevalence rates of personality disorders in community populations in Western countries. Prevalence rates were extracted and aggregated by random-effects models. Meta-regression and sensitivity analyses were performed and publication bias was assessed.

Results

The final sample comprised ten studies, with a total of 113 998 individuals. Prevalence rates were fairly high for any personality disorder (12.16%; 95% CI, 8.01–17.02%) and similarly high for DSM Clusters A, B and C, between 5.53 (95% CI, 3.20–8.43%) and 7.23% (95% CI, 2.37–14.42%). Prevalence was highest for obsessive–compulsive personality disorder (4.32%; 95% CI, 2.16–7.16%) and lowest for dependent personality disorder (0.78%; 95% CI, 0.37–1.32%). A low prevalence was significantly associated with expert-rated assessment (versus self-rated) and reporting of descriptive statistics for antisocial personality disorder.

Conclusions

Epidemiological studies on personality disorders in community samples are rare, whereas prevalence rates are fairly high and vary substantially depending on samples and methods. Future studies investigating the epidemiology of personality disorders based on the DSM-5 and ICD-11 and models of personality functioning and traits are needed, and efficient treatment should be a priority for healthcare systems to reduce disease burden.

Declaration of interest

None.

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Most cited references 20

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The structure of personality pathology: Both general ('g') and specific ('s') factors?

Carla Sharp, Aidan G C Wright, J Christopher Fowler … (2015)

Recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) conceptualize personality disorders (PDs) as categorical constructs, but high PD co-occurrence suggests underlying latent dimensions. Moreover, several borderline PD criteria resemble Criterion A of the new DSM-5 Section III general criteria for personality pathology (i.e., self and interpersonal dysfunction). We evaluated a bifactor model of PD pathology in which a general factor and several specific factors of personality pathology (PD 'g' and 's' factors, respectively) account for the covariance among PD criteria. In particular, we examined the extent to which the borderline PD criteria would load exclusively onto the g-factor versus on both the g- and one or more s-factors. A large (N = 966) sample of inpatients were interviewed for six DSM-IV (American Psychiatric Association, 1994) PDs using the (Structured Clinical Interview for Personality Disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1994) with no skip-outs. We ran a series of confirmatory, exploratory, and bifactor exploratory factor analyses on the rated PD criteria. The confirmatory analysis largely replicated the DSM PDs, but with high factor correlations. The "standard" exploratory analysis replicated four of the DSM PDs fairly well, but nearly half the criteria cross-loaded. In the bifactor analysis, borderline PD criteria loaded only on the general factor; the remaining PDs loaded either on both the general and a specific factor or largely only on a specific factor. Results are interpreted in the context of several possibilities to define the nature of the general factor.