In DSM-IV, a personality disorder is defined as an enduring pattern of inner experience and behavior manifested in cognition, affectivity, interpersonal functioning, or impulse control that is inflexible and enduring and that leads to clinically significant distress or impairment [19]. Whereas the assumption of lifetime persistent course for personality disorders is challenged by studies showing symptomatic remission after several years [20,21], such remissions may occur more slowly than axis I disorders, and impairment often persists long after symptoms remit [20,21]. Therefore, personality disorders have considerable public health and clinical significance. DSM-IV includes 10 personality disorders: antisocial, avoidant, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, schizoid, and schizotypal. The NESARC included seven personality disorders at wave 1 (antisocial, avoidant, dependent, histrionic, obsessivecompulsive, paranoid, schizoid) and three at wave 2 (borderline, narcissistic, and schizotypal) with antisocial personality disorder assessed at both waves 1 and 2. NESARC studies prior to 2011 showed considerable disability and comorbidity of substance use disorders associated across the range of DSM-IV personality disorders [5,22]. NESARC 2011 studies addressed the influence of personality disorders on the course of axis I disorders, and aspects of the cross-sectional associations of personality disorders with axis I disorders.
