Skip to main content
Article thumbnail
Location of Repository

Personality disorder in primary care : factors associated with therapy process and outcome.

By Steven H. Jones, Gerrard Burrell-Hodgson, Graham Tate and Barry Fowler

Abstract

Assessment and treatment of personality disorder (PD) is a key issue in UK mental health service provision (NIMH report, 2003), but there is limited information on individuals with personality disorder presenting to primary care mental health services. This study investigates the characteristics of PD in individuals receiving cognitive behaviour therapy (CBT) following GP referral and its relationship with therapist ratings of treatment process and outcome. One hundred and forty-eight participants completed the Millon Multiaxial Clinical Inventory (MCMI-III: Millon, Davis and Millon, 1997). Therapists completed a measure of therapy process and outcome (TPOQ) on 100 participants. Key therapy and process questions were answered for 60 participants who attended a minimum of five therapy sessions. MCMI-III indicated a rate of PD of 56.4%. Factor analysis of PD scales identified two factors: inward looking/emotionally distanced, and aggressive/acting out. For clinical syndromes (CLS), the factors were general psychopathology and substance abuse. TPOQ had two factors: therapeutic alliance and complexity in therapy. Regression analyses indicated that only those PDs contributing to the inward looking/emotionally distanced scale score were associated with therapeutic alliance problems. Conversely, complexity in therapy was only predicted by general psychopathology and not by personality disorder. This study identified high rates of personality disorder in primary care referrals to a clinical psychology service. It also indicated that relationships between the presence of personality disorder and therapist ratings of treatment difficulties were only associated with certain types of personality disorder. These findings are discussed in relation to service and therapy planning in mental health

Year: 2006
OAI identifier: oai:eprints.lancs.ac.uk:31925
Provided by: Lancaster E-Prints

Suggested articles

Citations

  1. (1988). A comparison of three self-report questionnaires for the diagnosis of DSM-III disorders.
  2. (1993). An MCMI cluster typology of obsessive-compulsives: a measure of personality characteristics and its relationship to treatment participation, compliance and outcome in behavior therapy.
  3. (1991). An MCMI-II item-level component analysis: personality and clinical factors.
  4. (1998). Assessing the field effectiveness of Acceptance and Commitment Therapy: an example of the manipulated training research method.
  5. (2001). Clinical Psychology Summary Information for 2000-01,
  6. (2001). Clinical Psychology Summary Information for 2000-01, England. London: Department of Health. Dreessen,L.andArntz,A.(1998).Theimpactofpersonalitydisordersontreatmentoutcomeofanxiety disorders: best-evidence synthesis.
  7. (1994). Cluster A personality disorder: a marker of worse treatment outcome of major depression?
  8. (1993). Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa.
  9. (2002). Cluster C personality disorder impedes alleviation of symptoms in major depression. doi
  10. (1992). Comorbidity among anxiety disorders: implications for treatment and DSM-IV.
  11. (1992). Comorbidity of personality disorders and depression: implications for treatment.
  12. (1995). Contemporary practices of psychological assessment by clinical psychologists. doi
  13. (1990). Diagnosis of personality disorders by the Millon Clinical Multiaxial Inventory. doi
  14. (2002). Distinctive activities of cognitive-behavioral therapy. A review of the comparative psychotherapy process literature.
  15. (2002). Distinctive activities of cognitive-behavioral therapy. A reviewofthecomparativepsychotherapyprocessliterature.ClinicalPsychologyReview,22,671–706.
  16. (2003). Effectiveness of cognitive therapy for depression in a community mental health center: a benchmarking study.
  17. (1998). Factor structure of the MCMI-III.
  18. (2001). Is electroconvulsive therapy effective for the depressed patient with comorbid borderline personality disorder?
  19. (2000). Negotiating the Therapeutic Alliance.
  20. (2002). New developments in cognitive-behavioural case formulation. Epidemiological, systemic and social context: an integrative approach. doi
  21. (1992). Personality disorder and clinical syndrome factors of MCMI-II scales.
  22. (2002). Personality disorder, primary care counselling and therapeutic effectiveness.
  23. (1994). Personality disorders do not influence the results of cognitive behavior therapies for anxiety disorders.
  24. (1994). Personality disorders do not influence the results of cognitive behavior therapies for anxiety disorders. Comprehensive Psychiatry, 35, 265–274.Personality disorder in primary care
  25. (1999). Personality disorders have no excessively negative impact on therapist-rated therapy process in the cognitive and behavioural treatment of Axis I anxiety disorders.
  26. (2002). Personality pathology and treatment outcome in major depression: a review.
  27. (1997). Prediction of outcome and early vs. late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy.
  28. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia.
  29. (1995). Psychological test use in criminal forensic evaluation.
  30. (2001). Response to cognitive therapy in depression: the role of maladaptive beliefs and personality disorders.
  31. (1997). Structured Clinical Interview for DSM-IV Personality Disorders,
  32. (1996). The assessment of personality disorders: implications for cognitive and behavior therapy. doi
  33. (1985). The diagnosis of personality disorder: a comparison of MMPI profile, Million Inventory, and clinical judgment in a Workers’ Compensation population.
  34. (1993). The epidemiology of personality disorders. In
  35. (1997). The impact of personality disorders on behavioral treatment outcome for social phobia. doi
  36. (1998). The impact of personality disorders on treatment outcome of anxiety disorders: best-evidence synthesis.
  37. (1987). The MCMI as a measure of DSM-III Axis II diagnoses: an empirical comparison.
  38. (1993). The MCMI as a predictor of DSM-III diagnostic categories: a review of the empirical research. In
  39. (1990). The Millon Clinical Multiaxial Inventory (MCMI): a review. doi
  40. (2000). The prevalence of personality disorder among UK primary care attenders.
  41. (1990). The relationship between the MCMI personality scales and DSM-III, axis II. doi
  42. (1992). Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model.
  43. (2001). Using Multivariate Statistics.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.