Comorbidity of axis I and axis II diagnoses in a sample of Egyptian patients with neurotic disorders.

Neurosis and personality disorder (PD) are two of the most used but least clarified and understood terms in psychiatry. The separation of PD by the American Psychiatric Association in DSM-III and -IV as a discrete axis of classification has been a major advance in psychiatric nosology. Also with the advent of DSM-III and its multiaxial system, it was recognized that both PD and clinical syndromes can coexist, and in some cases this coexistence may have implications on treatment response and prognosis. This study was performed on 200 neurotic patients in an attempt to investigate possible correlations between various neurotic subcategories and personality types. Our results confirm that PD and personality abnormality are significantly higher in neurotic patients than in controls and need to be considered in diagnostic assessment. Some comorbidity was shown between borderline PD and somatoform disorder; compulsive PD and obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD); and avoidant PD and phobia. However, our data failed to show a correlation between the presence of an additional PD and particular neurotic symptomatology. It seems that the association between neurotic disorders and PD should not be taken to indicate a direct causative relationship. It is likely that personality is just one of the predisposing factors that influence the individual response to psychological trauma and determine the form of neurosis. The most prevalent PD was found to be PD NOS, followed by borderline, compulsive, avoidant, and finally histrionic PDs. The term, multiple PD, should be given substance to characterize the diagnosis as a disorder, rather than leaving it at its current status of what seems to be a nondistinct clinical picture. Extensive research has to be undertaken in an attempt to decide which specific PDs most deserve to be included in the official nomenclature.