Personality Disorder and Physical Health Comorbidities: A Link With Bone Health?

Abstract

We examined whether personality disorders (PDs) (any, cluster A/B/C) were associated with bone mineral density (BMD) in a population-based sample of Australian women (n = 696). Personality and mood disorders were assessed using semi-structured diagnostic interviews. BMD was measured at the spine, hip, and total body using dual-energy x-ray absorptiometry (GE-Lunar Prodigy). Anthropometrics, medication use, physical conditions, and lifestyle factors were documented. The association between PDs (any, cluster A/B/C) and BMD (spine/hip/total body) was examined with multiple linear regression models. The best models were identified by backward elimination including age, weight, physical activity, smoking status, alcohol consumption, dietary calcium intake, mood disorders, physical multimorbidity, socioeconomic status, and medications affecting bone. The variables were retained in the model if p < 0.05. All potential interactions in final models were tested. Those with cluster A PD, compared to those without, had 6.7% lower hip BMD [age, weight adjusted mean 0.853 (95% CI 0.803–0.903) vs. 0.910 (95% CI 0.901–0.919) g/cm2, p = 0.027] and 3.4% lower total body BMD [age, weight, smoking, alcohol, calcium adjusted mean 1.102 (95% CI 1.064–1.140) vs. 1.139 (95% CI 1.128–1.150) g/cm2, p = 0.056]. No associations were observed between cluster B/C PDs and hip/total body BMD or between any of the PD clusters and spine BMD. To our knowledge, this study is the first to investigate the bone health of women with PD in a population-based sample. Given the paucity of literature, replication and longitudinal research including the examination of underlying mechanisms and sex differences are warranted.

Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

“…The bi-directional arrows in the conceptual frameworks account for the health selection model, which explains how deterioration in health (such as a CVD event or decline in cognitive functioning) may limit or reduce social involvement. It is also important to understand the upstream determinants of poor social health such as personality [ 17 ]. Maladaptive premorbid personality is associated with difficult interpersonal relationships and also impedes adaptive health behaviour through adverse lifestyle habits and higher rates of non-adherence to medication.…”

Exploring the comorbidity between personality and musculoskeletal disorders among adults: A scoping review

“…To ascertain PDs, the Structured Clinical Interview for DSM Axis II Personality Disorders (SCID-II) was the most commonly used semi-structured interview with most stating it was administered by either mental health professionals ( 48 , 51 , 55 – 58 , 61 , 64 , 66 , 81 ) or trained interviewers ( 44 , 63 , 80 ). Other methods to identify PD included the interrogation of medical records or chart reviews according to ICD-9 or ICD-10 criteria ( 54 , 74 , 79 ), and clinical impressions (according to DSM criteria) based on collateral sources such as psychological interviews and testing and/or flowcharts ( 59 , 75 ).…”

Are social isolation, lack of social support or loneliness risk factors for cardiovascular disease in Australia and New Zealand? A systematic review and meta‐analysis

“…A number of conceptual frameworks illustrate the pathways between social health and health, 13‐20 with several 13,18,20,21 being particularly relevant to our review as they describe the link between poor social health and CVD. The main, broad pathway that tends to be described is from poor social health, through molecular mechanisms, health behaviours, and chronic disease risk‐factors, leading to chronic mental and physical ill‐health and mortality; with each step being impacted by socio‐demographics, the sociological environment, and personality 18,20,22,23 . For example, being socially isolated or feeling lonely can overstimulate the body's stress response through increased levels of the stress hormone cortisol, raise blood pressure and decrease blood flow to vital organs through higher tonic vascular resistance, impair the immune system's ability to fight infections through lower production of white blood cells, and reduce sleep quality leading to less restorative sleep and daytime fatigue 24 .…”

“…The main, broad pathway that tends to be described is from poor social health, through molecular mechanisms, health behaviours, and chronic disease risk‐factors, leading to chronic mental and physical ill‐health and mortality; with each step being impacted by socio‐demographics, the sociological environment, and personality. 18 , 20 , 22 , 23 For example, being socially isolated or feeling lonely can overstimulate the body's stress response through increased levels of the stress hormone cortisol, raise blood pressure and decrease blood flow to vital organs through higher tonic vascular resistance, impair the immune system's ability to fight infections through lower production of white blood cells, and reduce sleep quality leading to less restorative sleep and daytime fatigue. 24 People with poor social health also tend to have more unhealthy lifestyles, such as undertaking less physical activity or eating unhealthily, which increases their risk of CVD.…”