Personality Disorders in Recent-Onset Bipolar Disorder Simone Pica, Jane Edwards, Henry J. Jackson, Richard C. Bell, Glen W. Bates, and Raymond P. Rudd zyxwvutsrqponmlkjihgfedcbaZYXW The frequency and types of DSM-III personality disorders (PDs) were investigated in a sample of 26 recent-onset bipolar-disordered (BD) patients. Results showed that 62% of BD patients had PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP). The most frequently diagnosed PDs were the histrionic, borderline, passive-aggressive, and antisocial categories. A comparison between the BD patients and a sample of 35 recent-onset schizophrenic patients showed significant differences for two PDs. Schizotypal PD was more frequently diagnosed in the schizophrenic group, while the BD group had a higher frequency of histrionic PD. 0 1990 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA by zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA W. B. Saunders Company. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDC T HE USE OF LITHIUM in treating patients with bipolar disorder (BD) has resulted in researchers neglecting psychological factors.’ Recent studies2t3 have suggested that BD patients’ premorbid personality may help predict patients’ responsiveness to lithium treatment. Research on personality in BD patients is minimal, and to the authors’ knowledge, the investigation of personality disorders (PDs) in this psychiatric population using structured instruments has not been undertaken. The implications of detecting PDs in patients with axis I disorders such as major depression and panic disorder have been shown.4-6In those studies, patients with concomitant axis II disorders were found to respond less favorably to treatment and have a poorer prognosis compared with non-personality-disordered patients. PREMORBID PERSONALITY IN BD Early psychoanalytic investigators (e.g., Abraham’**) who investigated intrapsy- chic processes involved in BD described them as having both oral and anal characteristics. Oral traits can include excessive dependence, pessimism, optimism, narcissism, demandingness, envy, and jealousy. Pathological anal traits can include orderliness, obstinancy, stubbornness, frugality, defiance, and sadomasochistic tendencies.’ Cohen et al.” conducted the most well-known psychoanalytic investigation of 12 BD patients who had received psychotherapy from 1 to 5 years. They were found to be envious, dependent, manipulative, demanding, unempathic, desirous of approval in their relationships, conscientious, competitive, and ambitious. Hirschfeld and Klerman” assessed premorbid personality in 119 depressed inpatients using the Maudsley Personality Inventory, the Lazare-Klerman Armor Personality Inventory, the Marke Nyman Temperament Scale, and the Leyton Obsessional Inventory. Twenty-four BD patients were diagnosed on the basis of the Schedule for Affective Disorders and Schizophrenia and the Research Diagnostic From the NH and MRC Schizophrenia Research Unit, Royal Park Hospital, Parkville, Australia; and the Department of zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Psychology, University of Melbourne, Parkville, Australia. Address reprint requests to Henry J. Jackson, Ph.D., NH and MRC Schizophrenia Research Unit, Royal Park Hospital, Private Bag No. 3, Parkville Vie 3052, Australia o 1990 by W.B. Saunders Company. 0010-440x/90/3106-0007$03.00/0 Comprehensive Psychiatry, Vol. 3 1, No. 6 (November/December), 1990: pp 499-5 10 499