Comorbidity of personality disorder (PD) and attention-deficit/hyperactivity disorder (ADHD) has been suggested in several reports. However, assessment of PD is problematic, and studies have overrelied on baseline evaluations.
Methods
Forty-seven patients entered a double-blind trial of osmotic release oral system (OROS) methylphenidate (MPH). Patients were assessed at baseline with the Wisconsin Personality Inventory IV (WISPI-IV) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Following the study, all information—including tests, family reports, and extended clinical observations—produced a final PD diagnosis. Three post hoc categories were created: PD-negative (no PD), PD-positive (1 PD), and PD-plus (2 or more PDs).
Results
Twenty-one (45%) patients had a PD on the final assessment vs 62% using SCID-II and 33% using WISPI-IV; final PD diagnosis revealed 9% cluster A, 17% cluster B, and 28% cluster C. Twenty-one percent of patients experienced multiple disorders. Using a weighted kappa, the number of PDs on the final assessment correlated with the WISPI-IV (κ =.53; P > .001) and the SCID-II (κ =.70; P < .001). However the SCID-II overidentified and the WISPI-IV underidentified PD.
Conclusion
Almost all PDs were represented in this sample, and past emphasis on cluster B appears unwarranted. Although the SCID-II and WISPI-IV had limited success in identifying specific PDs, they were more successful in identifying the number of PDs present in each patient. The small sample makes these findings preliminary.
MilbergerSBiedermanJFaraoneSV. Associations between ADHD and psychoactive substance use disorders: Findings from a longitudinal study of high-risk siblings of ADHD children. Am J Addict. 1997;6:318–329.
2.
BiedermanJMickEFaraoneSV. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry. 2002;159:36–42.
3.
BiedermanJFaraoneSVMonuteauxMC. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004;55:692–700.
4.
MyersWCBurketRCOttoTA. Conduct disorder and personality disorders in hospitalized adolescents. J Clin Psychiatry. 1993;54:21–26.
5.
BurketRCMyersWC. AxisI and personality comorbidity in adolescents with conduct disorder. Bull Am Acad Psychiatry Law. 1995;23:73–82.
6.
JohanssonPKerrMAndershedH.Linking adult psychopathy with childhood hyperactivity-impulsivity-attention problems and conduct problems through retrospective self-reports. J Pers Disord. 2005;19:94–101.
7.
SecnikKSwensenALageMJ. Comorbidities and costs of adult patients diagnosed with attentiondeficit hyperactivity disorder. Pharmacoeconomics. 2005;23:93–102.
8.
WilensTEKwonATanguayS. Characteristics of adults with attention deficit hyperactivity disorder plus substance use disorder: the role of psychiatric comorbidity. Am J Addict. 2005;14:319–327.
9.
CukrowiczKCTaylorJSchatschneiderC. Personality differences in children and adolescents with attention-deficit/hyperactivity disorder, conduct disorder, and controls. J Child Psychol Psychiatry. 2006;47:151–159.
10.
AnckarsaterHStahlbergOLarsonT. The impact of ADHD and autism spectrum disorders on temperament, character, and personality development. Am J Psychiatry. 2006;163:1239–1244.
11.
FossatiANovellaLDonatiD. History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study. Compr Psychiatry. 2002;43:369–377.
12.
HelgelandMIKjelsbergETorgersenS.Continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood. Am J Psychiatry. 2005;162:1941–1947.
13.
MillerCJMillerSRNewcomJH. Personality characteristics associated with persistent ADHD in late adolescence. J Abnorm Child Psychol. 2008;36:165–173.
14.
MayBBosJ.Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes. J Pers Assess. 2000;75:237–248.
15.
BurketRCSajidMWWasiakM. Personality comorbidity in adolescent females with ADHD. J Psychiatr Pract. 2005;11:131–136.
16.
ModestinJMatutatBWurmleO.Antecedents of opioid dependence and personality disorder: attention-deficit/hyperactivity disorder and conduct disorder. Eur Arch Psychiatry Clin Neurosci. 2001;251:42–47.
17.
GüçlüO, ErkiranM.Personality disorders in parents of children with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi.2005;8:18–23.
18.
MillerTWNiggJTFaraoneSV. Axis I and II comorbidity in adults with ADHD. J Abnorm Psychol. 2007; 116:519–528.
19.
