Psychosocial treatment refusal in personality disorder: a comparative study

Abstract

There is a paucity of research concerning the identifi cation of features implicated in treatment refusal by personality disorder. This study aims to identify clinical factors that may affect treatment uptake to a specialist psychosocial programme for personality disorder. Following a lengthy assessment, 39 patients (out of a total of 60 referrals) were offered entry to the programme. Fourteen patients who did not take up the offer of treatment and 25 patients who started the programme are compared on a number of demographic, diagnostic and clinical variables, including severity of presentation and subjective experience of the assessment process. The results show that, relative to non-refusers, refusers were signifi cantly younger, single, had a higher frequency of borderline personality disorder (BPD), experienced a less satisfactory relationship with the assessing clinician and had lower treatment expectations. Several dimensions measuring severity of presentation did not make a signifi cant contribution to treatment uptake. A logistic regression analysis showed that assessment-related variables total score and BPD were signifi cant predictors of treatment refusal. The low sample size and the specialist nature of the service are important limitations with regard to the generalizability of the fi ndings.

Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: A preliminary study

“…Internal consistency for the PAEQ total mean score and individual dimensions were calculated from the raw scores obtained from the study sample. In a previous study 16 the PAEQ showed a satisfactory level of internal consistency for the whole test (α = 0.82). Two out of the five dimensions (Therapeutic relationship = 7.42 ± 2.67, α = 0.82; and Expectation = 6.92 ± 2.72, α = 0.72) had a good level of Cronbach's alpha; another two (Perceived stress = 4.47 ± 2.33, α = 0.59; and Barriers to access = 6.47 ± 2.80, α = 0.53) showed a lower internal consistency and only one had an unacceptable value (Motivation = 7.45 ± 2.02, α = 0.30).…”

“…The PAEQ is a 10‐item self‐report measure that evaluates five dimensions relevant to the assessment of the subjective initial approach of patients who are engaged in the program. It has already been used in a previous study 16 to underline reasons which have an impact on treatment uptake. Service users are asked to self‐rate their perception and their personal experience regarding: (i) relationships with professionals; (ii) patients' expectations regarding the effectiveness of the proposed treatment; (iii) their motivation to engage in long‐term therapy and perceived need for change; (iv) the degree of distress elicited during the assessment process; and (v) the presence of possible adverse life circumstances and barriers to access into the treatment (for example, external life problems or logistic factors, such as timetable clashes, working or family engagements, etc.).…”

“…On the other hand, a group may elicit dysfunctional mechanisms, such as splitting and fragmentation, or behavior, such as manipulation among patients and staff. Teamwork is central to prevent splitting and to keep patients in treatment, by providing meaning, consistency and cohesion within the group 15,16 …”

Anger rumination and aggressive behaviour in borderline personality disorder

“…Borderline personality disorder (BPD) is a disorder characterized by problematic clinical features such as impulsiveness, emotional instability, interpersonal difficulties and dysfunctional cognitive processes (American Psychiatric Association, ). These clinical features also have a strong impact on an individual's general functioning (Skodol et al, ), treatment compliance (Chiesa, Martino & Pozzi, ; Martino, Menchetti, Pozzi, & Berardi, ), physical health status (Douzenis, Tsopelas, & Tzeferakos, ) and on their relationship with relatives and other people that live with them (Martino et al, ).…”

Adaptation and Psychometric Evaluation of the Italian Version of the Attitude to Personality Disorder Questionnaire (APDQ)

“…The management of this clinical population is notoriously problematic due to poor treatment compliance (Chiesa, Martino, & Pozzi, 2010; Martino, Menchetti, Pozzi, & Berardi, 2012) and the difficulties in maintaining balanced relationships with the clinicians as well as the people and family members who have contacts with patients (Martino et al, 2014). A psychometric instrument that assesses the attitude of clinicians and staff is important in evaluating and eventually preventing negative attitudes toward patients with PD because these attitudes can drastically affect general PD patient care and the quality of treatment that is provided.…”