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Cassel Personality Disorder Study

Methodology and treatment effects

Cassel Hospital, Richmond, Surrey

PETER FONAGY, PhD

Psychoanalysis Unit, Sub-Department of Clinical Psychology, University College, London

Declaration of interest This study was supported by the Sir Jules Thorn Charitable Trust and North Thames Regional Research and Development.

Correspondence: Dr M. Chiesa, Cassel Hospital, I Ham Common, Richmond, Surrey TW107JF. e-mail: marco{at}cassel.ftech.co.uk

Background The effectiveness of hospital-based treatment models for personality disorder is still uncertain.

Aims To compare effectiveness of two models of psychosocial intervention for personality disorder.

Method Two samples of people with personality disorder allocated to a one-stage treatment model (in-patient treatment with no after care) and to a two-stage model (shorter in-patient admission followed by outreach therapy) are prospectively compared.

Results Subjects in the two-stage sample did significantly better on global assessment of mental health (according to the Global Assessment Score (GAS)) at 6 and 12 months and on social adjustment (according to the Social Adjustment Scale (SAS)) at 12 months. Significant differences in rates of reliable improvement on the GAS (43% v. 17%) and SAS (39% v. 15%) in favour of the two-stage condition were found at 12 months. Subjects with borderline personality disorder (BPD) allocated to the two-stage model improved significantly more than such patients in the one-stage model.

Conclusions A long-term phased model which combines hospital-based and community-based strategies has advantages over a purely in-patient model for the treatment of BPD.

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