A Systematic Review of Personality Disorders and Health Outcomes

By Dixon-Gordon, Katherine L.; Whalen, Diana J. et al. | Canadian Psychology, May 2015 | Go to article overview

A Systematic Review of Personality Disorders and Health Outcomes


Dixon-Gordon, Katherine L., Whalen, Diana J., Layden, Brianne K., Chapman, Alexander L., Canadian Psychology


Nearly 10% of people in the general population suffer from personality disorders (PDs), based on epidemiological studies (Samuels, 2011). PDs are complex mental health problems with high costs to society (Frankenburg & Zanarini, 2004; van Asselt, Dirksen, Arntz, & Severens, 2007), attributable, in part, to the frequent co-occurrence of mental and medical health problems (Samuels, 2011). Although literature suggests that the cooccurrence of mental health problems among those with PDs is the rule rather than the exception (Zanarini et al., 1998; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2004), PDs are also associated with medical health problems such as cardiovascular disease (Moran et al., 2007; Powers & Oltmanns, 2013), sleep problems (Asaad, Okasha, & Okasha, 2002; Kamphuis, Karsten, de Weerd, & Lancel, 2013), arthritis, obesity (Powers & Oltmanns, 2013), and chronic pain (Fishbain et al., 2007).

Existing reviews of literature underscore a link between PDs and health conditions. For instance, reviews emphasise the association of borderline personality disorder (BPD) with sleep disturbance (Hafizi, 2013). Furthermore, researchers have identified consistent, robust relations between chronic pain conditions and PDs (Conrad, Wegener, Geiser, & Kleiman, 2013). Researchers have also highlighted the high rates of co-occurrence between PDs and other disorders, such as depression, eating disorders, anxiety, and substance use behaviours (Samuels, 2011; Zimmerman, Rothschild, & Chelminski, 2005). As such, it is likely that there is an interplay of medical and mental health problems among those with PDs.

Although there has been a recent surge in literature examining the association between health-related outcomes and PDs, to date, there is no comprehensive review and synthesis of this literature. Despite a large literature base on the adverse health problems associated with other mental health disorders, such as depression (Mavrides & Nemeroff, 2013), bipolar (Krishnan, 2005), and panic disorder (Smitherman, Kolivas, & Bailey, 2013), research on PDs and health-related issues lags behind these other areas. Further research in this area is particularly important because of the high societal cost and health care utilization associated with PDs (Frankenburg & Zanarini, 2004) and chronic conditions. The combination of PD traits or diagnoses, in addition to chronic health conditions, poses a particularly heavy burden on social health care systems (Frankenburg & Zanarini, 2004). PD features may present unique challenges for standard medical treatment, which is generally not designed to address complex combinations of mental and medical health problems. A systematic review of the link between PDs and health conditions would help to (a) highlight current gaps and future directions for research, (b) identify important areas for clinicians to assess and attend to (suggesting the importance of coordination of care across both psychosocial and medical health), and (c) suggest important targets for medical intervention among those with PDs.

The purpose of the current work is to provide a systematic review of recent empirical studies examining the association between PDs and health conditions. Specifically, this review focuses on sleep, obesity, chronic pain, and other chronic health conditions. The biopsychosocial (BPS) model (Engel, 1977) theorizes that adverse health problems result from a transactional relationship between psychological, biological, and social factors, rather than emerging from genetic or physiological factors alone. Thus, we also aimed to identify potential mechanisms (biological, behavioural, and environmental) underlying these associations. The objectives of the present review are to (1) provide a summary of the extant literature examining relations between PDs and health conditions, (2) examine the scientific rigor of the reviewed studies, and (3) provide recommendations for future research and clinical practice. …

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