MIDAS Project Publication Abstracts
Posternak, M.A., Zimmerman, M. The prevalence of atypical features
across mood, anxiety, and personality disorders. Comprehensive
Psychiatry, in press.
This study examines and compares the prevalence rates of the atypical
features subtype across each of the major mood, anxiety, and personality
disorders. It also evaluates the impact that comorbid anxiety and
personality disorders have on the likelihood that depressed patients will
present with atypical symptoms. Eleven hundred and thirty psychiatric
outpatients were evaluated for the presence of atypical symptoms. All axis
I diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID).
Personality disorders were assessed in a subset of 530 patients using the
Structured Interview for DSM-IV Personality Disorders (SIDP-IV). From a
sample of 579 patients diagnosed with a current major depressive disorder,
22.5% met criteria for the atypical subtype. Prevalence rates were similar
in bipolar and unipolar patients, though the pattern of symptoms was
distinct. Prevalence rates were lower in patients with dysthymic disorder
(12.5%), adjustment disorder with depressed mood (9.4%), and depression
NOS (7.9%). When major depression existed in the presence of a comorbid
anxiety disorder, the likelihood of presenting with atypical features
doubled. Nine percent of the patients diagnosed with an anxiety disorder
(without a comorbid depressive disorder) met criteria for atypical
features. Two of the four atypical symptoms, leaden paralysis and
rejection sensitivity, were found to be especially prominent in
non-depressed anxiety disorder patients. Of the 10 personality disorders
listed in DSM-IV, only avoidant personality disorder was associated with
the atypical features subtype. In large part, this was accounted for by
the high rate of rejection sensitivity in these patients. In conclusion,
as many as one-quarter of depressed patients who present for outpatient
psychiatric treatment meet criteria for the atypical features subtype.
There appears to be a strong association between anxiety and atypical
depression, but the exact nature of this association needs to be further
elucidated. It is unclear whether personality pathology is independently
associated with the atypical features subtype.
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