MoranPRenduAJenkinsR. The impact of personality disorder in UK primary care: a 1-year followup of attenders. Psychol Med. 2001;31:1447–1454.
20.
WilbergTDammenTFriisS.Comparing Personality Diagnostic questionnaire-4+ with Longitudinal, Expert, All Data (LEAD) standard diagnoses in a sample with a high prevalence of axis I and axis II disorders. Compr Psychiatry. 2000;41:295–302.
21.
HylerSERiederROWilliamsJB. A comparison of clinical and self-report diagnoses of DSM-III personality disorders in 552 patients. Compr Psychiatry. 1989;30:170–178.
22.
BronischTMombourW.Comparison of a diagnostic checklist with a structured interview for the assessment of DSM-III-R and ICD-10 personality disorders. Psychopathology. 1994;27:312–320.
23.
MarloweDBHusbandSDBonieskieLM. Structured interview versus self-report test vantages for the assessment of personality pathology in cocaine dependence. J Pers Disord. 1997;11:177–190.
24.
TenneyNHSchotteCKDenysDA. Assessment of DSM-IV personality disorders in obsessivecompulsive disorder: comparison of clinical diagnosis, self-report questionnaire, and semi-structured interview. J Pers Disord. 2003;17:550–561.
25.
LenzenwegerMFLorangerAWKorfineL. Detecting personality disorders in a nonclinical population. Application of a 2-stage procedure for case identification. Arch Gen Psychiatry. 1997;54:345–351.
26.
ZimmermanMPfohlBStanglD. Assessment of DSM-III personality disorders: the importance of interviewing an informant. J Clin Psychiatry. 1986;47:261–263.
27.
ZimmermanMPfohlBCoryellW. Diagnosing personality disorder in depressed patients. A comparison of patient and informant interviews. Arch Gen Psychiatry. 1988;45:733–737.
28.
BernsteinDPKasapisCBergmanA. Assessing axis II disorders by informant interview. J Pers Disord. 1997;11:158–167.
29.
PerryJC. Problems and considerations in the valid assessment of personality disorders. Am J Psychiatry. 1992;149:1645–1653.
30.
WilliamsEMarchantBKReimherrFW. The challenges in diagnosing ADHD in adults. CME LLC/ Psychiatric Times; 2007:(suppl 3);15–18.
31.
DavisonSLeeseMTaylorPJ. Examination of the screening properties of the personality diagnostic questionnaire 4+ (PDQ-4+) in a prison population. J Pers Disord. 2001;15:180–194.
32.
GuthriePCMobleyBD. A comparison of the differential diagnostic efficiency of three personality disorder inventories. J Clin Psychol. 1994;50:656–665.
33.
HuprichSK. Evaluating NEO Personality Inventory-Revised profiles in veterans with personality disorders. J Pers Disord. 2003;17:33–44.
34.
BlackDWBlumNLetuchyE. Borderline personality disorder and traits in veterans: psychiatric comorbidity, healthcare utilization, and quality of life along a continuum of severity. CNS Spectr. 2006;11:680–689.
35.
ReimherrFWWilliamsEDStrongRE. A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007;68:93–101.
36.
LangbehnDRPfohlBMReynoldsS. The Iowa Personality Disorder Screen: Development and preliminary validation of a brief screening interview. J Pers Disord. 1999;13:75–89.
37.
EkseliusLLindströmEvon KnorringL, . SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R. Acta Psychiatr Scand. 1994;90:120–123.
38.
JacobsbergLPerrySFrancesA.Diagnostic agreement between the SCID-II screening questionnaire and the Personality Disorder Examination. J Pers Assess. 1995;65:428–433.
39.
KleinMHBenjaminLSRosenfeldR. The Wisconsin Personality Disorders Inventory: I: Development, reliability, and validity. J Pers Disord. 1993;7:285–303.
40.
BenjaminLS. Interpersonal diagnosis and treatment of personality disorders, 2nd ed. New York, NY: The Guilford Press; 2002.
41.
SmithTLKleinMHBenjaminLS. Validation of the Wisconsin Personality Disorders Inventory-IV with the SCID-II. J Pers Disord. 2003;17:173–187.
42.
RobisonRJReimherrFWGalePD. Personality disorders in ADHD part 2: the effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD. Ann Clin Psychiatry. 2010;22:94–102.
