Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions.

Borderline personality disorder (BPD) is a complex, serious psychiatric disorder characterized by pervasive instability in regulation of emotion, self-image, interpersonal relationships, and impulse control.1 BPD is the most prevalent personality disorder in clinical settings and is associated with severe functional impairment, substantial treatment utilization, and high rates of mortality by suicide.2–5 Clinical studies have also shown BPD to be highly comorbid with most substance use, mood, anxiety, and other personality disorders (PDs).6–12 Although BPD is among the most frequently studied PDs in clinical settings, little is known about its prevalence, correlates, disability, and comorbidity in general population samples. Several earlier community studies13–27 of BPD were limited by selection of small samples (n=133–799) not entirely representative of the general population. Others preselected individuals from larger general population samples based on responses to PD screening instruments or psychopathology,15,19,20,24 further limiting the size of the survey samples on which to base prevalence estimates. Of the 2 larger-scale epidemiologic surveys, the one conducted in Norway28 (n = 2,053) was compromised by a low response rate (57%), and the Australian survey29 (n=10,641) used a PD screening measure rather than a diagnostic assessment instrument to assess PDs. Because of these limitations, very little is known about the sociodemographic characteristics, disability, and comorbidity of BPD with other psychiatric disorders. The 1 study that presented data on disorder-specific comorbidity19 did not control for other comorbid disorders, thereby precluding analysis of common and unique factors underlying disorder-specific associations with BPD. The lack of comprehensive and detailed information on DSM-IV BPD in the United States represents a gap in our knowledge relevant to prevention, treatment, and economic costs. The present study was designed to address this gap using data from the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).30 The Wave 2 NESARC covered DSM-IV alcohol and specific drug use disorders, and mood and anxiety disorders assessed in the 2001–2002 Wave 1 NESARC,31, 32 in addition to BPD, schizotypal and narcissistic PDs, and posttraumatic stress disorder (PTSD). The remaining DSM-IV PDs (avoidant, dependent, obsessive-compulsive, paranoid, schizoid, histrionic, and antisocial), were assessed in the Wave 1 NESARC. The sample size and high response rate of the Wave 2 NESARC allow for reliable and precise estimation of lifetime prevalence of BPD, especially among important sociodemographic subgroups of the population. Furthermore, comorbidity of BPD with each Axis I and II disorder was examined while controlling for both sociodemographic characteristics and additional psychiatric disorders to determine the unique relationship of each specific disorder to BPD. The importance of controlling for other disorders that are highly comorbid with one another represents an advance in our understanding of comorbidity recently highlighted in the epidemiologic literature.33, 34 This study also provides information on mental and physical disability associated with BPD. Because so little is known about sex differences in BPD, information on correlates, disability and comorbidity of BPD is presented for the total sample and by sex.