The impact of a diagnosis of personality disorder on service usage in an adult Community Mental Health Team
- 433 Downloads
Patients with a diagnosis of personality disorder (PD) have multiple and diverse needs. It has been noted that individuals with personality disorder are high users of health care resources, especially psychiatric services, ambulance services and emergency departments. In addition PD has been shown to be a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions. This study aimed to compare the patterns of service usage, clinical ratings of symptoms and functioning, as well as demographic and clinically relevant historical variables between a group of patients with PD and a random sample of all other patients registered with a South London Community Mental Health Team.
A case–control design was used to examine service usage patterns over a one-year period for 73 cases and 96 controls. Diagnoses were established by clinician discussion. Clinical outcomes were measured with Health of the Nation Outcome Scales and Global Assessment of Functioning, while service use was recorded using ten variables obtained from case note review.
People with a diagnosis of PD were more often white and had a history of abuse, particularly childhood emotional abuse. They were higher users of some aspects of the service as compared to controls, and had significantly higher severity of symptoms and poorer functioning on clinician-rated measures.
This study confirms previous findings that people with PD have more severe symptomatology and greater degrees of functional impairment when compared to those without. Community clinicians should routinely screen attenders to predict likely difficulties that might arise and to make provision for these difficulties in the treatment and management of clients.
KeywordsPersonality disorder Service use Community Mental Health Team
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 3.Jackson HJ, Burgess PM (2002) Personality disorders in the community: results from the Australian National Survey of Mental Health and Wellbeing Part II. Relationships between personality disorder, Axis I mental disorders and physical conditions with disability and health consultations. Soc Psychiatry Psychiatr Epidemiol 37:251–260PubMedCrossRefGoogle Scholar
- 10.Newton-Howes G, Tyrer P, Anagnostakis K, Cooper S, Bowden-Jones O, Weaver T, COSMIC study team (2010) The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in Community Mental Health Teams. Soc Psychiatry Psychiatr Epidemiol 45(4):453–460PubMedCrossRefGoogle Scholar
- 14.Tyrer P, Seivewright H (2000) Studies of outcome. In: Personality disorders: diagnosis, management and course, 2 edn. Butterworth-Heinemann, Oxford, pp 105–125Google Scholar
- 15.Dowson JH, Grounds AT (eds) (1995) Personality disorders, recognition and clinical management. Cambridge University Press, CambridgeGoogle Scholar
- 16.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Text Revision (DSM-IV-TR) WashingtonGoogle Scholar
- 17.World Health Organisation (1992) The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. World Health Organisation, GenevaGoogle Scholar
- 18.Wing JK, Curtis RH, Beevor AS (1996) HoNOS: health of the nation outcome scales. College Research Unit, LondonGoogle Scholar
- 20.SPSS Inc (2004) SPSS 12.0.2 [Computer software]. SPSS Inc., ChicagoGoogle Scholar
- 21.Siegel S, Castellan NJ (1988) Nonparametric statistics for the behavioural sciences, 2nd edn. McGraw-Hill, New YorkGoogle Scholar
- 22.Office of National Statistics (2003) Census 2001, Local Authority Profiles, http://www.ons.gov.uk/ons/rel/census/census-2001-local-authority-profiles/local-authority-profiles/london.pdf. Accessed 4 April 2012
- 29.National Institute of Mental Health in England (2003). Personality disorder: no longer a diagnosis of exclusion Department of HealthGoogle Scholar
- 31.Casey P (2000) The epidemiology of personality disorders. In: Tyrer P (ed) Personality disorders: diagnosis management and course, 2nd edn. Arnold, London, pp 71–79Google Scholar