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Personality disorders and unmet needs among psychiatric inpatients.


Abstract

OBJECTIVE: This study sought to examine the association between unmet need and personality disorders in a sample of psychiatric inpatients. The authors tested the hypothesis that the presence of a personality disorder would be independently associated with a significantly greater number of unmet needs.

METHODS: A total of 153 psychiatric inpatients from four acute hospital wards serving an inner-city borough in London, United Kingdom, received standardized assessments of need and personality disorder by use of the Camberwell Assessment of Need Short Assessment Schedule and Structured Clinical Interview for DSM-IV Personality Disorders.

RESULTS: Fifty-four percent of the sample had a personality disorder. The presence of a personality disorder was associated with greater unmet need. In multiple regression analyses, after adjustment was made for the effects of all covariates, severity of personality disorder was significantly associated with unmet need. Personality disorder was significantly associated with greater need in eight of 22 domains of need: self-care, psychotic symptoms, psychological distress, risk to self, risk to others, alcohol use, sexual expression, and budgeting.

CONCLUSIONS: Personality disorder was found to be independently associated with a greater level of unmet need among psychiatric inpatients. The study highlights for the first time the importance of a comprehensive assessment of need for patients with personality disorders.


Hayward, M., Slade, M., & Moran, P. A. (2006). Personality Disorders and Unmet Needs Among Psychiatric Inpatients. Psychiatric Services, 57(4), 538–543. doi:10.1176/ps.2006.57.4.538

 

Note from PDV!: It is important to look at the link between personality disorder and high levels of neediness from several different angles. "In a mental health context, needs include broad domains of health and social functioning, which are necessary to survive and prosper in the community". It is not surprising that a diagnosis which has it's theoretic basis in culturally inappropriate behaviour to have it's symptoms represent a difficulty integrating and engaging in a community. Irregular social skills and difficulties with relationship aspects are not uncommon in people who have trauma, especially childhood trauma, these are adaptive when you are dealing with ongoing abuse or neglect but seem odd or inappropriate when removed from the context. The link between childhood adversity and chronic health problems has been demonstrated, as is chronic stress and increased risk of a whole host of health issues. We must also consider that within the pool of people diagnosed with certain PDs are people with unrecognised neurodivergence, especially women but probably also people of other genders who present in non-stereotyped ways.


As easy as it is to say "well, we clearly need to assess psych patients for PDs to know who might be more needy!" I would caution against this. I would suggest instead that this link between unmet needs and PD criteria could also be evidence for the idea that many PDs are the stigmatised pathologisation of especially "needy" people, in both the common parlance and this very specific definition. A glaring issue of the construct of PDs is that it does not address common aetiology nor make any attempt to address the link between childhood adversity and the development of these symptoms, and the criteria represents a very shallow understanding of the experiences of people who experience it. Those who self harm for sensory reasons are distinct from those that self harm for emotional regulation, but both are lumped in under BPD, for one example. The fact that those who have greater unmet needs just so happen to end up with possibly the most stigmatising diagnosis that enables clincians and services to reject and dismiss them is incredibly suspect to me.

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