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Comorbidity of Personality Disorders and Somatization Disorder: A Meta-analytic Review

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Abstract

Meta-analysis of studies assessing the comorbidity of somatization disorder (SD) with one or more personality disorders (PDs) revealed that-contrary to the assertions of the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision)-SD co-occurs with the majority of Axis II PDs. Although comorbidity effect sizes (rs) linking SD with paranoid PD and obsessive-compulsive PD were small, effect sizes for antisocial, borderline, narcissistic, histrionic, avoidant, and dependent PD yielded rs about or above 0.20. Comorbidity information in future versions of the DSM should be revised to reflect the greater number of PDs empirically linked with SD.

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Notes

  1. Other categories of Somatoform Disorder in the DSM-IV-TR are Conversion Disorder, Pain Disorder, Hypochondriasis, Undifferentiated Somatoform Disorder, Body Dysmorphic Disorder, and Somatoform Disorder Not Otherwise Specified.

  2. The same is true for SD Axis I comorbidity information, which has undergone only minor changes since 1980. In the DSM-III (American Psychiatric Association (APA) 1980) and DSM-III-R (American Psychiatric Association (APA) 1987) SD was presumed to be comorbid with anxiety and depressed mood; in the DSM-IV (American Psychiatric Association (APA) 1994) and DSM-IV-TR (American Psychiatric Association (APA) 2000) SD was hypothesized to be comorbid with Major Depressive Disorder, Panic Disorder, and Substance Use Disorders.

  3. The search terms dependency, dependent, and oral were included because the initial goal of this analysis was to assess the link between dependent PD and SD. After the initial search of the literature was complete it became clear that a broad array of PDs were, to varying degrees, comorbid with SD, so the analysis was broadened to include all DSM-IV PDs.

  4. Only two studies (Stern et al. 1993; Lilienfeld et al. 1986) used non-DSM criteria to diagnose PDs (Lilienfeld et al. 1986, used a combination of DSM and ICD criteria). Exclusion of these studies from the analysis did not change appreciably any obtained SD-PD comorbidity effect sizes.

  5. Of the six studies that produced more than one effect size per PD, three contributed two effect sizes, and three contributed four effect sizes.

  6. Other researchers have suggested that childhood abuse may represent a common factor underlying SD and various PDs (see Smith 1991).

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Authors and Affiliations

  1. Derner Institute of Advanced Psychological Studies, Adelphi University, 212 Blodgett Hall, Garden City, NY, 11530, USA

    Robert F. Bornstein & Stephanie H. Gold

Authors
  1. Robert F. Bornstein
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  2. Stephanie H. Gold
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Corresponding author

Correspondence to Robert F. Bornstein.

Appendix

Appendix

Studies Included in the Meta-Analysis*

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Frick, P. J., Kuper, K., Silverthorne, P., & Cotter, M. (1995). Social behavior, somatization, and sensation-seeking behavior in mothers of clinic-referred children. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 805–812.1

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Hayward, C., & King, R. (1990). Somatization and personality disorder traits in nonclinical volunteers. Journal of Personality Disorders, 4, 402–406.1

Hudziak, J. J., Boffeli, T. J., Kriesman, J. J., Battaglia, M. M., Stanger, C., & Guze, S. B. (1996). Clinical study of the relation of borderline personality disorder to Briquet’s syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. American Journal of Psychiatry, 153, 1598–1606.2

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Large, R. G. (1986). DSM-III diagnoses in chronic pain. Journal of Nervous and Mental Disease, 174, 295–303.1,2

Lecompte, D. (1989). Psychotherapy in non-organic somatization: A comparative study. European Journal of Psychiatry, 3, 82–90.1,2

Lilienfeld, S. O., VanValkenburg, C., Larntz, K., & Akiskal, H. (1986). The relationship of histrionic personality disorder to antisocial personality and somatization disorders. American Journal of Psychiatry, 143, 718–722.1,2

Mallouh, S. K., Abbey, S. E., & Gillies, L. A. (1995). The role of loss in treatment outcomes of persistent somatization. General Hospital Psychiatry, 17, 187–191.2

Modestin, J., Furrer, R., & Malti, T. (2004). Study on alexithymia in adult non-patients. Journal of Psychosomatic Research, 56, 707–709.1

Morrison, J. (1989). Histrionic personality disorder in women with somatization disorder. Journal of Psychosomatic Medicine, 30, 433–437.2

Murphy, G. E., & Wetzel, R. D. (1982). Family history of suicidal behavior among suicide attempters. Journal of Nervous and Mental Disease, 170, 86–90.2

North, C. S., Hansen, K., Wetzel, R. D., Compton, W., Napier, M., & Spitznagel, E. L. (1997). Nonpsychotic thought disorder: Objective clinical identification of somatization and antisocial personality in language patterns. Comprehensive Psychiatry, 38, 171–178.2

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Prasad, R. B., Val, E. R., Lahmeyer, H. W., Gaviria, M., Rodgers, P., Weiler, M., & Altman, E. (1990). Associated diagnoses (comorbidity) in patients with borderline personality disorder. Psychiatric Journal of the University of Ottawa, 15, 22–27.2

Rost, K. M., Akins, R. N., Brown, F. W., & Smith, G. R. (1992). The comorbidity of DSM-III-R personality disorders in somatization disorder. General Hospital Psychiatry, 14, 322–326.1,2

Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (2001). Adult somatic preoccupation and its relationship to childhood trauma. Violence and Victims, 16, 39–47.1

Sierles, F. S., Chen, J., McFarland, R. E., & Taylor, M. A. (1983). Posttraumatic stress disorder and concurrent psychiatric illness: A preliminary report. American Journal of Psychiatry, 140, 1177–1179.2

Smith, G. R., Golding, J. M., Kashner, T. M., & Rost, K. (1991). Antisocial personality disorder in primary care patients with somatization disorder. Comprehensive Psychiatry, 32, 367–372.2

Snyder, S., & Pitts, W. M. (1986). Characterizing somatization, hypochondriasis, and hysteria in the borderline personality disorder. Acta Psychiatrica Scandinavica, 73, 307–314.1

Stern, J., Murphy, M., & Bass, C. (1993). Personality disorders in patients with somatization disorder: A controlled study. British Journal of Psychiatry, 163, 785–789.1,2

Taylor, J., & Carey, G. (1998). Antisocial behavior, substance use, and somatization in families of adolescent drug abusers and adolescent controls. American Journal of Drug and Alcohol Abuse, 24, 635–643.1

* A superscript of 1 indicates that the study was included in the dataset from which SD-PD comorbidity effect sizes (r’s) were derived; a superscript of 2 indicates that the study was included in the dataset from which base rates of different PDs in SD patients were calculated.

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Bornstein, R.F., Gold, S.H. Comorbidity of Personality Disorders and Somatization Disorder: A Meta-analytic Review. J Psychopathol Behav Assess 30, 154–161 (2008). https://doi.org/10.1007/s10862-007-9052-2

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