Study: One in five young adults has a personality disorder. What does that really mean?

by  James Hubbard, M.D., M.P.H.

I need psychiatric help.  Not the usual kind (well, maybe), but someone in the psychiatric field to help me understand what this new report in the Archives of General Psychiatry is really telling us.  I know the headlines, that almost half of adults 18 to 24 have a psychiatric disorder.  Alcohol was higher in college students.  Nicotine and drug addiction was higher in non-college students, along with bipolar disorder.

How were these disorders diagnosed?  What was the criteria for diagnosis?  What are we to do about it?
Is this just another “scare of the day”?  Are smoking and drinking now “psychiatric disorders”?

Last question first.

According to the Diagnostic and Statistical Manual for Mental Disorders (or DSM, which is psychiatry’s bible for diagnosis), yes, nicotine and excessive alcohol use are disorders.  I know these are serious problems with dangerous consequences, but I’m just letting you know the study includes them.

The headlines I’m seeing emphasize that one in five young adults has a personality disorder.

How were these diagnosed?

As far as I can tell, the data came from a 2004 interview-type survey that found that 14.79 percent of U.S. adults had at least one personality disorder. Higher rates were found in Native Americans, blacks, young adults, low socioeconomic status, divorced, separated, widowed, never-married.

The top 3 were:

  • obsessive-compulsive: 7.88 percent
  • paranoid: 4.41 percent
  • antisocial: 3.63 percent

The diagnosis criteria was based on DSM criteria.  I don’t know the details, but I don’t think psychiatrists/psychologists make a confident diagnosis with one short interview.

What are we to do?

If you or your peers think your personality is causing problems for you, get help.  Even if you’re just a little concerned there’s no harm to be evaluated.  But a lot of us seem to manage fine.  One of my medical school professors thought many good doctors are borderline obsessive-compulsive. Dr. Rob at “Musings of a Distractible Mind” embraces his ADHD.

Check out criteria for personality disorders at the Mayo online. I bet you find yourself in a couple.

Is this another “scare of the day”?

Yes and No (I hedge a lot).  The headline needs context.  Some people look for a label as an excuse for their, or their children’s, behavior instead of trying to change bad habits and embrace the positives.  On the other hand, some have a true disorder that leads to harmful tendencies.  Treatment could avert serious consequences  So it is important to raise awareness.

What to you think? Is this over-hyped news or not?  Do you think awareness can lead to effective treatment, or are we all victims of our personality?  (Many criminals have antisocial personalities.)  Have you found ways to embrace you “abnormal” personality traits for the positive?

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14 Responses to “Study: One in five young adults has a personality disorder. What does that really mean?”

  1. Dr. J Says:

    Another thought provoking topic. Medicalizing variations of normal or real dysfunction? Ego syntonic or dystonic? Hopefully those of us with questions as to our behaviors can find knowledgeable providers to help guide us in managing these challenges.

    Dr. Js last blog post..Looking for an independent woman? Check out her waist

  2. James Hubbard, M.D., M.P.H. Says:

    I agree Dr. J, and embrace our differences.

  3. Judy Rodman Says:

    Normal can be boring, and hard for me to relate to:)

    I think it’s important to know that what some may call a personality disorder, others may call brilliant job requirement! Personally, I want my doctor, accountant and recording engineer to have a bit of good ole obsessive-compulsive syndrome! And to be a great creative artist, one almost always has bigger mood swings.

    Imho, it all comes down to maturing enough to deal with the dark side of the disorder in a positive way, either discovering the coping mechanisms on one’s own or getting professional help.

    Judy Rodmans last blog post..Singing with your eyes closed

  4. James Hubbard, M.D., M.P.H. Says:

    Thanks Judy. You are right on.

  5. Mark Says:

    This does get the wheels turning indeed. I have a teenage daughter…I am printing this one out. Thank you!

  6. cathy Says:

    Really, with some exceptions (bipolar comes to mind), it seems that most personality disorders have a spectrum. People can have life disturbing OCD or mild OCD that doesn’t significantly impact day-to-day life (for example) – where do you draw the line as to what is “normal” and what needs to be treated with medication? And where do the researchers draw that line? I think that the researchers are probably right that a high percentage of us has some sort of personality disorder. I think that the better study might have looked at how many of us have a personality disorder that is damaging enough to require medication or some sort of intervention.

    cathys last blog post..Friday Link Love

  7. Sagan Says:

    Everyone has some kind of problem or issue- for some people it’s more extreme than others. And for those of us who only have mild issues (because an extreme/serious one would be one that requires real help), we need to figure out how to deal with them or at least NOT hide behind them.

  8. James Hubbard, M.D., M.P.H. Says:

    Good idea Mark. Help her use her strongest personality to her advantage.

  9. James Hubbard, M.D., M.P.H. Says:

    Cathy,
    Sometimes it is difficult to know where to draw the line. One red flag is if the personality trait seems to be affecting your work, school, social life, etc. evaluation can’t hurt. Treatment can be medication, psychotherapy or both.

    There are different psych diseases with similiar names. For instance, obessesive-compulsive personality disorder(need for perfection) is different than obessesive-compulsive disease (rituals of doing same thing over and over), schizoid personality is different than schizophrenia. Causes and treatments can be different also.

  10. James Hubbard, M.D., M.P.H. Says:

    Agreed Sagan. It may be you can figure out how to deal with them yourself or you may need help. Some people are truly disabled, but many others can embrace the positives if they find out how to cope.

  11. lhubbard Says:

    The New York Times just posted a story on “Art and Mental Illness.” I’ve thought of us doing an article on this, too. I think the topic is fascinating.

