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Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study

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Abstract

Background

It is not yet clear whether chronic fatigue syndrome (CFS) is associated with elevated levels of personality disorders.

Purpose

This study aims to determine the prevalence of DSM-IV axis II personality disorders among patients with CFS.

Methods

We examined the prevalence of personality disorders in a sample of 92 female CFS patients and in two well-matched control groups, i.e., normal community individuals (N = 92) and psychiatric patients (N = 92). Participants completed the assessment of DSM-IV personality disorders questionnaire (ADP-IV), which yields a categorical and dimensional evaluation of personality disorder features.

Results

The prevalence of personality disorders in CFS patients (16.3 %) was significantly lower than in psychiatric patients (58.7 %) and was similar to that in the community sample (16.3 %). Similar results were found for dimensional and pseudodimensional scores, except for the Depressive (DE) and Obsessive–Compulsive Personality Disorder (O-C) subscales. Patients with CFS had significantly higher levels of DE features compared to normal controls and similar dimensional scores on the O-C scale compared to psychiatric controls.

Conclusions

Although the CFS sample was characterized by depressive and obsessive–compulsive personality features, this study provides no evidence for the assumption that these patients generally show a higher prevalence of axis II pathology. Given the conflicting findings in this area, future studies using multiple measures to assess personality disorders in CFS are needed to substantiate these findings.

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References

  1. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953–9.

    Article  PubMed  CAS  Google Scholar 

  2. Carruthers BM, van de Sande MI, De Meirleir KL, et al. Myalgic encephalomyelitis: International Consensus Criteria. J Intern Med. 2011;270:327–38.

    Article  PubMed  CAS  Google Scholar 

  3. Van Houdenhove B, Kempke S, Luyten P. Psychiatric aspects of chronic fatigue syndrome and fibromyalgia. Curr Psychiatr Rep. 2010;12:208–14.

    Article  Google Scholar 

  4. Van Houdenhove B, Luyten P. Chronic fatigue syndrome reflects loss of adaptability. J Intern Med. 2010;268:249–51.

    Article  PubMed  Google Scholar 

  5. Luyten P, Kempke S, Van Wambeke P, Claes S, Blatt SJ, Van Houdenhove B. Self-critical perfectionism, stress generation, and stress sensitivity in patients with chronic fatigue syndrome: relationship with severity of depression. Psychiatry. 2011;74:21–30.

    PubMed  Google Scholar 

  6. Van Den Eede F, Moorkens G, Van Houdenhove B, Cosyns P, Claes SJ. Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. Neuropsychobiology. 2007;55:112–20.

    Article  Google Scholar 

  7. Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a ‘crash’ in the stress system? Med Hypotheses. 2009;72:701–5.

    Article  PubMed  Google Scholar 

  8. Dittner AJ, Rimes K, Thorpe S. Negative perfectionism increases the risk of fatigue following a period of stress. Psychol Health. 2011;26:253–68.

    Article  PubMed  Google Scholar 

  9. Deary V, Chalder T. Personality and perfectionism in chronic fatigue syndrome: a closer look. Psychol Health. 2010;25:465–75.

    Article  PubMed  Google Scholar 

  10. Fukuda S, Kuratsune H, Tajima S, et al. Premorbid personality in chronic fatigue syndrome as determined by the Temperament and Character Inventory. Compr Psychiatr. 2010;51:78–85.

    Article  Google Scholar 

  11. Kempke S, Van Houdenhove B, Luyten P, Goossens L, Bekaert P, Van Wambeke P. Unraveling the role of perfectionism in chronic fatigue syndrome: is there a distinction between adaptive and maladaptive perfectionism? Psychiatr Res. 2011;186:373–7.

    Article  Google Scholar 

  12. Kempke S, Luyten P, Van Houdenhove B, Goossens L, Bekaert P, Van Wambeke P. Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome. Clin Rheumatol. 2011;30:1543–8.

    Article  PubMed  Google Scholar 

  13. Luyten P, Van Houdenhove B, Cosyns N, Van den Broeck A-L. Are patients with chronic fatigue syndrome perfectionistic-or were they? A case–control study. Pers Indiv Differ. 2006;40:1473–83.

    Article  Google Scholar 

  14. Moss-Morris R, Spence MJ, Hou R. The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychol Med. 2011;41:1099–107.

