Personality disorder and suicide risk among patients in the veterans affairs health system.

Nelson, Sharon M.; Griffin, Cameron; Hein, Tyler C.; Bowersox, Nicholas W.; McCarthy, John F.

doi:10.1037/per0000521

Cited by 5 publications

(3 citation statements)

References 46 publications

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“…As such, personality disorder diagnosis was categorized as a general, unidimensional construct. Moreover, we coded personality disorder diagnosis based on a single visit, which may have decreased accuracy relative to convergence across two separate visits (Nelson et al, 2022). As such, an important next step in extending this research would be to examine specific personality disorder diagnoses using an empirically validated approach (e.g., Structured Clinical Interview for DSM-5 Personality Disorder).…”

Section: Discussionmentioning

confidence: 99%

Personality Disorder Diagnosis Among Justice-Involved Veterans

et al. 2023

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Justice-involved veterans are more likely to experience myriad mental health sequelae. Nonetheless, examination of personality psychopathology among justice-involved veterans remains limited, with studies focused on males within correctional settings. We examined Department of Veterans Affairs (VA) electronic medical records for 1,534,108 (12.28% justice-involved) male and 127,230 (8.79% justice-involved) female veterans. Male and female veterans accessing VA justice-related services were both approximately three times more likely to have a personality disorder diagnosis relative to those with no history of using justice-related services. This effect persisted after accounting for VA use (both overall and mental health), age, race, and ethnicity. Augmenting and tailoring VA justice-related services to facilitate access to evidence-based psychotherapy for personality psychopathology may promote optimal recovery and rehabilitation among these veterans.

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Section: Discussionmentioning

confidence: 99%

Personality Disorder Diagnosis Among Justice-Involved Veterans

et al. 2023

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“…As much of this previous work utilized gold-standard diagnostic methods (e.g., structured diagnostic interviews), this discrepancy may suggest issues with clinician approaches to identify and treat PDs within the VHA patient population. This may be especially relevant in veteran samples as it has been speculated that clinicians may be hesitant to provide PD diagnoses within the VHA system for several reasons, including that PDs are not conditions which make VHA patients eligible for service-connected disability benefits and the lack of appropriate treatment referral options available (Dean, 2021, Nelson et al, 2021). Differences in access to treatment or the quality of diagnostic assessment were not evaluated in terms of their potential impact on diagnosis, treatment, or outcomes.…”

Section: Discussionmentioning

confidence: 99%

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

Nelson¹,

Merrill²,

Bowersox³

2023

Psychological Services

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Individuals with serious mental illnesses (SMI) or personality disorders (PD) have complex treatment needs and are at risk of adverse outcomes. Yet, little is known about the impact of comorbid SMI and PD on risk factors. This study used the Veterans Health Administration (VHA)’s corporate data warehouse (CDW) to assess the differences between those with and without a comorbid PD, as well as the prevalence and impact of PD diagnoses on high-intensity/emergency service utilization in VHA patients with a SMI diagnosis (schizophrenia spectrum disorders and bipolar spectrum disorders). In fiscal year 2018, 163,904 VHA patients had encounters that listed SMI diagnoses, including 9,216 patients who had encounters that listed PD diagnoses. Bivariate analyses and logistic regression were used to compare group characteristics and determine whether a PD diagnosis was associated with utilization of high-intensity care services. The SMI with no PD and SMI with comorbid PD (SMI–PD) groups differed in terms of demographic, medication, clinical, and service utilization characteristics, including that the SMI–PD group was 5.25 times more likely to have documented suicide risk and 4.73 times more likely to have documented behavioral risk. After controlling for multiple patient characteristics, patients in the SMI–PD group were 1.35 times more likely to have some emergency department (ED) utilization and 1.94 times more likely to have some inpatient mental health use. Having a diagnosed comorbid PD was associated with increased prevalence of medical and psychiatric problems. Findings suggest that patients with comorbid PDs have particularly high-treatment needs and may benefit from assessment of, and adapted treatments for, PDs.

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“…In their various forms, PDs are associated with high social costs, including excessive psychiatric and physical medical treatment utilization, interpersonal and sexual violence, other criminal behavior, and lower educational and occupational attainment (Gatner et al, 2022; Soeteman et al, 2008; Tyrer et al, 2010). Most concerning clinically, is that some forms of PD are associated with dramatically higher risk for suicide attempts and completion (Ansell et al, 2015; Nelson et al, 2021).…”

Section: Why a New Path Is Needed: Problems With Traditional Personal...mentioning

confidence: 99%

It’s time to replace the personality disorders with the interpersonal disorders.

Wright

Ringwald

Hopwood

et al. 2022

American Psychologist

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Personality disorders (PDs) are among the most common and severe classes of psychopathology. From a clinical perspective, it is challenging to help individuals with personality disorders because treatment ruptures, discontinuation, reversals, and failures are relatively common. An additional clinical challenge is that the model used to diagnose personality disorders is demonstrably incorrect. Recent efforts to improve diagnosis of personality disorders apply two criteria: the first distinguishes personality disorders from other kinds of psychopathology and the second distinguishes different types of personality disorders. However, this approach has been problematic in that, as currently operationalized, it does not provide a clear demarcation for personality disorders, and it uses a framework for individual differences that is more apt as a model of variation in psychopathology in general. This article proposes that the core of personality disorders involves difficulties understanding and relating to self and others, and thus the personality disorders should be recast as the interpersonal disorders. Interpersonal dysfunction explains extreme social challenges and treatment difficulties that are characteristic of this class of psychopathology. This approach provides a clearer model for distinguishing these kinds of problems, as demonstrated by reformulating traditional personality disorder symptoms from an interpersonal perspective. Public Significance StatementPersonality disorders are among the most common and severe classes of psychopathology. Research and intervention development for personality disorders is held back by an invalid diagnostic system. Replacing the personality disorders with the interpersonal disorders would provide a more valid, ethical, useful, and clinically compelling model.

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Personality disorder and suicide risk among patients in the veterans affairs health system.

Cited by 5 publications

References 46 publications

Personality Disorder Diagnosis Among Justice-Involved Veterans

Personality Disorder Diagnosis Among Justice-Involved Veterans

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

It’s time to replace the personality disorders with the interpersonal disorders.

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