Hospital adjustment in personality disorder patients admitted to a therapeutic community milieu

This study investigated aspects of adjustment to the therapeutic community milieu in a group of personality disorder patients. Eighty-one patients con secutively admitted to the Cassel Hospital for medium/long-term residential treatment between April 1994 and October 1997 comprised the sample. The ad justment to the milieu was rated on the Hospital Adjustment Scale, while ou tcome was evaluated at G-monthly intervals using a battery of self-rated an d rater-based instruments. The aims of the study were: (a) to identify demo graphic and pre-admission clinical variables that would predict adjustment to the therapeutic regime; (b) to study the relationship between hospital a djustment and external social adjustment; and (c) to investigate the hypoth esis chat hospital adjustment and internally and externally directed aggres sion do not predict clinical outcome. The results showed that pre-admission level of global functioning and a previous history of substance misuse are the most significant predictors of hospital adjustment. No significant ass ociation between hospital adjustment and external social adjustment was fou nd. Neither hospital adjustment nor level of aggressiveness predicted outco me at 12 months. The implications of these results for therapeutic communit y treatment of personality disorder are discussed.