The Epidemiology of Personality and Eating

Disorders

Personality Disorders (PD)

Methodological Issues

Reliability and validity of diagnostic criteria Lack of a “gold standard” to validate diagnosis

Symptoms tend to be part of the individual’s normal experience, so may not be described to interviewer Self-report of certain traits may require insight the

individual does not have Reluctance to self-report of negative traits may result

in under-diagnosis Information should be sought from another person

familiar with the individual being diagnosed

Source: Lyons MJ, Jerskey BA. Personality disorders: Epidemiological findings, methods, and concepts. In: Textbook in Psychiatric Epidemiology, MT Tsuang and M. Tohen (eds.), 2nd edition. New York: Wiley-Liss, Inc., 2002.

Prevalence of Personality Disorders (Overall and Cluster A), NCS-R Study

Any personality disorder: 11.9% Cluster A: 6.2%Paranoid PD: 2.3% (95% CI:0.7%-4.0%)

Schizoid PD: 4.9% (95% CI:0.6%-9.2%)

Schizotypal PD: 3.3% (95% CI:0.0%-7.2%)

Source: Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comborbidity Survey Replication. Biological Psychiatry 2—7;62(6):553-564.

Prevalence of Personality Disorders (Cluster B), NCS-R Study

Cluster B: 2.3%Antisocial PD: 1.0% (95% CI: 0.0-1.9%)

More common in men than womenBorderline PD: 1.6% (95% CI: 0.3-3.0%)

Histrionic PD: 0.0% (95% CI: 0.0%-1.3%)

Narcissistic PD: 0.0% (95% CI: 0.0-1.3%)

Source: Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comborbidity Survey Replication. Biological Psychiatry 2007;62(6):553-564.

Prevalence of Personality Disorders (Cluster C)

Cluster C: 6.8%Avoidant PD: 5.2% (95% CI: 2.0-8.3%)

Dependent PD: 0.6% (95% CI: 0.0-1.5%)

Obsessive compulsive PD: 2.4% (95% CI: 0.8-4.0%)

Source: Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comborbidity Survey Replication. Biological Psychiatry 2—7;62(6):553-564.

Sociodemographic Risk Factors for Personality Disorders

Gender, race/ethnicity, family income, and marital status are not significantly associated with PD in the NCS-R Study Antisocial personality disorder is more common in

men than women Young people and those with less education have the

highest prevalence of Cluster B personality disorders Unemployment is associated with borderline

personality disorder

Source: Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comborbidity Survey Replication. Biological Psychiatry 2—7;62(6):553-564.

Comorbid Conditions

Individuals with PD have greater odds of anxiety, mood, and impulse-control disorders (axis I disorders)

Source: Lyons MJ, Jerskey BA. Personality disorders: Epidemiological findings, methods, and concepts. In: Textbook in Psychiatric Epidemiology, MT Tsuang and M. Tohen (eds.), 2nd edition. New York: Wiley-Liss, Inc., 2002.

Eating Disorders

Lifetime Prevalence of Eating Disorders, NCS-R Study

Anorexia nervosa Men: 0.3%; Women: 0.9%

Bulimia nervosa Men: 0.5%; Women: 1.5%

Binge eating disorder Men: 2.0%; Women: 3.5%

Subthreshold binge eating disorder Men: 1.9%; Women: 0.6%

Source: Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 200;61:348-358.

12-Month Prevalence of Eating Disorders, NCS-R Study

Bulimia nervosaMen: 0.1%; Women: 0.5%

Binge eating disorderMen: 0.8%; Women: 1.6%

Subthreshold binge eating disorderMen: 0.8%; Women: 0.4%

Source: Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 200;61:348-358.

Median Age of Onset

Source: Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 200;61:348-358.

Anorexia nervosa 18.0 years

Bulimia nervosa 18.0 years

Binge eating disorder 21.0 years

Subthreshold binge eating disorder 20.0 years

Median Years with Episode

Source: Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 200;61:348-358.

Anorexia nervosa 1.0 years

Bulimia nervosa 5.0 years

Binge eating disorder 4.0 years

Subthreshold binge eating disorder 2.0 years

12-month Persistence

Source: Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 200;61:348-358.

Anorexia nervosa 0%

Bulimia nervosa 30.6%

Binge eating disorder 44.2%

Subthreshold binge eating disorder 47.2%

Comorbid Conditions

Source: Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 200;61:348-358.

Individuals with a lifetime diagnosis of anorexia nervosa had a significantly lower BMI than those without any eating disorder

Individuals with a lifetime diagnosis of binge eating disorder had a higher prevalence of BMI ≥40 relative to respondents without any eating disorder

Eating disorders are associated with mood, anxiety, impulse-control, and substance use disorders