Today I’m going to blog about personality disorders, which may be one of the most divisive diagnoses clinically; For both patients and staff. In my experience, some patients may feel stigmatized by the diagnosis and some staff may develop maladaptive alienation; As outlined by Watts and Morgan in the paper with the subtitle ‘Dangers for patients who are hard to like’ (Watts 1994).
However, there are groups of people supporting people suffering from ‘personality disorders’ and Mental Elf has collaborated with the British and Irish Group for the Study of Personality Disorders (BIGSPD) and launched a. series of short videos Sharing highlights from their 2025 conference in Liverpool. This community of professionals is interested in broadening the understanding of ‘personality disorders’ and complex emotional and relational needs.
So it seems appropriate to share this paper, published in Lancet Psychiatry in December 2025, which looks at the global epidemiology of ‘personality disorders’ and the results may not be exactly what you expect!
Shahid and others Completed a global systematic review and meta-regression of population-based surveys regarding any potentially diagnostic ‘personality disorder’ within the DSM or ICD-10. This paper looks at the prevalence, mortality and clinical stability of ‘personality disorders’ using population-representative data in high-income countries (HICs) and low- to middle-income countries (LMICs).
find out ‘Personality Disorder’ Video Recorded at the 2025 BIGSPD conference in Liverpool.
methods
PRISMA and GATHER guidelines were followed regarding paper selection. By looking for cross-sectional or longitudinal studies in peer-reviewed journals reporting the prevalence or mortality associated with any ‘personality disorder’, papers between the years 1980 and 2024 were identified. Papers were excluded if they relied on self-report or non-representative samples.
The quality of the studies was assessed using the Joanna Briggs Institute’s critical appraisal tools. Meta-regression analyzes were completed to estimate the prevalence and standardized mortality ratios associated with ‘personality disorders’.
Result
60 studies were identified in 28 countries, representing 139,373 individuals for prevalence and 392,420 individuals for mortality.
spread
- HIC 5.2% (95% uncertainty interval 3.7 to 7.3).
- LMIC 4.1% (95% uncertainty interval 2.8 to 6.0) p=0.013.
However, note the overlapping 95% uncertainty intervals, meaning the true result could be anywhere within that range.
- The prevalence was significantly higher in men than in women (P<0.0001) and at younger ages than at older ages (P<0.0001).
- Diagnostic criteria and interviewer qualifications influenced prevalence estimates, with use of ICD-10 being associated with lower prevalence than DSM, and administration by mental health professionals giving greater importance to prevalence than those described as ‘experienced practitioners’.
mortality rate
- ‘Personality disorders’ were associated with higher mortality, with inpatients showing the highest risk (standardized mortality ratio (SMR) of 4.7).
- The risk of mortality in outpatients was low (SMR 1.8), whereas the SMR in the combined inpatient and outpatient samples was 2.2.
- The risk of mortality decreased with age and was higher in men than women.
clinical stability
- ‘Personality disorders’ showed moderate clinical stability, with rates ranging from 34.1% to 73% depending on the duration of follow-up (the shorter the duration the greater the stability).
- There was a downward trend in long-term stability, potentially reflecting symptom improvement over time.
The variation between studies was very high for prevalence (I2=98·8%) and mortality (I2=99·4%) and study quality assessment indicated that 59 studies were of high quality, with only one study being of moderate quality. Furthermore, publication bias was identified in the prevalence analysis.
Personality disorders are more common in high-income countries than in low- and middle-income countries.
conclusion
The authors concluded that:
Personality disorders are common, associated with premature mortality, and clinically stable, yet it has been excluded from studies of the global burden of diseases, injuries, and risk factors.
We provide a comprehensive synthesis of personality disorder epidemiology, providing the necessary foundation to inform future global projections and policy responses.
Strengths and limitations
This paper reflects a very comprehensive view of global data regarding ‘personality disorders’; However it has flagged some problems with the available evidence base:
- No eligible data were identified after 2014, reducing the timeliness of the search.
- There is limited data from LMICs which restricts the generalizability of the findings.
- Publication bias was detected in the prevalence analysis, potentially inflating the prevalence estimates.
- Additional mortality data were scarce, most of which were in HICs.
- Clinical stability data were limited to clinical samples, which may overrepresent severe cases.
- Significant heterogeneity related to study design, diagnostic methods, and sample characteristics.
To try to minimize the impact of the data set, the study had strong criteria, and included a wide range of countries and set a good benchmark for further developing research.
Significant heterogeneity was found across studies, limiting the reliability of the results.
Implications for practice
This study provides a comprehensive review of ‘personality disorder’ epidemiology to date, revealing its significant prevalence, clinical stability and association with increased mortality, although cautioned with a series of data limitations.
It would not be unusual for staff within clinical services to hypothesize that borderline personality disorder (BPD) is more common in women and antisocial personality disorder is more common in men, although gender differences in these community-based studies are minimal and need to be considered in day-to-day practice.
The authors have highlighted that The prevalence rate of personality disorders identified in this study is similar to the global point prevalence identified for anxiety in the Global Burden of Disease Study 2021 and higher than that of depressive disorders (2.9%).. However, personality disorders do not get as much ‘airtime’ as other conditions and indeed are not included in GBD studies or evident in public health initiatives and service planning. Except on a larger scale, does it return to stigma and lethal isolation?
conclusion Highlight the need for better data collection, global recognition and tailored mental health services Effectively addressing the burden of personality disorders.
Future research should focus on underrepresented areas, adopt a dimensional diagnostic framework, and explore age-specific patterns of remission and stability.
The findings highlight the need for improved data collection, global validation and adapted mental health services to effectively address the burden of personality disorders.
Statement of Interests
Dr. Kirsten Lawson has no conflicts of interest to declare. No AI was used in the development of this blog.
edited by
Dr Simon Bradstreet.
Link
primary paper
Shadid, J., Ferrari, A.J., Bach, B., Sellboom, M., Sharp, C., Hutsebot, J., D’Huart, D., Santomauro, D.F., and Channon, A. (2025) Global epidemiology of personality disorders: a systematic review and meta-regression. Lancet Psychiatry 2025 12(12) 932 – 946
Other references
Watts, D and Morgan, G. (1994). Fatal separation. Danger to patients who are hard to like. The British Journal of Psychiatry 1994 164(1) 11-15
