Oldham J M, Skodol A E, Kellman H D, Hyler S E, Doidge N, Rosnick L, Gallaher P E
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York.
Am J Psychiatry. 1995 Apr;152(4):571-8. doi: 10.1176/ajp.152.4.571.
In light of continuing controversies concerning the DSM-III-R system for diagnosing personality disorders, their construct validity, and the assignment of disorders to a particular axis, the authors studied patterns of axis I-axis II comorbidity.
Semistructured interviews were used to assess axis I and axis II disorders in 200 inpatients and outpatients. Odds ratios were calculated to determine significant comorbidity between classes of current axis I disorders and axis II personality disorders diagnosed according to two methods and defined at two diagnostic thresholds. Distributions of personality disorder traits were also compared in patients with and without axis I disorders.
Significantly elevated odds ratios were found for co-occurrence of current mood disorders with avoidant and dependent personality disorders; anxiety disorders with borderline, avoidant, and dependent personality disorders; psychotic disorders with schizotypal, borderline, and dependent personality disorders; psychoactive substance use disorders with borderline and histrionic personality disorders; and eating disorders with schizotypal, borderline, and avoidant personality disorders. These results held when conservative and liberal definitions of personality disorders were used. Non-specific axis I and axis II associations were confirmed for distributions of personality disorder traits.
Significant associations occurred between most axis I classes of disorders and axis II disorders and traits in more than one cluster. All axis I classes of disorders except mood disorders co-occurred with borderline personality disorder; however, patients with mood disorders had elevated levels of borderline traits. When any personality disorder was present, there were significant odds that a mood, anxiety, psychotic, or eating disorder would also be present; psychoactive substance use disorders, in contrast, significantly co-occurred with borderline and histrionic personality disorders.
鉴于关于《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中人格障碍诊断系统、其结构效度以及将障碍归至特定轴的问题仍存在争议，作者研究了轴I与轴II共病模式。
采用半结构化访谈评估200名住院患者和门诊患者的轴I和轴II障碍。计算优势比以确定当前轴I障碍类别与根据两种方法诊断并在两个诊断阈值定义的轴II人格障碍之间的显著共病情况。还比较了有和没有轴I障碍患者的人格障碍特质分布。
发现当前心境障碍与回避型和依赖型人格障碍共病、焦虑障碍与边缘型、回避型和依赖型人格障碍共病、精神病性障碍与分裂型、边缘型和依赖型人格障碍共病、精神活性物质使用障碍与边缘型和表演型人格障碍共病、进食障碍与分裂型、边缘型和回避型人格障碍共病时，优势比显著升高。当使用人格障碍的保守和宽松定义时，这些结果依然成立。对于人格障碍特质分布，证实了非特异性的轴I和轴II关联。
大多数轴I障碍类别与轴II障碍以及多个簇中的特质之间存在显著关联。除心境障碍外，所有轴I障碍类别均与边缘型人格障碍共病；然而，心境障碍患者的边缘型特质水平升高。当存在任何人格障碍时，出现心境、焦虑、精神病性或进食障碍的可能性显著增加；相比之下，精神活性物质使用障碍与边缘型和表演型人格障碍显著共病。
