Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial
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Background: It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. Aims: This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. Method: Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. Results: At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those with personality disorder adhered more closely to CBT-HA, and after 8 years, they had a significantly better outcome than those with personality difficulty and no personality disorder (p < 0.002). Similar results were found in those scoring high on the Dependent Personality Questionnaire. All these differences increased over the follow-up period. Costs were similar in all groups but were somewhat higher in the CBT-HA one; this finding is hypothesised to be due to fuller hospital treatment once health anxiety is discounted. Conclusion: Personality disorder in people with health anxiety, particularly in those who have anxious and dependent traits, reinforces the benefits of cognitive behaviour therapy, particularly in the longer term.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Personality and Mental Health |
| Vol/bind | 15 |
| Udgave nummer | 1 |
| Sider (fra-til) | 72-86 |
| Antal sider | 15 |
| ISSN | 1932-8621 |
| DOI | |
| Status | Udgivet - 2021 |
| Eksternt udgivet | Ja |
Bibliografisk note
Funding Information:
The project was funded by the National Institute for Health Research (NIHR) under its Health Technology Assessment (HTA) Programme (grant reference number 07/01/26). The views expressed are those of the authors and not necessarily of the NIHR or the Department of Health and Social Care. Paul Salkovskis, John Green, David Murphy, Barbara Barrett and Steven Reid were investigators, together with Peter Tyrer, Helen Tyrer and Mike Crawford, in the original trial. We particularly thank the Mental Health Research Network, and especially Sandra O'Sullivan, for adopting and promoting the trial, and support for excess treatment costs from the Department of Health. The North London and East Midlands hubs of the Mental Health Research Network, were invaluable in adopting, promoting and aiding recruitment in the trial, and it could not have been done without them. We thank Gene Paykel (chair) and later, John Brazier, Deborah Rutter and Paul Bassett of the Data Monitoring and Ethical Committee and Richard Mayou (chair), Amrit Sachar, Rosemary Davidson, Devaka Fernando and Roger Mulder of the Trial Steering Committee, and the many therapists who provided the treatment. We also thank Kate Davidson for her comments on the initial manuscript. Jayne Morton, Kevin Connolly, Mary Wyatt and Gail Marcuson acted as the support group (CHASSIS) in the study, and in addition to the main research assistants, Faye Cooper, Amy Murphy, Lorraine O'Connell, Kate Rhodes, Julie Sinclair, Brendon Stubbs, David Trevor and Gemma Walker were also active in recruitment. We also give special thanks to Sharon McAllister, Yvonne Lisseman-Stones, Sarah Finnis, Simon Dupont and Kate Rhodes for their help in organizing and giving therapy, and Ian Lovett, Keith Mitchelmore, Mary Tourette, Lotte Dinesen and Sachin Thakrar for their help in ensuring full hospital data over the 8-year period. We also are grateful to the 107 consultants, but especially John Rowley, Marcus Harbord, Derek Bell and Maurice Partridge, who supported the study from its outset. The full data from this study are available by contacting Peter Tyrer, Michael Crawford (m.crawford@imperial.ac.uk) and Duolao Wang (duolao.wang@lstmed.ac.uk).
Funding Information:
The project was funded by the National Institute for Health Research (NIHR) under its Health Technology Assessment (HTA) Programme (grant reference number 07/01/26). The views expressed are those of the authors and not necessarily of the NIHR or the Department of Health and Social Care. Paul Salkovskis, John Green, David Murphy, Barbara Barrett and Steven Reid were investigators, together with Peter Tyrer, Helen Tyrer and Mike Crawford, in the original trial. We particularly thank the Mental Health Research Network, and especially Sandra O'Sullivan, for adopting and promoting the trial, and support for excess treatment costs from the Department of Health. The North London and East Midlands hubs of the Mental Health Research Network, were invaluable in adopting, promoting and aiding recruitment in the trial, and it could not have been done without them. We thank Gene Paykel (chair) and later, John Brazier, Deborah Rutter and Paul Bassett of the Data Monitoring and Ethical Committee and Richard Mayou (chair), Amrit Sachar, Rosemary Davidson, Devaka Fernando and Roger Mulder of the Trial Steering Committee, and the many therapists who provided the treatment. We also thank Kate Davidson for her comments on the initial manuscript.
Publisher Copyright:
© 2020 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd
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