    http://well.blogs.nytimes.com/2008/12/11/art-and-mental-illness/?partner=rss

    Leigh Ann Hubbard
    Managing Editor
    James Hubbard’s My Family Doctor

  12. Dan Says:

    Bipolar Disability
    Bipolar (manic-depressive illness) has been defined as a major affective mood disorder in which one alternates between the mental states of deep and brutal depression and embellished elation- with the depressive episodes occurring more frequently in one who is said to be Bipolar.
    Bipolar is believed to affect one’s cognition, emotions, perceptions, and behavior- along with psychosomatic presentations (such as pain with depressive episodes, for example). It is thought to be due to a physiological dysfunctional brain in one affected with bipolar by many. Yet Bipolar allows for exceptional abilities when a bipolar person is in their manic phase at times. So perhaps a brain alteration should be what has happened, or what is happening, instead of a dysfunction
    The etiology for bipolar is unknown. As many as half of those suspected as having a bipolar are thought to have at least one parent with some sort of mood disorder similar to bipolar disorder, which suggests a genetic predisposition may be present.
    It is also believed that bipolar presents itself with symptoms associated with the definition of bipolar when one is between the ages of 15 and 25 years old. The disorder was entered in the psychiatrists’ bible, the DSM, in 1980, although bipolar disorder is thought to have existed for quite some time.
    Also, those with bipolar are thought to be in possession of heightened creativity during their manic phases, as well as they have accelerated growth of their neurons. This is not necessarily a bad thing, it seems.
    Research has determined that as many as 15 to over 30 percent of bipolar patients commit suicide if they are left untreated, or undertreated. Also, as many as half of those affected with bipolar also have at times severe substance abuse issues along with their bipolar as well.
    Bipolar patients are also often experiencing anxiety issues that vary, and are treated often as a result of these medical issues. The disorder varies as far as severity goes- with some bipolar patients being more severely affected than others. In fact, there are at least 6 classifications of bipolar, according to the DSM.
    Bipolar patients are thought to be symptomatic half of their lives. As stated previously, the depressive episodes occur more frequently than manic ones. When symptomatic, bipolar patients are thought to be rather disabled, according to some, when in their depressive state in particular. The diagnosis has become more frequent recently. In one decade, the assigned diagnosis of bipolar rose from being about 25 per 100 thousand people to being 1000 per 100,000 people.
    Most diagnosed with bipolar are not diagnosed based on solid, comprehensive, or psychiatric review that is often absent of valid or standard diagnostic methods. Some believe as many as 5 percent of the human population may be affected by bipolar disorder- which may include as many as 12 million people in the United States. This is if the diagnostic criteria developed by others were to be fully utilized.
    A subjective questionnaire called the Mental Status Examination is often utilized when diagnosing one suspected has having bipolar disorder. Many believe the diagnosis has increased recently due to the progressive treatment options now available. It is an argument of increased awareness versus over-diagnosis.
    Yet the diagnosis is vague, as children and adolescents are often absent in research with bipolar. Also, there is not any objective diagnostic testing to rely upon for bipolar.
    Many younger than 18 years of age are prescribed atypical anti-psychotics as first line treatment, which is largely not recommended as treatment options. In fact, close to half a million of those younger than 18 years of age are prescribed the atypical anti-psychotic Risperdal alone, it has been determined. The class of medications overall is thought to be prescribed to about 10 percent of those non-adults thought to have bipolar.
    While not recommended, about a half of all those assessed as being bipolar are prescribed antidepressants, such as SSRIs, as first line treatment. It has been suggested that this class of drugs has decreased the risk of suicide attempts compared with other classes of antidepressants for close to 20 years. Yet tricyclic antidepressants have been determined to be efficacious in over half of those diagnosed with bipolar – with a greater amount of research behind this class of drugs.
    The most recognized treatments for bipolar long term are lithium (Ekalith or Lamictal- along with an anti-convulsant. Sugar intake is thought to vex the symptoms of one with a bipolar disorder as well.
    Atypical anti-psychotics have been prescribed for bipolar, which change some aspects of the brain, physiologically, as does the disease itself. In fact, one may argue the brain becomes more efficient due to both the disorder and the treatment with the atypical anti-psychotics. Yet many recommend the utilization of this class of drugs with bipolar disorder only if psychosis is present as well.
    As many as 15 percent of bipolar disorder patients diagnosed as such are prescribed an atypical presently. This class of medications may be particularly beneficial for those women who are diagnosed with bipolar who are pregnant, however.
    Lithium, which is essentially a very light metal with low density in which the salts are obtained for medicinal treatment, and an anti-convulsant are believed to be standard bipolar treatment, pharmacologically, studies have shown. This is due to Dr. John Cade and his examination with lithium and its benefits with those who have psychotic excitement close to 60 years ago.
    Ekalith is believed to be both neuro-protective as well as having an anti-suicidal affect in those believed to be bipolar- and is viewed as a mainstay as far as treatment for bipolar goes with many who treat the disorder. Lithium is thought to regulate the calcium molecule in the brain, so this and valporate are historically the medicinal treatment options preferred for those with bipolar disorder.
    Bipolar is difficult to detect, and is often diagnosed as major depression with many affected by this disorder. There is no objective criteria protocol available to utilize when assessing any patient believed to be suffering from any mental disorder. So such mental disorders that are diagnosed are ambiguous, yet that does not conclude that such disorders do not exist, such as the case with bipolar disorder.
    Yet perhaps a health care provider should be very thorough and knowledgeable when assessing a patient believed to have a mental condition such as bipolar. And those who study bipolar should consider calling it Bipolar Ability instead of Bipolar Disorder. A disorder is something considered outside the realms of within normal limits, thus no order exists. An ability is when one has the power to do something utilizing their skills, talent, and expertise.
    Both words may or not apply to Bipolar. I’m going with bipolar having atypical abilities.
    http://www.dbsalliance.org, http://www.nmha.org
    Dan Abshear
    Author’s note: What has been annotated is based upon information and belief.

  13. James Hubbard’s My Family Doctor Blog » Blog Archive » Thank you, bloggers! (Plus: New health, mom and Boomer sites to discover.) Says:

    [...] Living Healthy in the Real World, “Life Lessons: Food Photo Diary” (linked to personality disorders post) [...]

  14. Thank you! (Plus, find new health, mom and baby-boomer blogs) Says:

    [...] Living Healthy in the Real World: “Life Lessons: Photo Food Diary” (linked to post on young adults and personality disorders) [...]

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