Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T11:20:22.764Z Has data issue: false hasContentIssue false

Major depression and dimensional representations of DSM-IV personality disorders: a population-based twin study

Published online by Cambridge University Press:  17 November 2009

T. Reichborn-Kjennerud*
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway Institute of Psychiatry, University of Oslo, Norway Department of Epidemiology, Columbia University, New York, NY, USA
N. Czajkowski
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
E. Røysamb
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway Department of Psychology, University of Oslo, Norway
R. E. Ørstavik
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
M. C. Neale
Affiliation:
The Virginia Institute for Psychiatric and Behavioral Genetics and Departments of Psychiatry and Human Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
S. Torgersen
Affiliation:
Department of Psychology, University of Oslo, Norway
K. S. Kendler
Affiliation:
The Virginia Institute for Psychiatric and Behavioral Genetics and Departments of Psychiatry and Human Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
*
*Address for correspondence: T. Reichborn-Kjennerud, M.D., Division of Mental Health, Norwegian Institute of Public Health, Box 4404Nydalen, N-0403Oslo, Norway. (Email: ted.reichborn-kjennerud@fhi.no)

Abstract

Background

Major depressive disorder (MDD) co-occurs frequently with personality disorders (PDs). The extent to which this results from shared genetic or environmental risk factors remains uncertain.

Method

Young adult twins (n=2801) from the population-based Norwegian Institute of Public Health Twin Panel were assessed at personal interview for DSM-IV lifetime MDD and the 10 Axis II PDs. The relationship between MDD and dimensional representations of all PDs was explored by stepwise logistic regression. Multivariate Cholesky twin models were fitted using the Mx program, and genetic and environmental correlations were estimated.

Results

Dimensional representations of borderline (BPD), avoidant (AVPD) and paranoid personality disorder (PPD) were independently and significantly associated with increased risk for MDD. Multivariate twin modeling indicated that one latent factor accounted for the genetic covariance between MDD and the three PDs. The genetic correlations between MDD and dimensional representations of BPD, AVPD and PPD were +0.56, +0.22 and +0.40 respectively. No sex differences or shared environmental effects were found. The structure of the individual-specific environmental factors influencing MDD and the three PDs were similar to the genetic factors but the environmental correlations were lower: +0.39, +0.23 and +0.27 respectively.

