Personality Disorders as a Predictor of Outcome

This study is intended to determine whether the additional presence of personality disorder predicts poor hospital and posthospital recovery in psychiatric inpatients with Axis I disorders. Seventy-eight patients who were subsequently hospitalized had reliable DSM-III-R Axis I and personality disorder (PD) assessments. At hospital admission, at discharge, and at 1- and 2-year follow-up, measures of clinical functioning (BPRS, MADS, Health Sickness Scale), ratings of treatment completion, and working alliance were obtained. Thirty-five percent of patients met criteria for personality disorder. Personality disorder significantly predicted (at either the .01 or the .05 level) greater comorbidity at admission; poorer working alliance and treatment completion at discharge; poorer global outcome, symptomatic severity, autonomy, and social investments at 1-year follow-up; and poorer interpersonal relationships at 2 years. At 2 years, PD patients had obtained more therapy but these were less specific treatments. DSM-III-R personality disorder diagnosis is suggested to be a valuable predictor of slow recovery, poor treatment compliance, and long-term psychosocial risk in psychiatric inpatients. Treatment resistance in PD patients should be a major target of clinical intervention, research, and institutional policies.