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Personality Disorders and Long-Term Sick Leave: A Population-Based Study of Young Adult Norwegian Twins

  • Line C. Gjerde (a1), Espen Røysamb (a1) (a2), Nikolai Czajkowski (a1) (a2), Gun Peggy Knudsen (a1), Kristian Østby (a1), Kristian Tambs (a1), Kenneth S. Kendler (a3) (a4), Ted Reichborn-Kjennerud (a1) (a5) and Ragnhild E. Ørstavik (a1)...


Personality disorders (PDs) reduce global functioning, are associated with high levels of work disability, and are thus also likely to influence long-term sick leave (LTSL). Previous research has indicated significant genetic influence on both DSM-IV PDs and LTSL. To what degree genes contributing to PDs also influence LTSL has not been investigated. The aims of the current study were to investigate which PDs were significantly associated with LTSL, to what extent the genetic contributions to these PDs account for the heritability of LTSL, and to explore the hypothesis of a causal association between PDs and LTSL. The sample consisted of 2,771 young, adult Norwegian twins, born 1967–1979. PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV). The age range for the interview was 20–32. The data were subsequently linked to public records of LTSL (sick leave >16 days) up to 11 years later. The odds ratio for being in the highest LTSL category (>15% sick leave) when fulfilling the DSM-IV criteria for any PD diagnosis was 2.6 (1.8–3.8, 95% CI). Dimensional representations of schizotypal, paranoid, and borderline PD were independently and significantly associated with LTSL. The heritability of LTSL was 0.50. Genetic factors shared with the PDs accounted for 20% of this. The association between PDs and LTSL was due to shared genetic and not environmental influences, and was mainly explained by one common genetic factor. The hypothesis of a causal association was not supported, indicating that the association is explained by overlapping genetic liability between PDs and LTSL.


Corresponding author

address for correspondence: Line C. Gjerde, Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403 Oslo, Norway. E-mail:


