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29 Epidemiology of DSM-Ill PDs
were reported with structured interviews, 1.7% with the SIPDL2 and
2.2% with the SCID.'OAnother study" carried out at the ECA Baltimore
site, ascertained the prevalence of compulsive PD in the community. and
found a prevalence of 1.7%. Males had a rate about five times higher
than females. The disorder was also more frequent among white, highly
educated, married, and employed subjects, and it was associated with
anxiety disorders. However, the study derived the diagnosis from an
interview originally not intended to diagnose PDs. This could mean that
they identified adaptive obsessive-compulsive traits rather than a PD.
Using the PDQ, Zimmerman and C~ryell'~ found a low rate (0.4%),
while Reich et al,15 in their study, which included only 235 subjects,
found no cases. The rate was higher with an interview, suggesting that
passive-aggressive persons may under-report on self-administered questionnaires.
Epidemiological studies carried out in psychlatric settings
Table 3 lists the main prevalence studies of PD carried out in in-patient
and out-patient psychiatric samples.
To summarize, although the prevalence of PD among psychiahic outpatients
and in-patients can be high, both in patients with only a PD and in
those with an Axis I disorder (especially affective disorders), no final wnclusion
can be reached because the available sNdieS reported very different
prevalence rates. The differences are probably due to differences in sampling,
diagnostic criteria, assessment methods, availability of mental health
services, prevalence of Axis I disorders, and sociocultural factors. Even
when authors use ICD or DSM criteria, they may have done so in different
ways. There are, however, some consistencies acmss studies. The most
prevalent PD seems to be hoderline, both in in-patient and out-patient settings.
The next most common FDs tend to be schiwtypal and histrionic.
These three disorders are also characterized by the lowest social functioning.
They are especially common in in-patient settings, as theirsymptomatology
often results in hospitaliition due to suicidal hehavim, substance
abuse, and cognitive-perceptual abnormalities. In out-patient settings,
dependent and passive-aggressive PDs are also common.
In a study carried out among 2344 patients attending a public psychiatric
facility and having a DSM-111 diagnosis of PD, cluster B patients