Personality Disorders Prevalent, Under-Treated, in South Africa

September 4, 2008 • Science Update

Almost seven percent of South African people age 20 or older have a personality disorder, an umbrella term for several personality types characterized by chronic social dysfunction, a large study funded by NIMH and others reveals.  However, less than one-fifth of the people with a disorder received mental-health treatment in the year before the study.

More than one-third of those with a personality disorder also had a substance abuse disorder or an anxiety, mood or impulse-control disorder.

Results were published online ahead of print on September 3, 2008 in Psychopathology, by S. Suliman, M.A., D.J. Stein, Ph.D., and S. Seedat, Ph.D., of the Universities of Stellenbosch and Cape Town, and D. R. Williams, Ph.D., of the Harvard School of Public Health.

Symptoms of personality disorder often are extreme enough to be disabling because they may severely disrupt personal and professional relationships and, thus, home and work life. Some patients may have eccentric behaviors that include paranoia, while others display dramatic, emotional behaviors that include self-centered, antisocial, or other traits. Still others have anxious, fearful behaviors, including obsessions, compulsions, avoidance, or dependence.

The rate of personality disorder found in this study is lower than the nine percent rate found in the U.S. in other studies,¹ but is similar to that in other low- to middle-income countries.

Data for the research came from the South African Stress and Health study, which was carried out in conjunction with the World Health Organization World Mental Health Survey Initiative

The study included 4,433 community-dwelling South Africans of all races, with Black South Africans comprising the majority of respondents. Few studies of personality disorder, and none of this size, had been conducted in South Africa previously.

The findings reveal not only the low treatment rate of psychiatric disorders in South Africa, but also that personality disorder and its tendency to occur with other psychiatric illnesses is a universal phenomenon that cuts across countries and races.

In addition to NIMH, other organizations that provided funding include the National Institute on Drug Abuse and Fogarty International Center, also of the National Institutes of Health; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; the Pan American Health Organization; Eli Lilly and Company; Ortho-McNeil Pharmaceutical, Inc.; GlaxoSmithKline; and Bristol-Myers Squibb. Supplemental funding was provided by the South African Department of Health and the University of Michigan. Drs. Stein and Seedat are also supported by the Medical Research Council of South Africa.

Reference:

Suliman S, Stein DJ, Williams DR, Seedat S. DSM-IV Personality Disorders and Their Axis I Correlates in the South African Population . Psychopathology. 2008 Sep 3;41(6):356-364. [Epub ahead of print]

¹ Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication . Biol Psychiatry. 2007 Sep 15;62(6):553-64.