Conclusions

There is substantial overlap between liability factors for MDD and BPD from cluster B, PPD from cluster A and AVPD from cluster C. The vulnerability to general PD pathology and MDD seem to be closely related. The patterns of co-morbidity observed between diverse psychiatric disorders might result from just a few liability factors.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akaike, H (1987). Factor analysis and AIC. Psychometrica 52, 317332.Google Scholar
Akiskal, HS, Yerevanian, BI, Davis, GC, King, D, Lemmi, H (1985). The nosologic status of borderline personality: clinical and polysomnographic study. American Journal of Psychiatry 142, 192198.Google ScholarPubMed
Coid, J, Yang, M, Tyrer, P, Roberts, A, Ullrich, S (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry 188, 423431.CrossRefGoogle ScholarPubMed
Distel, MA, Trull, TJ, Derom, CA, Thiery, EW, Grimmer, MA, Martin, NG, Willemsen, G, Boomsma, DI (2008). Heritability of borderline personality disorder features is similar across three countries. Psychological Medicine 38, 12191229.Google Scholar
Gunderson, JG, Morey, LC, Stout, RL, Skodol, AE, Shea, MT, McGlashan, TH, Zanarini, MC, Grilo, CM, Sanislow, CA, Yen, S, Daversa, MT, Bender, DS (2004). Major depressive disorder and borderline personality disorder revisited: longitudinal interactions. Journal of Clinical Psychiatry 65, 10491056.Google Scholar
Harris, JR, Magnus, P, Tambs, K (2002). The Norwegian Institute of Public Health Twin Panel: a description of the sample and program of research. Twin Research 5, 415423.Google Scholar
Hasin, DS, Goodwin, RD, Stinson, FS, Grant, BF (2005). Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry 62, 10971106.CrossRefGoogle ScholarPubMed
Hettema, JM, Neale, MC, Myers, JM, Prescott, CA, Kendler, KS (2006). A population-based twin study of the relationship between neuroticism and internalizing disorders. American Journal of Psychiatry 163, 857864.CrossRefGoogle ScholarPubMed
Johnson, BA, Brent, DA, Connolly, J, Bridge, J, Matta, J, Constantine, D, Rather, C, White, T (1995). Familial aggregation of adolescent personality disorders. Journal of the American Academy of Child and Adolescent Psychiatry 34, 798804.Google Scholar
Kendler, KS, Aggen, SH, Czajkowski, N, Roysamb, E, Tambs, K, Torgersen, S, Neale, MC, Reichborn-Kjennerud, T (2008). The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study. Archives of General Psychiatry 65, 14381446.CrossRefGoogle ScholarPubMed
Kendler, KS, Bulik, CM, Silberg, J, Hettema, JM, Myers, J, Prescott, CA (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Archives of General Psychiatry 57, 953959.CrossRefGoogle ScholarPubMed
Kendler, KS, Czajkowski, N, Tambs, K, Torgersen, S, Haggen, S, Neale, MC, Reichborn-Kjennerud, T (2006 a). Dimensional representations of DSM-IV Cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study. Psychological Medicine 36, 15831591.Google Scholar
Kendler, KS, Gatz, M, Gardner, CO, Pedersen, NL (2006 b). Personality and major depression: a Swedish longitudinal, population-based twin study. Archives of General Psychiatry 63, 11131120.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929937.CrossRefGoogle ScholarPubMed
Kessler, RC, Davis, CG, Kendler, KS (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine 27, 11011119.CrossRefGoogle ScholarPubMed
Klein, MH, Wonderlich, S, Shea, MT (1993). Models of relationships between personality and depression: toward a framework for theory and research. In Personality and Depression (ed. Klein, M. H., Kupfer, D. J. and Shea, M. T.), pp. 154. Guilford Press: New York.Google Scholar
Koenigsberg, HW, Anwunah, I, Mitropoulou, V, Schopick, F, Siever, LJ (1999). Relationship between depression and borderline personality disorder. Depression and Anxiety 10, 158167.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Krueger, RF (2005). Continuity of axes I and II: toward a unified model of personality, personality disorders, and clinical disorders. Journal of Personality Disorders 19, 233261.Google Scholar
Krueger, RF, Markon, KE (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111133.CrossRefGoogle ScholarPubMed
Krueger, RF, Skodol, AE, Livesley, WJ, Shrout, PE, Huang, YQ (2007). Synthesizing dimensional and categorical approaches to personality disorders: refining the research agenda for DSM-V Axis II. International Journal of Methods in Psychiatric Research 16, S65S73.Google Scholar
Lenzenweger, MF, Lane, MC, Loranger, AW, Kessler, RC (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry 62, 553564.CrossRefGoogle ScholarPubMed
Livesley, WJ, Jang, KL, Vernon, PA (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry 55, 941948.Google Scholar
