Influence of apparently negative personality characteristics on the long‐term outcome of health anxiety: Secondary analysis of a randomized controlled trial

Abstract

Background It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long‐term impact are few. We examined the influence of personality status on the 8‐year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. Aims This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. Method Personality dysfunction, using both ICD‐10 and ICD‐11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty‐four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT‐HA) or standard care. Total costs over follow‐up were calculated from hospital data and compared by personality group. Results At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD‐10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those with personality disorder adhered more closely to CBT‐HA, and after 8 years, they had a significantly better outcome than those with personality difficulty and no personality disorder (p < 0.002). Similar results were found in those scoring high on the Dependent Personality Questionnaire. All these differences increased over the follow‐up period. Costs were similar in all groups but were somewhat higher in the CBT‐HA one; this finding is hypothesised to be due to fuller hospital treatment once health anxiety is discounted. Conclusion Personality disorder in people with health anxiety, particularly in those who have anxious and dependent traits, reinforces the benefits of cognitive behaviour therapy, particularly in the longer term. © 2020 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd

The recording of personality strengths: An analysis of the impact of positive personality features on the long‐term outcome of common mental disorders

“…A personality problem can be a personality strength at the same time. In another study of the treatment of health anxiety in medical patients with an adapted form of CBT, those with personality disorder had significantly better outcomes compared with non‐personality disordered patients, and the findings suggested that better adherence to the treatment programme and lower drop‐outs in the personality disordered group (who had prominent anankastic and anxious domain traits) was the main reason for this (Tyrer, Wang, et al, 2021 ).…”

Myths and misunderstanding about personality disorder

“…Figure 2 shows the long-term outcome (8 years) of over 400 patients treated with health anxiety in a randomised controlled trial using a psychological method based on cognitive behavioural therapy. 11 Those with a high degree of dependent personality at baseline had a much better outcome with treatment than others with low degrees of dependence. Quite a few of those with high dependence were men.…”

“…It is also unwise to assume automatically that those with personality problems will fare worse in treatment than others. Figure 2 shows the long‐term outcome (8 years) of over 400 patients treated with health anxiety in a randomised controlled trial using a psychological method based on cognitive behavioural therapy 11 . Those with a high degree of dependent personality at baseline had a much better outcome with treatment than others with low degrees of dependence.…”

“…Mean changes in levels of health anxiety in 444 patients separated by scores on the Dependent Personality Questionnaire (DPQ) over an 8‐year period 11 . Adapted from Tyrer P, Wang D, Tyrer H, et al .…”

Consensus building and clinical translation: The path to an impactful and evidence‐based personality disorder classification system

“…Finally, Tyrer et al 14 . present the results of a randomized clinical treatment trial of patients with health anxiety, some of whom met ICD‐11 criteria for PD, whereas others did not.…”