    Article  PubMed  CAS  Google Scholar 

  15. Van Campen E, Van Den Eede F, Moorkens G, et al. Use of the Temperament and Character Inventory (TCI) for assessment of personality in chronic fatigue syndrome. Psychosomatics. 2009;50:147–54.

    Article  PubMed  Google Scholar 

  16. Van Houdenhove B, Bruyninckx K, Luyten P. In search of a new balance. Can high “action-proneness” in patients with chronic fatigue syndrome be changed by a multidisciplinary group treatment? J Psychosom Res. 2006;60:623–5.

    Article  PubMed  Google Scholar 

  17. van Geelen SM, Sinnema G, Hermans HJ, Kuis W. Personality and chronic fatigue syndrome: methodological and conceptual issues. Clin Psychol Rev. 2007;27:885–903.

    Article  PubMed  Google Scholar 

  18. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA; 1994.

    Google Scholar 

  19. Ciccone DS, Busichio K, Vickroy M, Natelson BH. Psychiatric morbidity in the chronic fatigue syndrome: are patients with personality disorder more physically impaired? J Psychosom Res. 2003;54:445–52.

    Article  PubMed  Google Scholar 

  20. Millon C, Salvato F, Blaney N, et al. A psychological assessment of chronic fatigue syndrome/chronic Epstein–Barr virus patients. Psychol Health. 1989;3:131–41.

    Article  Google Scholar 

  21. Johnson SK, DeLuca J, Natelson BH. Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression. J Psychiatr Res. 1996;30:9–20.

    Article  PubMed  CAS  Google Scholar 

  22. Henderson M, Tannock C. Objective assessment of personality disorder in chronic fatigue syndrome. J Psychosom Res. 2004;56:251–4.

    Article  PubMed  Google Scholar 

  23. Nater UM, Jones JF, Lin JM, Maloney E, Reeves WC, Heim C. Personality features and personality disorders in chronic fatigue syndrome: a population-based study. Psychother Psychosom. 2010;79:312–8.

    Article  PubMed  Google Scholar 

  24. Hyler SE, Rieder RO. PDQ-R: Personality Diagnostic Questionnaire-Revised. New York: State Psychiatric Institute; 1987.

    Google Scholar 

  25. Hyler SE. Personality Diagnostic Questionnaire-4+ (PDQ-4+). New York: State Psychiatric Institute; 1994.

    Google Scholar 

  26. First M, Spitzer R, Gibbon M, Williams J, editors. Structured Clinical Interview for DSM-III-R personality disorders (SCID-III). Washington, DC: American Psychiatric Press; 1987.

    Google Scholar 

  27. Courjaret J, Schotte CK, Wijnants H, Moorkens G, Cosyns P. Chronic fatigue syndrome and DSM-IV personality disorders. J Psychosom Res. 2009;66:13–20.

    Article  PubMed  Google Scholar 

  28. Schotte CK, de Doncker D, Vankerckhoven C, Vertommen H, Cosyns P. Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV. Psychol Med. 1998;28:1179–88.

    Article  PubMed  CAS  Google Scholar 

  29. Reus RJ, Berg JF, Emmelkamp PM. Personality Diagnostic Questionnaire 4+ is not useful as a Screener in Clinical Practice 2012. Clin Psychol Psychother (in press)

  30. Wilberg T, Dammen T, Friis S. 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 Psychiatr. 2000;41:295–302.

    Article  CAS  Google Scholar 

  31. Kay JH, Altshuler LL, Ventura J, Mintz J. Prevalence of axis II comorbidity in bipolar patients with and without alcohol use disorders. Ann Clin Psychiatr. 1999;11:187–95.

    Article  CAS  Google Scholar 

  32. Schotte CK, De Doncker DA, Dmitruk D, Van Mulders I, D'Haenen H, Cosyns P. The ADP-IV questionnaire: differential validity and concordance with the semi-structured interview. J Pers Disord. 2004;18:405–19.

    PubMed  Google Scholar 

  33. Jason LA, Richman JA, Rademaker AW, et al. A community-based study of chronic fatigue syndrome. Arch Intern Med. 1999;159:2129–37.

    Article  PubMed  CAS  Google Scholar 

  34. Doering S, Renn D, Hofer S, et al. Validation of the “Assessment of DSM-IV Personality Disorders (ADP-IV)” Questionnaire. Z Psychosom Med Psychother. 2007;53:111–28.