Melartin, TK, Rytsala, HJ, Leskela, US, Lestela-Mielonen, PS, Sokero, TP, Isometsa, ET (2002). Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study. Journal of Clinical Psychiatry 63, 126134.CrossRefGoogle ScholarPubMed
Morey, LC, Hopwood, CJ, Gunderson, JG, Skodol, AE, Shea, MT, Yen, S, Stout, RL, Zanarini, MC, Grilo, CM, Sanislow, CA, McGlashan, TH (2007). Comparison of alternative models for personality disorders. Psychological Medicine 37, 983994.CrossRefGoogle ScholarPubMed
Neale, MC (2003). A finite mixture distribution model for data collected from twins. Twin Research 6, 235239.Google Scholar
Neale, MC, Boker, SM, Xie, G, Maes, HH (1999). Mx: Statistical Modeling, 5th edn.Department of Psychiatry, Box 126 MCV: Richmond, VA 23298.Google Scholar
Neale, MC, Cardon, LR (1992). Methodology for Genetic Studies of Twins and Families. Kluwer Academic Publishers: Dordrecht.Google Scholar
Neale, MC, Eaves, LJ, Kendler, KS (1994). The power of the classical twin study to resolve variation in threshold traits. Behavior Genetics 24, 239258.Google Scholar
Ørstavik, RE, Kendler, KS, Czajkowski, N, Tambs, K, Reichborn-Kjennerud, T (2007). The relationship between depressive personality disorder and major depressive disorder: a population-based twin study. American Journal of Psychiatry 164, 18661872.CrossRefGoogle ScholarPubMed
Pfohl, B, Blum, N, Zimmerman, M (1995). Structured Interview for DSM-IV Personality (SIDP-IV). University of Iowa, Department of Psychiatry: Iowa City.Google Scholar
Reichborn-Kjennerud, T, Czajkowski, N, Neale, MC, Orstavik, RE, Torgersen, S, Tambs, K, Roysamb, E, Harris, JR, Kendler, KS (2007). Genetic and environmental influences on dimensional representations of DSM-IV cluster C personality disorders: a population-based multivariate twin study. Psychological Medicine 37, 645653.CrossRefGoogle ScholarPubMed
Riso, LP, Klein, DN, Anderson, RL, Ouimette, PC (2000). A family study of outpatients with borderline personality disorder and no history of mood disorder. Journal of Personality Disorders 14, 208217.CrossRefGoogle ScholarPubMed
SAS Institute (2005). SAS OnlineDoc version 9.1.3. SAS Institute Inc.: Cary, NC.Google Scholar
Saulsman, LM, Page, AC (2004). The five-factor model and personality disorder empirical literature: a meta-analytic review. Clinical Psychology Review 23, 10551085.CrossRefGoogle ScholarPubMed
Shea, MT, Stout, RL, Yen, S, Pagano, ME, Skodol, AE, Morey, LC, Gunderson, JG, McGlashan, TH, Grilo, CM, Sanislow, CA, Bender, DS, Zanarini, MC (2004). Associations in the course of personality disorders and Axis I disorders over time. Journal of Abnormal Psychology 113, 499508.CrossRefGoogle ScholarPubMed
Siever, LJ, Davis, KL (1991). A psychobiological perspective on the personality disorders. American Journal of Psychiatry 148, 16471658.Google ScholarPubMed
Skodol, AE, Stout, RL, McGlashan, TH, Grilo, CM, Gunderson, JG, Shea, MT, Morey, LC, Zanarini, MC, Dyck, IR, Oldham, JM (1999). Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS). Depression and Anxiety 10, 175182.Google Scholar
Sullivan, PF, Eaves, LJ (2002). Evaluation of analyses of univariate discrete twin data. Behavior Genetics 32, 221227.CrossRefGoogle ScholarPubMed
Sullivan, PF, Neale, MC, Kendler, KS (2000). Genetic epidemiology of major depression: review and meta-analysis. American Journal of Psychiatry 157, 15521562.CrossRefGoogle ScholarPubMed
Tambs, K, Rønning, T, Prescott, CA, Kendler, KS, Reichborn-Kjennerud, T, Torgersen, S, Harris, JR (2009). The Norwegian Institute of Public Health twin study of mental health: examining recruitment and attrition bias. Twin Research and Human Genetics 12, 158168.CrossRefGoogle ScholarPubMed
Torgersen, S, Czajkowski, N, Jacobson, K, Reichborn-Kjennerud, T, Roysamb, E, Neale, MC, Kendler, KS (2008). Dimensional representations of DSM-IV cluster B personality disorders in a population-based sample of Norwegian twins: a multivariate study. Psychological Medicine 38, 16171625.Google Scholar
Torgersen, S, Lygren, S, Oien, PA, Skre, I, Onstad, S, Edvardsen, J, Tambs, K, Kringlen, E (2000). A twin study of personality disorders. Comprehensive Psychiatry 41, 416425.Google Scholar
White, CN, Gunderson, JG, Zanarini, MC, Hudson, JI (2003). Family studies of borderline personality disorder: a review. Harvard Review of Psychiatry 11, 8–19.Google Scholar
Wittchen, HU, Lachner, G, Wunderlich, U, Pfister, H (1998). Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568578.Google Scholar
Wittchen, HU, Pfister, H (1997). DIA-X-Interviews (M-CIDI): Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X 12 Monate); Ergänzungsheft (DIA-X 12 Monate); PC-Programm zur durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Swets & Zeitlinger: Frankfurt, Germany.Google Scholar