The burden of personality disorder: A district-based survey

Patients with a clinical diagnosis of personality disorder (PD) often suffe r prolonged distress. They are a considerable burden on psychiatric service s and they are experienced as difficult to manage by their keyworkers. This paper describes the creation of a community-based case register of patient s suffering from PD. It explores the relationship between psychological dis tress, personality dysfunction, service utilisation and keyworker stress. Mental Health workers were asked to identify those patients on their caselo ad whose primary problem was PD. This list provided the basis for the case register. Patients completed the revised Personality Diagnostic Questionnai re IV (PDQ 4); the General Health Questionnaire (GHQ); and the Beck Depress ion Inventory - 21 item (BDI). A brief, semi-structured interview was condu cted by Community Psychiatric Nurses to estimate service utilisation and ke yworker stress. The mean GHQ was -14.58; the mean BDI score was 28.22. The mean number of P Ds per patient was 4.5. One quarter of patients (21/80) had been admitted a t least once to a psychiatric ward in the previous year and 17% (13/80) had presented to casualty at least once in the previous two months. 57% of the patients had weekly or more contacts with a helping agency. The number of PD diagnoses per patient as measured by the PDQ 4 was not found to be predi ctive of stress experienced by CPNs, whereas high BDI and GHQ scores were s trongly correlated. Similarly, the number of admissions to a psychiatric wa rd was associated with high BDI and GHQ scores but not with number of PDs p er patient. It is feasible to establish a case register of all patients in the district with PD. There are high levels of depression and distress amongst patients with PD being treated as outpatients. Service utilisation and keyworker st ress are not predicted by number of PDs per patient but are strongly associ ated with distress as measured by the GHQ and BDI. The implications of thes e findings are discussed.