Personality Disorder in Panic Disorder Patients Rosenberg, N.K, Bech, P., Lorenzen, K . , Mellergird, M., Rasmussen, S . , Rafaelsen, OJ., Rosenberg, R.

Rosenberg NK, Bech P, Lorenzen K, Mellerghrd M, Rasmussen S, Rafaelsen OJ, Rosenberg R. Personality Disorder in Panic Disorder Patients. Nord Psykiatr Tidsskr 1986;

Cand. Psych Nicole Rosenberg, Cenrralsygehuset H i i l e r ~ d , psykiurrisk afd. S, DK-3400 Hille- r@d.

40: 437-439. Oslo. ISSN 002%1455.

In the third edition of the American Psychi- atric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-111) ( 1 ) a multiaxial system for clinical evaluation is recommended. Axis I and I1 include all of the mental disorders. Personality Disorders are assigned to axis I, whereas all the other mental disorders are assigned to axis 11. The purpose of the present study was to eluci- date the relationship between the axis 1 diagnosis Panic Disorder and the Persona- lity Disorder diagnoses on axis 11.

Material and Method The probands were 45 patients, 29 females and 16 males, participating in a multicenter study, the Cross-national Collaborative Pa- nic Disorder Study (Phase 11), intending to evaluate the efficacy of alprazolam, imipra- mine and placebo in Panic Disorder pati- ents.

DSM-I11 axis I diagnoses were obtained from an interview constructed for the cross- national study: Structured Clinical Interview for DSM-111, Upjohn version. All patients included fulfilled the DSM-I11 criteria for Panic Disorder. Patients with concomitant Major Depression were included only if the depression was considered to be secondary to the anxiety disorder. Patients with orga- nic diseases, psychotic symptoms, obsessive- compulsive disorder, or addiction were ex- cluded.

The patient-rated scale Symptom Check- list - 90 Items (SCL-90) was given to pati- ents after the axis I diagnosis had been sta- ted and before they entered the study. The SCL-90 in the present study was employed to obtain a profile of the psychopathological symptoms as an indicator of the axis I symp- tomatology .

DSM-I11 diagnoses on axis 11, Personality Disorders, were stated by two clinicians independently, based on information from clinical interviews done during the cross- national trial, and consensus diagnoses for all patients were obtained. Participation in the trial was from 4 weeks to 9 months.

Statistical analysis: t-test was applied.

Results A high agreement in Personality Disorder diagnoses (mean: 73%) between the raters was found. Consensus diagnoses for the 45 Panic Disorder patients were: 10 patients had No Personality Disorder, 16 had Dependent Personality Disorder, 9 had Mixed Personality Disorder, 5 Histrionic, 2 Avoidant, 2 Obsessive Compulsive, and 1 Paranoid Personality Disorder.

No differences were found in the distribu- tion of Personality Disorders in the Panic Disorder patients, neither when sex was considered nor when presence or absence of Major Depression was considered.

The SCL-90 profile of the patient-group

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438 N . Rosenberg et a1

as a whole showed high scores on the soma- tization, the anxiety, and the phobic anxiety dimensions and low scores on the psychoti- cism and anger-hostility dimensions.

Profiles of males and females were identi- cal, but significant differences with respect to depression, anxiety, and phobic anxiety scores were found (Fig. 1).

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Fig. 1. ( 9 & d): SCL-90 profiles for Panic Disorder females and males. Dimensions: somatization. obses- sive-compulsive, interpersonal sensitivity, depression. anxiety, anger-hostility, phobic-anxiety, paranoid idea- tion, and psychoticism. Statistical analyses: t-test.

The profiles of Panic Disorde'r patients with and without Major Depression were similar (Fig. 2).

SCL-90

i i - 1 2. 22

Fig. 2. (Depr. & A depr): SCL-90 profiles for Panic Disorder patients with and without Major Depression.

The SCL-90 profiles of patients with the consensus diagnoses No Personality Disor- der, Dependent or Mixed Personality Disor- der are shown in Fig. 3.

SCL-90

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Fig. 3 . (Dependent, Mixed & No Disorder): SCL-90 profiles for Panic Disorder patients with Dependent, Mixed, or No Personality Disorder. P-values for t-test analysis of scores for Dependent Personality Disorder vs No Personality Disoder are shown.

The profiles were similar, but patients with No Personality Disorder had the lowest scores on most dimensions.

Discussion An important result of the present study was that the DSM-111 axis I diagnosis Panic Dis- order was seen in patients with Personality Disorders as well as in patients without. Furthermore the group of patients with Per- sonality Disorders was heterogenous. So the study suggests some independency between the axis I diagnosis Panic Disorder and the axis I1 diagnoses.

A fairly large number of the Panic Disor- der patients were diagnosed as Mixed Perso- nality Disorder. As this category comprises patients not fulfilling all criteria within any one of the Personality Disorders, but having traits from two or more of them, this points to some limitations of the present classifica- tion of Personality Disorders in DSM-111.

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Personoliry Disorder in Panic DiForder Patients 439 males on several SCL-90 dimensions. This discrepancy, too, is open to several interpre- tations: Panic Disorder might be more severe in females, or the symptoms might be experienced as being more bothersome by females than by males.

Another important finding was the simila- rity of the SCL-90 profiles of patients with and without Major Depression, of patients with the different categories of Personality Disorders, and of the two sexes.

As expected all Panic Disorder patients had high scores on the somatization, anxi- ety, and phobic anxiety dimensions. Surpris- ingly, the SCL-90 profiles of patients with and without Major Depression were identi- cal, including the depression dimension. As in previous studies this indicates difficulties in differentiating between anxiety and dep- ression (2,3).

Interestingly, Panic Disorder patients had the same profiles independent of the pre- sence of Personality Disorders. However, patients with Personality Disorders had hig- her scores on most of the SCL-90 dimensi- ons. This suggests Personality Disorder being correlated to relatively more severe axis I symptomatology than No Personality Disorder in Panic Disorder patients. This finding is open to several interpretations: Patients with Personality Disorders might have more axis I symptoms or they might experience their symptoms as more bother- some than do patients with No Personality Disorder.

In accordance with previous studies on sex differences in patients with emotional complaints, females had higher scores than

Conclusion In the present study Panic Disorder was seen in patients with and without Persona- lity Disorders. The symptom profiles on the SCL-90 were similar in males and females, the patients with and without Major Depres- sion, and in patients with and without Perso- nality Disorders. Differences were seen, however, in SCL-90 scores between the sexes and between patients with and without Personality Disorders, indicating that Panic Disorder exists in different degrees of seve- rity.

References 1. American Psychiatric Association; Diagnostic and

Statistical Manual of Mental Disorders (third edi- tion). Washington DC: APA, 1980.

2. Breier A, Charney DS, Heninger GR 1985. The Diagnostic Validity of Anxiety Disorders and Their Relationship to Depressive Illness. Am J Psychiat.

3. Reich J. The Epidemiology of Anxiety. J Nerv Ment 142: 7; 787-97.

Dis 174: 3; 129-36.

The study was sponsored by the Upjohn Company.

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