    PubMed  Google Scholar 

  35. Bastiaansen L, Rossi G, Schotte C, De Fruyt F. The structure of personality disorders: comparing the DSM-IV-TR Axis II classification with the five-factor model framework using structural equation modeling. J Pers Disord. 2011;25:378–96.

    Article  PubMed  Google Scholar 

  36. Schotte CKW. New instruments for diagnosing personality disorders. Curr Opin Psychiatr. 2000;13:605–9.

    Article  Google Scholar 

  37. Schotte C, De Doncker D. Assessment of DSM-IV Personality Disorders questionnaire (ADP-IV). Edegem (Antwerp): UZA; 1994.

    Google Scholar 

  38. First M, Gibbon M, Spitzer R, Williams J, editors. User's guide for the structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, D.C.: APA; 1997.

    Google Scholar 

  39. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum; 1988.

    Google Scholar 

  40. Grant BF, Hasin DS, Stinson FS, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatr. 2004;65:948–58.

    Article  Google Scholar 

  41. Ekselius L, Tillfors M, Furmark T, Fredrikson M. Personality disorders in the general population: DSM-IV and ICD-10 defined prevalence as related to sociodemographic profile. Pers Indiv Differ. 2001;30:311–20.

    Article  Google Scholar 

  42. Lerman SF, Shahar G, Rudich Z. Self-criticism interacts with the affective component of pain to predict depressive symptoms in female patients. Eur J Pain. 2012;16:115–22.

    Article  PubMed  CAS  Google Scholar 

  43. Uguz F, Cicek E, Salli A, et al. Axis I and Axis II psychiatric disorders in patients with fibromyalgia. Gen Hosp Psychiatr. 2010;32:105–7.

    Article  Google Scholar 

  44. Wessely S, White PD. There is only one functional somatic syndrome. Br J Psychiatry. 2004;185:95–6.

    Article  PubMed  Google Scholar 

  45. Pae CU, Luyten P, Marks DM, et al. The relationship between fibromyalgia and major depressive disorder: a comprehensive review. Curr Med Res Opin. 2008;24:2359–71.

    Article  PubMed  CAS  Google Scholar 

  46. Arnold LM. Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics. 2008;49:185–90.

    Article  PubMed  Google Scholar 

  47. Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P. Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord. 2010;126:174–9.

    Article  PubMed  Google Scholar 

  48. Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. 2003;160:221–36.

    Article  PubMed  Google Scholar 

  49. Reyes M, Nisenbaum R, Hoaglin DC, et al. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med. 2003;163:1530–6.

    Article  PubMed  Google Scholar 

  50. Luyten P, Blatt SJ. Integrating theory-driven and empirically-derived models of personality development and psychopathology: a proposal for DSM V. Clin Psychol Rev. 2011;31:52–68.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Greta Moorkens for her help in data collection of the Antwerp sample.

We would also like to thank the anonymous reviewers for their helpful comments.

Data collection of the Leuven sample was partially funded by a research grant from the National Fund for Scientific Research—Flanders (Belgium) (No. 3H080485).

Author information

Authors and Affiliations

  1. Department of Psychology, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium

    Stefan Kempke & Patrick Luyten

  2. Department of Psychiatry, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Filip Van Den Eede

  3. Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Filip Van Den Eede

  4. Department of Clinical Psychology, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussels, Belgium

    Chris Schotte

  5. Department of Clinical and Lifespan Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium

    Chris Schotte

  6. Department of Psychiatry, University Hospitals Leuven, University of Leuven, Leuven, Belgium

    Stephan Claes & Boudewijn Van Houdenhove

  7. Chronic Fatigue Syndrome Reference Center, University Hospitals Leuven, University of Leuven, Pellenberg, Belgium

    Peter Van Wambeke & Boudewijn Van Houdenhove

  8. Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, University of Leuven, Leuven, Belgium

    Peter Van Wambeke

  9. Research Department of Clinical, Educational and Health Psychology, University College London, London, UK

    Patrick Luyten

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  1. Stefan Kempke
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  2. Filip Van Den Eede
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  7. Patrick Luyten
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Correspondence to Stefan Kempke.

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Kempke, S., Van Den Eede, F., Schotte, C. et al. Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study. Int.J. Behav. Med. 20, 219–228 (2013). https://doi.org/10.1007/s12529-012-9273-y

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  • DOI: https://doi.org/10.1007/s12529-012-9273-y

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