Personality disorder is often underdiagnosed or misdiagnosed in secondary care settings. This can lead to challenges in accessing appropriate care for patients, and the allocation of resources in these services.
Objectives:
The primary objective was to estimate the rate of personality disorder in a cohort of individuals presenting to a typical urban secondary care mental health service in Australia. The secondary objective was to compare this to the recorded rate of personality disorder diagnosis in this setting.
Methods:
A retrospective chart review was completed for 376 patients (52.7% female, M = 47.26, SD = 16.99, 16–94 years). Data collected included the Standardised Assessment of Personality – Abbreviated Scale (SAPAS), a standardised screening tool for Personality Disorder. Demographic and clinical data included participant age, gender, location, presenting problem, diagnosis, and mortality. Statistical analyses included univariate analyses and the χ2 test of independence.
Results:
Of the entire sample, 289 participants (76.86%) completed the screening tool, with 214 participants (56.91%) meeting caseness for personality disorder. Comparatively, only 13 participants (3.46%) had a personality disorder diagnosis listed on their electronic medical records. The estimated rate of personality disorder was 16.46 times greater than the recorded rate of personality disorder diagnosis.
Conclusion:
Estimated rate of personality disorder using a brief screening tool was found to be very high in a large urban Australian secondary care mental health service. However, the recorded rate in the same service was found to be very low. The discrepancy found between estimated and recorded rates have potential implications for access to appropriate care and resource allocation in this setting. The results suggest health professionals may benefit from further education and training in the identification and clinical assessment of personality disorder.
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