Article2002

Personality Pathology and Treatment Outcome in Major Depression: A Review

355 citations0/0 files storedAmerican Journal of Psychiatry

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Personality Disorders and Psychopathology Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Personality Traits and Psychology

Abstract

OBJECTIVE: A longstanding belief among many clinicians is that patients with depression and comorbid personality pathology have a worse response to standard depression treatment. This presents potentially significant treatment implications, since personality pathology in depressed patients appears to be common. METHOD: PsycINFO and MEDLINE were systematically searched for studies relating personality to treatment outcome. Over 50 studies were obtained and grouped according to the method used to assess personality pathology. RESULTS: High neuroticism scores generally predicted worse outcome, especially over long-term follow-up. Tridimensional Personality Questionnaire scores did not have a consistent relationship to treatment outcome despite some promising initial findings. Most studies involved patients with comorbid personality disorders; these studies produced conflicting results. Other measures of personality pathology produced an array of findings ranging from a moderately worse outcome to no difference. CONCLUSIONS: Whether or not personality pathology significantly worsens outcome in patients with major depression appears to depend on study design, since the rate of personality pathology varies markedly depending on how it is measured. In addition, depressed patients with personality pathology appear less likely to receive adequate treatment in uncontrolled studies. Finally, studies rarely control for depression characteristics (e.g., chronicity, severity) that may influence outcome and be related to personality pathology. Overall, the best-designed studies reported the least effect of personality pathology on depression treatment outcome. Clinically, this suggests that comorbid personality pathology should not be seen as an impediment to good treatment response.

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References

1987A Systematic Method for Clinical Description and Classification of Personality Variants 1994Diagnosing Personality Disorders 1983Assessing personality: effects of the depressive state on trait measurement 1985A Structured Interview for the DSM-III Personality Disorders 1990Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program 1991The Ego Impairment Index as a Predictor of Outcome in Melancholic Depressed Patients Treated With Tricyclic Antidepressants

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2011Leader development and the dark side of personality 2015Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials 2005Continuity of Axes I and II: Toward a Unified Model of Personality, Personality Disorders, and Clinical Disorders 2011Relationship of Personality Disorders to the Course of Major Depressive Disorder in a Nationally Representative Sample 2006Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders.2013Influence of Personality on the Outcome of Treatment in Depression: Systematic Review and Meta-Analysis

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