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Akaike, H. (1987). Factor analysis and AIC. Psychometrica, 52, 317332.
Akselsen, A., Lien, S., & Siverstøl, Ø. (2007). FD-Trygd. List of variables. Oslo: Statistics Norway.
APA (American Psychiatric Association). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
APA. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev). Washington, DC: Author.
Boker, M. S., Neale, M. C., Maes, H., Wilde, M., Spiegel, M., Brick, T., . . . Fox, J. (2011). OpenMx: An open source extended structural equation modeling framework. Psychometrica, 76, 306317.
Coid, J., Yang, M., Tyrer, P., Roberts, A., & Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry, 188, 423431.
De Moor, M. H. M., Boomsma, D. I., Stubbe, J. H., Willemsen, G., & de Geus, E. J. C. (2008). Testing causality in the association between regular exercise and symptoms of anxiety and depression. Archives of General Psychiatry, 65, 897905.
Dekkers-Sanchez, P. M., Hoving, J. L., Sluiter, J. K., & Frings-Dresen, M. H. W. (2008). Factors associated with long-term sick leave in sick-listed employees: A systematic review. Occupational and Environmental Medicine, 65, 153157.
Dobson, A. J. (2002). An introduction to generalized linear models. London: Chapman & Hall/CRC.
Falconer, D. S. (1965). Inheritance of liability to certain diseases estimated from incidence among relatives. Annals of Human Genetics, 29, 5176.
Gjerde, L. C., Czajkowski, N., Roysamb, E., Orstavik, R. E., Knudsen, G. P., Østby, K., . . . Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126, 448457.
Gjerde, L. C., Knudsen, G. P., Czajkowski, N., Gillespie, N., Aggen, S. H., Røysamb, E., . . . Ørstavik, R. E. (2013). Genetic and environmental contributions to long-term sick leave and disability pension: A population-based study of young adult Norwegian twins. Twin Research and Human Genetics, 16, 759766.
Gjesdal, S., & Bratberg, E. (2003). Diagnosis and duration of sickness absence as predictors for disability pension: Results from a three-year multi-register based and prospective study. Scandinavian Journal of Public Health, 31, 246254.
Gjesdal, S., Haug, K., & Ringdal, P. R. (2005). The risk of disability pension among young persons on long-term sick leave. Tidsskrift for Den Norske Lægeforeningen, 125, 18011805.
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., . . . Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69, 533545.
Henderson, M., Harvey, S. B., Overland, S., Mykletun, A., & Hotopf, M. (2011). Work and common psychiatric disorders. Journal of the Royal Society of Medicine, 104, 198207.
Hensing, G., Andersson, L., & Brage, S. (2006). Increase in sickness absence with psychiatric diagnosis in Norway: A general population-based epidemiologic study of age, gender and regional distribution. BMC Medicine, 4, 19.
Holm, A. L., & Severinsson, E. (2008). The emotional pain and distress of borderline personality disorder: A review of the literature. International Journal of Mental Health Nursing, 17, 2735.
Huang, Y., Kotov, R., de Girolamo, G., Preti, A., Angermeyer, M., Benjet, C., . . . Kessler, R. C. (2009). DSM–IV personality disorders in the WHO World Mental Health Surveys. British Journal of Psychiatry, 195, 4653.
Hultin, H., Lindholm, C., & Moller, J. (2012). Is there an association between long-term sick leave and disability pension and unemployment beyond the effect of health status? A cohort study. Plos One, 7, e35614.
Jinks, J. L., & Fulker, D. W. (1970). Comparison of biometrical genetical, MAVA, and classical approaches to analysis of human behavior. Psychological Bulletin, 73, 311349.
Kendler, K. S., Aggen, S. H., Czajkowski, N., Roysamb, E., Tambs, K., Torgersen, S., . . . Reichborn-Kjennerud, T. (2008). The structure of genetic and environmental risk factors for DSM-IV personality disorders: A multivariate twin study. Archives of General Psychiatry, 65, 14381446.
Kendler, K. S., Aggen, S. H., Knudsen, G. P., Roysamb, E., Neale, M. C., & Reichborn-Kjennerud, T. (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV Axis I and All Axis II disorders. American Journal of Psychiatry, 168, 2939.
Kendler, K. S., Czajkowski, N., Tambs, K., Torgersen, S., Aggen, S. H., Neale, M. C., & Reichborn-Kjennerud, T. (2006). Dimensional representations of DSM-IV Cluster A personality disorders in a population-based sample of Norwegian twins: A multivariate study. Psychological Medicine, 36, 15831591.
Kendler, K. S., Myers, J., Torgersen, S., Neale, M. C., & Reichborn-Kjennerud, T. (2007). The heritability of cluster A personality disorders assessed by both personal interview and questionnaire. Psychological Medicine, 37, 655665.
Kendler, K. S., Neale, M. C., MacLean, C. J., Heath, A. C., Eaves, L. J., & Kessler, R. C. (1993). Smoking and major depression. A causal analysis. Archives of General Psychiatry, 50, 3643.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593602.
Knudsen, A. K., Harvey, S. B., Mykletun, A., & Overland, S. (2013). Common mental disorders and long-term sickness absence in a general working population. The Hordaland Health Study. Acta Psychiatrica Scandinavica, 127, 287297.
Knudsen, A. K., Skogen, J. C., Harvey, S. B., Stewart, R., Hotopf, M., & Moran, P. (2012). Personality disorders, common mental disorders and receipt of disability benefits: Evidence from the British National Survey of Psychiatric Morbidity. Psychological Medicine, 42, 26312640.
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62, 553564.
Ligthart, L., & Boomsma, D. I. (2012). Causes of comorbidity: Pleiotropy or causality? Shared genetic and environmental influences on migraine and neuroticism. Twin Research and Human Genetics, 15, 158165.
Livesley, W. J., & Jang, K. L. (2000). Toward an empirically based classification of personality disorder. Journal of Personality Disorders, 14, 137151.
Magnus, P., Berg, K., & Nance, W. E. (1983). Predicting zygosity in Norwegian twin pairs born 1915–1960. Clinical Genetics, 24, 103112.
Marinangeli, M. G., Butti, G., Scinto, A., Di Cicco, L., Petruzzi, C., Daneluzzo, E., & Rossi, A. (2000). Patterns of comorbidity among DSM-III-R personality disorders. Psychopathology, 33, 6974.
