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Psychiatric and other clinicians have often speculated on whether the presence of a personality disorder would indicate a poorer course of treatment for an Axis I disorder. Starting around 1990, the standardized criteria of the DSM increased interest in examining this area empirically. This report updates my previous reviews and examines other writing in this area. There is still a considerable body of evidence indicating that personality may cause a poorer treatment outcome of an Axis I disorder; however, there are also intriguing new developments. The introduction of new drug treatments that may be helpful with some dysfunctional personality traits changes some of the findings and may suggest that there may be preferential treatments for some Axis I patients with certain comorbid personality traits. (In certain cases this may apply to some specific psychotherapy techniques as well.) In addition, at times, personality traits may predict a positive outcome to treatment. This review is an attempt to bring together this diverse area and suggest where fruitful areas of research and intervention may possibly be found.
As far as I am able to determine, reviews on the effect of Axis II disorders (measured by DSM standardized method) on the outcome of an Axis I disorder began with my first two articles (Reich & Green, 1991; Reich & Vasile, 1993). It was at that time that the DSM criteria had begun to allow for the development of this topic by listing diagnostic criteria for personality disorders. A decade has gone by with the addition of new empirical reports and reviews in the literature. It seems an appropriate time to update those reviews. To provide a context I will first briefly summarize my previous reviews and those of others on this topic.
EARLIER REVIEWS
My first report (Reich & Green, 1991), based on 21 studies mostly of anxiety and depressive disorders, concluded that the presence of a personality disorder had a negative effect on the outcome of treatment of Axis I disorders. This effect occurred whether personality was measured during the acute phase before treatment or subsequently. It was a robust finding that even extended to placebo effects. At that time, there was insufficient data to determine whether there were specific personality traits that were responsible for this...