Psychosocial treatment refusal in personality disorder: A comparative study

There is a paucity of research concerning the identification 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 significantly 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 significant contribution to treatment uptake. A logistic regression analysis showed that assessment-related variables total score and BPD were significant 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 findings. Copyright (C) 2010 John Wiley & Sons, Ltd.