Skip to main content
Top
Published in: Social Psychiatry and Psychiatric Epidemiology 12/2014

01-12-2014 | Original Paper

Personality disorders are important risk factors for disability pensioning

Authors: Kristian Amundsen Østby, Nikolai Czajkowski, Gun Peggy Knudsen, Eivind Ystrom, Line C. Gjerde, Kenneth S. Kendler, Ragnhild E. Ørstavik, Ted Reichborn-Kjennerud

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 12/2014

Login to get access

Abstract

Purpose

To determine whether personality disorders (PDs) are associated with increased risk of disability pensioning in young adults, independent of other common mental disorders.

Methods

2,770 young adults from the general population were assessed for PDs by the Structured Interview for DSM-IV Personality, and for common mental disorders by the Composite of International Diagnostic Interview. These data were linked to the Norwegian National Insurance Administration’s recordings of disability benefits for a 10-year period. Logistic regression analyses were applied to investigate the association between PDs and disability pensioning. The analyses were conducted for three types of PD measures: categorical diagnoses (any PD), dimensional scores of individual PDs and higher order components retrieved by principal component analyses.

Results

Having any PD was strongly associated with disability pensioning, regardless of disability diagnosis. The estimated odds ratio (OR) was substantially higher for PDs [OR 4.69 (95 % confidence interval (CI) 2.6–8.5)] than for mood disorders [OR 1.3 (CI 0.7–2.3)] and anxiety disorders [OR 2.3 (CI 1.3–4.3)]. Measured dimensionally, all PD traits except antisocial traits were significantly associated with disability pensioning. After adjusting for co-occurring traits of other PDs, only schizoid, dependent and borderline PD traits showed a significant positive association with disability pension, while antisocial traits showed a significant negative association. The principal component analyses showed that negative affectivity, psychoticism, and detachment was associated with an increased risk of disability pensioning, while antagonism/disinhibition and obsessivity were not.

