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Tijdschrift voor Psychiatrie 49 (2007) 9, 597 - 609

New research

Personality disorders in an institution for ambulatory mental health care. Prevalence, type and severity, treatment indication and drop out

C.A. ten Kate, E.H.M. Eurelings-Bontekoe, N. Mulder, Ph. Spinhoven

summary
background Personality disorders occur frequently. The presence of one or more personality disorders can influence the severity of the symptoms and can affect coping, treatment indication and drop out.
aim To study the prevalence of personality disorders in an ambulatory health care centre and to investigate the influence of both the severity and the nature of personality disorders on the following: symptomatology, interpersonal behaviour, coping and defence mechanisms, personality traits, treatment indication and drop out.
method We studied the prevalence of personality disorders in 100 patients using the International Personality Disorder Examination (ipde), a semi-structured interview. Symptoms, interpersonal behaviour, coping and defence mechanisms and personality traits were assessed by means of self-reports. Patients were assigned to specific types of treatment by their own doctors, who were not aware of the assessment results.
results Most of the patients suffered from a personality disorder. Patients with cluster-A-type personality disorders were all assigned to treatment. The majority of patients with cluster- B-type personality disorders were assigned to Axis-ii-type treatment but most patients with cluster-A-and cluster-C personality disorders were assigned to Axis-I-type treatment. The dropout percentage was higher among patients with a personality disorder than among those without. Among patients with personality disorders the drop-out percentage was highest in those from the A and C clusters. Patients with personality pathology from the A cluster were 13 times more likely to drop out than those without A cluster pathology, patients with C cluster pathology were 11 times more likely to drop out than those without C cluster pathology.
conclusion In ambulatory mental health care more attention needs to be given to the diagnosis of personality disorders. Results suggest that in the treatment of patients with A and C cluster pathology much effort must be directed at fostering therapeutic alliance and compliance to treatment.

keywords coping behavior, coping skills, patient dropouts, personality disorders, prevalence