Martin, N. G., & Eaves, L. J. (1977). The genetical analysis of covariance structure. Heredity, 38, 7995.
McCrae, R. R., & Costa, P. T. Jr. (1990). Personality in adulthood. New York: Guilford Press.
McCrae, R. R., Lockenhoff, C. E., & Costa, P. T. (2005). A step toward DSM-V: Cataloguing personality-related problems in living. European Journal of Personality, 19, 269286.
Michon, H. W. C., ten Have, M., Kroon, H., van Weeghel, J., de Graav, R., & Schene, A. H. (2008). Mental disorders and personality traits as determinants of impaired work functioning. Psychological Medicine, 38, 16271637.
Moncrieff, J., & Pomerleau, J. (2000). Trends in sickness benefits in Great Britain and the contribution of mental disorders. Journal of Public Health Medicine, 22, 5967.
Nakao, K., Gunderson, J. G., Phillips, K. A., Tanaka, N., Yorifuji, K., Takaishi, J., & Nishimura, T. (1992). Functional impairment in personality disorders. Journal of Personality Disorders, 6, 2433.
Neale, M. C. (2003). A finite mixture distribution model for data collected from twins. Twin Research, 6, 235239.
Neale, M. C., & Cardon, L. R. (1992). Methodology for genetic studies of twins and families. Dordrecht: Kluwer Academic.
Neale, M. C., & Kendler, K. S. (1995). Models of comorbidity for multifactorial disorders. American Journal of Human Genetics, 57, 935953.
Neale, M. C., & Maes, H. H. (2000). Methodology for genetic studies of twins and families. Dordrecht: Kluwer Academic.
Neale, M. C., Roysamb, E., & Jacobson, K. (2006). Multivariate genetic analysis of sex limitation and G x E interaction. Twin Research & Human Genetics, 9, 481489.
Noren, K., Lindgren, A., Haellstom, T., Thormaehlen, B., Vinnars, B., Wennberg, P., . . . Barber, J. P. (2007). Psychological distress and functional impairment in patients with personality disorders. Nordic Journal of Psychiatry, 61, 260270.
NOU (Norwegian Official Reports). (2000). Sickness absence and disability pensioning — A labour market for all (Norwegian Official Reports 2000:27). Oslo: Author.
OECD (Organisation for Economic Co-operation and Development). (2010). Sickness, disability and work. Breaking the barriers. A synthesis of findings across OECD countries. Paris: Author.
Østby, K. A., Czajkowski, N., Knudsen, G. P., Gjerde, L. C., Kendler, K. S., Ørstavik, R. E., & Reichborn-Kjennerud, T. (submitted). Personality disorders are an important risk factor for disability pensioning.
Pfohl, B., Blum, N., & Zimmerman, M. (1995). Structured Interview for DSM-IV Personality (SIDP-IV). Iowa City, IA: Department of Psychiatry, University of Iowa.
Reichborn-Kjennerud, T., Czajkowski, N., Neale, M. C., Orstavik, R. E., Torgersen, S., Tambs, K., . . . Kendler, K. S. (2007). Genetic and environmental influences on dimensional representations of DSM-IV Cluster C personality disorders: A population-based multivariate twin study. Psychological Medicine, 37, 645653.
Roysamb, E., Kendler, K. S., Tambs, K., Orstavik, R. E., Neale, M. C., Aggen, S. H., . . . Reichborn-Kjennerud, T. (2011). The joint structure of DSM-IV Axis I and Axis II disorders. Journal of Abnormal Psychology, 120, 198209.
Skodol, A. E., Johnson, J. G., Cohen, P., Sneed, J. R., & Crawford, T. N. (2007). Personality disorder and impaired functioning from adolescence to adulthood. British Journal of Psychiatry, 190, 415420.
Soderberg, E., & Alexanderson, K. (2003). Sickness certification practices of physicians: A review of the literature. Scandinavian Journal of Public Health, 31, 460474.
SSB (Statistics Norway StatBank). (2013). Population's level of education. Oslo: Author. Retrieved from
Stormer, S., & Fahr, R. (2013). Individual determinants of work attendance: Evidence on the role of personality. Applied Economics, 45, 28632875.
Suvisaari, J., Aalto-Setala, T., Tuulio-Henriksson, A., Harkanen, T., Saarni, S. I., Perala, J., . . . Lonnqvist, J. (2009). Mental disorders in young adulthood. Psychological Medicine, 39, 287299.
Svedberg, P., Ropponen, A., Alexanderson, K., Lichtenstein, P., & Narusyte, J. (2012). Genetic susceptibility to sickness absence is similar among women and men: Findings from a Swedish twin cohort. Twin Research and Human Genetics, 15, 642648.
Tambs, K., Ronning, T., Prescott, C. A., Kendler, K. S., Reichborn-Kjennerud, T., Torgersen, S., & Harris, J. R. (2009). The Norwegian Institute of Public Health twin study of mental health: Examining recruitment and attrition bias. Twin Research and Human Genetics, 12, 158168.
Torgersen, S., Czajkowski, N., Jacobson, K., Reichborn-Kjennerud, T., Roysamb, E., Neale, M. C., & Kendler, K. S. (2008). Dimensional representations of DSM-IV Cluster B personality disorders in a population-based sample of Norwegian twins: A multivariate study. Psychological Medicine, 38, 16171625.
Torgersen, S., Myers, J., Reichborn-Kjennerud, T., Røysamb, E., Kubarych, T., & Kendler, K. S. (2012). The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire. Journal of Personality Disorders, 26, 848866.
Trull, T. J., & Durrett, C. A. (2005). Categorical and dimensional models of personality disorder. Annual Review of Clinical Psychology, 1, 355380.
Vaez, M., Rylander, G., Nygren, A., Asberg, M., & Alexanderson, K. (2007). Sickness absence and disability pension in a cohort of employees initially on long-term sick leave due to psychiatric disorders in Sweden. Social Psychiatry and Psychiatric Epidemiology, 42, 381388.
Vlasveld, M. C., van der Feltz-Cornelis, C. M., Anema, J. R., van Mechelen, W., Beekman, A. T., van Marwijk, H. W., & Penninx, B. W. (2012). The associations between personality characteristics and absenteeism: A cross-sectional study in workers with and without depressive and anxiety disorders. Journal of Occupational Rehabilitation, 23, 309317.
Widiger, T. A., & Mullins-Sweatt, S. N. (2009). Five-factor model of personality disorder: A proposal for DSM-V. Annual Review of Clinical Psychology, 5, 197220.
Widiger, T. A., & Trull, T. J. (2007). Plate tectonics in the classification of personality disorder — Shifting to a dimensional model. American Psychologist, 62, 7183.



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