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Co-morbidity of personality disorders

The co-morbidity of mental illness with personality disorder is a controversial topic, made difficult by disagreement over diagnosis and the fundamentals of personality structure. However, there would appear to be four possible points of view:

1Personality disorder and mental illness cannot exist simultaneously. This position perhaps provides the weakest argument, with little empirical evidence. However, the process of medical diagnosis perhaps implies that each is mutually exclusive.

2 All mentally ill people have a personality disorder. This may have some validity, as there is increasing evidence that those people with a mental illness may have a biological vulnerability, which may include some personal characteristics. However, the evidence for this position seems to suggest that those personality differences are not of a severity to enable a diagnosis of personality disorder.

3 Some personality disordered people will develop mental illness but that each can occur separately. This view is the one implied by the DSM classification system whereby both clinical mental disorder and personality disorder can be diagnosed on different axes. Current research evidence would suggest that there is significant co-morbidity between personality disorder and mental illness but that there is not an absolute or predictable link.

4 Personality disorder is a chronic neurotic disorder. This view observes that many features of personality disorders are similar to those observed in non-psychotic mental illness such as anxiety and mood disorders. It is argued that they are merely present for the person’s life from an earlier onset than those other neurotic disorders seen later in life.

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