Conclusions

PDs are strongly associated with disability pensioning in young adults, and might be more important predictors of work disability than anxiety and depressive disorders. Certain aspects of pathologic personalities are particularly important predictors of disability.
Literature
1.
go back to reference OECD (2003) Disability programmes in need of reform—a policy brief. OECD Publishing, Paris OECD (2003) Disability programmes in need of reform—a policy brief. OECD Publishing, Paris
2.
go back to reference OECD (2010) Sickness, disability and work: breaking the barriers. OECD Publishing, Paris OECD (2010) Sickness, disability and work: breaking the barriers. OECD Publishing, Paris
3.
go back to reference Gjesdal S, Ringdal PR, Haug K, Maeland JG (2008) Long-term sickness absence and disability pension with psychiatric diagnoses: a population-based cohort study. Nord J Psychiatry 62:294–301PubMedCrossRef Gjesdal S, Ringdal PR, Haug K, Maeland JG (2008) Long-term sickness absence and disability pension with psychiatric diagnoses: a population-based cohort study. Nord J Psychiatry 62:294–301PubMedCrossRef
4.
go back to reference Karpansalo M, Kauhanen J, Lakka TA, Manninen P, Kaplan GA, Salonen JT (2005) Depression and early retirement: prospective population based study in middle aged men. J Epidemiol Community Health 59:70–74PubMedCentralPubMedCrossRef Karpansalo M, Kauhanen J, Lakka TA, Manninen P, Kaplan GA, Salonen JT (2005) Depression and early retirement: prospective population based study in middle aged men. J Epidemiol Community Health 59:70–74PubMedCentralPubMedCrossRef
5.
go back to reference Knudsen AK, Overland S, Aakvaag HF, Harvey SB, Hotopf M, Mykletun A (2010) Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res 69:59–67PubMedCrossRef Knudsen AK, Overland S, Aakvaag HF, Harvey SB, Hotopf M, Mykletun A (2010) Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res 69:59–67PubMedCrossRef
6.
go back to reference Mykletun A, Heradstveit O, Eriksen K, Glozier N, Overland S, Maeland JG, Wilhelmsen I (2009) Health anxiety and disability pension award: the HUSK study. Psychosom Med 71:353–360PubMedCrossRef Mykletun A, Heradstveit O, Eriksen K, Glozier N, Overland S, Maeland JG, Wilhelmsen I (2009) Health anxiety and disability pension award: the HUSK study. Psychosom Med 71:353–360PubMedCrossRef
7.
go back to reference Mykletun A, Knudsen AK (2009) Tapte arbeidsår ved uførepensjonering for psykiske lidelser. Norwegian institute of public health, Norway Mykletun A, Knudsen AK (2009) Tapte arbeidsår ved uførepensjonering for psykiske lidelser. Norwegian institute of public health, Norway
8.
go back to reference Mykletun A, Overland S, Dahl AA, Krokstad S, Bjerkeset O, Glozier N, Aaro LE, Prince M (2006) A population-based cohort study of the effect of common mental disorders on disability pension awards. Am J Psychiatry 163:1412–1418PubMedCrossRef Mykletun A, Overland S, Dahl AA, Krokstad S, Bjerkeset O, Glozier N, Aaro LE, Prince M (2006) A population-based cohort study of the effect of common mental disorders on disability pension awards. Am J Psychiatry 163:1412–1418PubMedCrossRef
9.
go back to reference Huang Y, Kotov R, de GG, Preti A, Angermeyer M, Benjet C, Demyttenaere K, de GR, Gureje O, Karam AN, Lee S, Lepine JP, Matschinger H, Posada-Villa J, Suliman S, Vilagut G, Kessler RC (2009) DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry 195:46–53PubMedCentralPubMedCrossRef Huang Y, Kotov R, de GG, Preti A, Angermeyer M, Benjet C, Demyttenaere K, de GR, Gureje O, Karam AN, Lee S, Lepine JP, Matschinger H, Posada-Villa J, Suliman S, Vilagut G, Kessler RC (2009) DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry 195:46–53PubMedCentralPubMedCrossRef
10.
go back to reference Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJV (2008) The economic burden of personality disorders in mental health care. J Clin Psychiatry 69:259–265PubMedCrossRef Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJV (2008) The economic burden of personality disorders in mental health care. J Clin Psychiatry 69:259–265PubMedCrossRef
11.
go back to reference Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B (2010) Personality disorder: a new global perspective. World Psychiatry 9:56–60PubMedCentralPubMed Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B (2010) Personality disorder: a new global perspective. World Psychiatry 9:56–60PubMedCentralPubMed
12.
go back to reference American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders DSM-IV-TR. American Psychiatric Association, Washington American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders DSM-IV-TR. American Psychiatric Association, Washington
13.
go back to reference Ansell EB, Sanislow CA, McGlashan TH, Grilo CM (2007) Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Compr Psychiatry 48:329–336PubMedCrossRef Ansell EB, Sanislow CA, McGlashan TH, Grilo CM (2007) Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Compr Psychiatry 48:329–336PubMedCrossRef
14.
go back to reference Dimeff LA, McDavid J, Linehan MM (1999) Pharmacotherapy for borderline personality disorder: a review of the literature and recommendations for treatment. J Clin Psychol Med Settings 6:113–138CrossRef Dimeff LA, McDavid J, Linehan MM (1999) Pharmacotherapy for borderline personality disorder: a review of the literature and recommendations for treatment. J Clin Psychol Med Settings 6:113–138CrossRef
15.
go back to reference Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A (2012) The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res 36:427–440CrossRef Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A (2012) The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res 36:427–440CrossRef
16.
go back to reference Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011) Borderline personality disorder. Lancet 377:74–84PubMedCrossRef Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011) Borderline personality disorder. Lancet 377:74–84PubMedCrossRef
17.
go back to reference Coid J, Yang M, Tyrer P, Roberts A, Ullrich S (2006) Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 188:423–431PubMedCrossRef Coid J, Yang M, Tyrer P, Roberts A, Ullrich S (2006) Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 188:423–431PubMedCrossRef
18.
go back to reference Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP (2004) Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 65:948–958PubMedCrossRef Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP (2004) Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 65:948–958PubMedCrossRef
19.
go back to reference Hengartner MP, Muller M, Rodgers S, Rossler W, Ajdacic-Gross V (2014) Occupational functioning and work impairment in association with personality disorder trait-scores. Soc Psychiatry Psychiatr Epidemiol 49:327–335PubMedCrossRef Hengartner MP, Muller M, Rodgers S, Rossler W, Ajdacic-Gross V (2014) Occupational functioning and work impairment in association with personality disorder trait-scores. Soc Psychiatry Psychiatr Epidemiol 49:327–335PubMedCrossRef
20.
go back to reference Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ (2011) Personality disorder types proposed for DSM-5. J Pers Disord 25:136–169PubMedCrossRef Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ (2011) Personality disorder types proposed for DSM-5. J Pers Disord 25:136–169PubMedCrossRef
21.
go back to reference Knudsen AK, Skogen JC, Harvey SB, Stewart R, Hotopf M, Moran P (2012) Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity. Psychol Med 42:1–10CrossRef Knudsen AK, Skogen JC, Harvey SB, Stewart R, Hotopf M, Moran P (2012) Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity. Psychol Med 42:1–10CrossRef
22.
go back to reference Markon KE, Krueger RF, Watson D (2005) Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. J Pers Soc Psychol 88:139–157PubMedCentralPubMedCrossRef Markon KE, Krueger RF, Watson D (2005) Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. J Pers Soc Psychol 88:139–157PubMedCentralPubMedCrossRef
23.
go back to reference Harris JR, Magnus P, Tambs K (2002) The Norwegian Institute of Public Health Twin Panel: a description of the sample and program of research. Twin Res 5:415–423PubMedCrossRef Harris JR, Magnus P, Tambs K (2002) The Norwegian Institute of Public Health Twin Panel: a description of the sample and program of research. Twin Res 5:415–423PubMedCrossRef
24.
go back to reference Akselsen A, Lien S, Sandnes T (2003) FD-trygd dokumentasjonsrapport. Pensjoner. Grunn og hjelpestønader 1992–2001. Rikstrygdeverket, Norway Akselsen A, Lien S, Sandnes T (2003) FD-trygd dokumentasjonsrapport. Pensjoner. Grunn og hjelpestønader 1992–2001. Rikstrygdeverket, Norway
25.
go back to reference Pfohl BB, Zimmerman M (1995) Structured interview for dsm-iv personality (sidp-iv). University of Iowa, Department of Psychiatry, Iowa City Pfohl BB, Zimmerman M (1995) Structured interview for dsm-iv personality (sidp-iv). University of Iowa, Department of Psychiatry, Iowa City
26.
go back to reference World Health Organization (1997) Composite of international diagnostic interview World Health Organization (1997) Composite of international diagnostic interview
27.
go back to reference Dobson AJ (2002) An introduction to generalized linear models. Chapman & Hall/CRC, USA Dobson AJ (2002) An introduction to generalized linear models. Chapman & Hall/CRC, USA
29.
go back to reference Oldham JM, Skodol AE, Kellman HD, Hyler SE, Rosnick L, Davies M (1992) Diagnosis of Dsm-Iii-R personality-disorders by 2 structured interviews—patterns of comorbidity. Am J Psychiatry 149:213–220PubMed Oldham JM, Skodol AE, Kellman HD, Hyler SE, Rosnick L, Davies M (1992) Diagnosis of Dsm-Iii-R personality-disorders by 2 structured interviews—patterns of comorbidity. Am J Psychiatry 149:213–220PubMed
30.
go back to reference American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders DSM-5. American Psychiatric Association, Washington American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders DSM-5. American Psychiatric Association, Washington
31.
go back to reference Andrew T, Hart DJ, Snieder H, de LM, Spector TD, MacGregor AJ (2001) Are twins and singletons comparable? A study of disease-related and lifestyle characteristics in adult women. Twin Res 4:464–477PubMedCrossRef Andrew T, Hart DJ, Snieder H, de LM, Spector TD, MacGregor AJ (2001) Are twins and singletons comparable? A study of disease-related and lifestyle characteristics in adult women. Twin Res 4:464–477PubMedCrossRef
32.
go back to reference Johnson W, Krueger RF, Bouchard TJ Jr, McGue M (2002) The personalities of twins: just ordinary folks. Twin Res 5:125–131PubMedCrossRef Johnson W, Krueger RF, Bouchard TJ Jr, McGue M (2002) The personalities of twins: just ordinary folks. Twin Res 5:125–131PubMedCrossRef
33.
go back to reference Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH (2007) Comparison of alternative models for personality disorders. Psychol Med 37:983–994PubMedCrossRef Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH (2007) Comparison of alternative models for personality disorders. Psychol Med 37:983–994PubMedCrossRef
34.
go back to reference Tambs K, Ronning T, Prescott CA, Kendler KS, Reichborn-Kjennerud T, Torgersen S, Harris JR (2009) The Norwegian Institute of Public Health twin study of mental health: examining recruitment and attrition bias. Twin Res Hum Genet 12:158–168PubMedCentralPubMedCrossRef Tambs K, Ronning T, Prescott CA, Kendler KS, Reichborn-Kjennerud T, Torgersen S, Harris JR (2009) The Norwegian Institute of Public Health twin study of mental health: examining recruitment and attrition bias. Twin Res Hum Genet 12:158–168PubMedCentralPubMedCrossRef
35.
go back to reference Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 69:533–545PubMedCentralPubMedCrossRef Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 69:533–545PubMedCentralPubMedCrossRef
36.
go back to reference Reichborn-Kjennerud T, Czajkowski N, Roysamb E, Orstavik RE, Neale MC, Torgersen S, Kendler KS (2010) Major depression and dimensional representations of DSM-IV personality disorders: a population-based twin study. Psychol Med 40:1475–1484PubMedCentralPubMedCrossRef Reichborn-Kjennerud T, Czajkowski N, Roysamb E, Orstavik RE, Neale MC, Torgersen S, Kendler KS (2010) Major depression and dimensional representations of DSM-IV personality disorders: a population-based twin study. Psychol Med 40:1475–1484PubMedCentralPubMedCrossRef
37.
go back to reference Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69:1033–1045PubMedCentralPubMedCrossRef Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69:1033–1045PubMedCentralPubMedCrossRef
38.
go back to reference Vilaplana M, McKenney K, Riesco MD, Autonell J, Cervilla JA (2010) Depressive comorbidity in personality disorders. Revista de Psiquiatria y Salud Mental 3:4–12PubMed Vilaplana M, McKenney K, Riesco MD, Autonell J, Cervilla JA (2010) Depressive comorbidity in personality disorders. Revista de Psiquiatria y Salud Mental 3:4–12PubMed
Metadata
Title
Personality disorders are important risk factors for disability pensioning
Authors
Kristian Amundsen Østby
Nikolai Czajkowski
Gun Peggy Knudsen
Eivind Ystrom
Line C. Gjerde
Kenneth S. Kendler
Ragnhild E. Ørstavik
Ted Reichborn-Kjennerud
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 12/2014
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-014-0878-0

Other articles of this Issue 12/2014

Social Psychiatry and Psychiatric Epidemiology 12/2014 Go to the issue