Social Functioning and Personality disorders

Personality Disorders Impair Social Functioning

Problems in social functioning appear to be an enduring component of personality disorders (PDs), suggests new research from New York. Based on the expectation that “personality disorders disrupt normal experiences, such as establishing a career or intimate relationships outside the family of origin,” Andrew Skodol (Columbia University, New York) and colleagues explored which aspects of PD psychopathology are more important.

The researchers studied change in psychosocial functioning, as measured on
the Longitudinal Interval Follow-up Evaluation, in 600 treatment-seeking or treated patients over a 2-year period. Among the participants, 81 exhibited schizotypal (“cold” people), 155 borderline, 137 avoidant, and 142 obsessive-compulsive PD. The remaining 85 patients had major depressive disorder (MDD) without PD.

The researchers found that after an intensive treatment significant improvement occurred in only three of seven domains, and this was largely attributable to improvements in patients with MDD and no PD. Specifically, significant improvements were seen for relationships with spouse or mate – although the researchers acknowledge that only about 20% of the participants had such a relationship – recreation, and global social adjustment.

Patients with borderline PD or obsessive-compulsive PD showed no overall improvement over time in these measures.

“Compared with the degree that PD psychopathology improves, the results of the present study are consistent with the hypothesis that functional impairment improves less than psychopathology over a 2-year period in patients with PDs,” Skodol and co-workers comment in the journal Psychological Medicine.

Skodol et al concluded that, because personality psychopathology usually begins in adolescence or early adulthood, “the potential for derailments in occupational paths and in the development of mature interpersonal relationships is great. Even after symptomatic improvement, it might be expected to take some time to overcome these deficits and to make up the ground necessary to achieve ‘normal’ functioning.”

The bottom line is that after some personality disorders are set in the childhood and adolescence, social functioning will be impaired even after treatment. This has important implications for families who often expect and do not see what they hope for after treatment, that is, an immediate improvement in all spheres.

2005; 35: 443-451