Comorbid axis I and axis II disorders in early adolescence: outcomes 20 years later
2009
Although Axis II personality disorders in adolescence have been linked to psychopathology
and psychosocial impairment in early adulthood, little is known about their effects over longer
periods.Objectives: To evaluate and compare long-term prognoses of adolescent personality disorders and cooccurring
Axis I disorders. Design: Population-based longitudinal study. Setting: Upstate New York. Participants:
A community sample of 629 adolescents interviewed at a mean age of 13.8 years and again at a mean
age of 33.2 years.Main Outcome Measures: Clinically assessed psychiatric disorders and self-reported attainment
and function. Results: Axis I (mood, anxiety, disruptive behavior, and substance use disorders) and Axis
II disorders in adolescence showed risks for negative prognoses lasting 20 years. Co-occurring Axis I and Axis
II disorders consistently presented the highest risk, often approximating the sum of the axis-associated risk
or even several times the risk of disorders in either axis alone. Conclusions: Long-term prognoses of Axis I
and Axis II disorders are of comparable magnitude and often additive when comorbid. These findings are highly
relevant to the current debate over how personality disorders should be handled in DSM-V.
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