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Social Functioning of Patients With Personality Disorder in Secondary Care

The authors are affiliated with the Department of Psychological Medicine, Imperial College, Exhibition Rd., London SW7 2AZ, United Kingdom (e-mail: giles.newton-howes{at}imperial.ac.uk).

OBJECTIVE: Patients with personality disorder are often viewed as falling outside the primary therapeutic role of specialist care. This focus on axis I disorders can lead to overlooking patients' personality function. This study explored the social dysfunction associated with personality function and its severity within secondary care. METHODS: A cross-sectional survey using census data, face-to-face interviews, and audit of case notes was used to collect information from secondary care populations in four urban settings in the United Kingdom. The Quick Personality Assessment Schedule, the Comprehensive Psychopathology Rating Scale, and operational criteria for diagnosis were used to confirm axis I and axis II disorders. Social functioning was assessed with the Camberwell Assessment of Need and the Social Functioning Questionnaire. Because this was a secondary analysis, a priori hypotheses were tested to the p=.01 level to minimize the possibility of type I error. RESULTS: A total of 2,528 key workers completed questionnaires (99%), and 282 randomly selected patients were interviewed (71%). Severity of personality disorder accounted for 14% of the variance in objective measure of social dysfunction and for 19% of the variance in subjective measure of social dysfunction. Of other mental disorders, only depression interacted significantly with either measure, according to multiple stepwise linear regression. CONCLUSIONS: Personality disturbance led to social dysfunction to a greater extent than most other pathology. In order to address the issue of social dysfunction, a variety of approaches are needed to turnattention toward personality pathology.

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