title: Impact of personality status on the outcomes and cost of cognitive-behavioural therapy for health anxiety.
abstract: Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT).
  
  
  
  To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years.
  
  
  
  Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years.
  
  
  
  In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder.
  
  
  
  The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Rahil
authors.initials: R
authors.lastname: Sanatinia
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK p.tyrer@imperial.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Tyrer
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Tyrer
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Crawford
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Loebenberg
authors.affiliation: Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006998:Hypochondriasis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult