Treatment utilization by patients with personality disorders.
OBJECTIVE
Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder.


METHODS
Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups-schizotypal, borderline, avoidant, and obsessive-compulsive-and in a comparison group of patients with major depressive disorder.


RESULTS
Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment except self-help groups, and patients with obsessive-compulsive personality disorder reported greater utilization of individual psychotherapy. Patients with borderline personality disorder were also more likely to have used antianxiety, antidepressant, and mood stabilizer medications, and those with borderline or schizotypal personality disorder had a greater likelihood of having received antipsychotic medications. Patients with borderline personality disorder had received greater amounts of treatment, except for family/couples therapy and self-help, than the depressed patients and patients with other personality disorders.


CONCLUSIONS
These results underscore the importance of considering personality disorders in diagnosis and treatment of psychiatric patients. Borderline and schizotypal personality disorder are associated with extensive use of mental health resources, and other, less severe personality disorders may not be addressed sufficiently in treatment planning. More work is needed to determine whether patients with personality disorders are receiving adequate and appropriate mental health treatments.
Bender
D S
DS
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. benderd@pi.cpmc.columbia.edu
Dolan
R T
RT
Skodol
A E
AE
Sanislow
C A
CA
Dyck
I R
IR
McGlashan
T H
TH
Shea
M T
MT
Zanarini
M C
MC
Oldham
J M
JM
Gunderson
J G
JG
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001883:Borderline Personality Disorder / Q000188:drug therapy / Q000628:therapy; D003193:Compulsive Personality Disorder / Q000188:drug therapy / Q000628:therapy; D003631:Day Care, Medical; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010554:Personality Disorders / Q000188:drug therapy / Q000628:therapy*; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012569:Schizotypal Personality Disorder / Q000188:drug therapy / Q000628:therapy; D012657:Self-Help Groups
D011619:Psychotropic Drugs