Democratic therapeutic community treatment for personality disorder: randomised controlled trial

Steve Pearce; Lisle Scott; Gillian Attwood; Kate Saunders; Madeleine Dean; Ritz De Ridder; David Galea; Haroula Konstantinidou; Mike Crawford

doi:10.1192/bjp.bp.116.184366

Democratic therapeutic community treatment for personality disorder: randomised controlled trial

Br J Psychiatry. 2017 Feb;210(2):149-156. doi: 10.1192/bjp.bp.116.184366. Epub 2016 Dec 1.

Authors

Steve Pearce¹, Lisle Scott², Gillian Attwood², Kate Saunders², Madeleine Dean², Ritz De Ridder², David Galea², Haroula Konstantinidou², Mike Crawford²

Affiliations

¹ Steve Pearce, MRCPsych, Lisle Scott, MSc, MBChB, Gillian Attwood, RMN, Oxford Health NHS Foundation Trust, Oxford, UK; Kate Saunders, DPhil, MRCPsych, University of Oxford, Oxford; Madeleine Dean, MSc, School of Health and Human Sciences, University of Essex, Colchester, UK; Ritz De Ridder, MRCPsych, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK; David Galea, MRCPsych, Seksjon for psykosebehandling, Oslo Universitetssykehus HF, Oslo, Norway; Haroula Konstantinidou, MRCPsych, Francis Dixon Lodge, Leicester; Mike Crawford, MD, FRCPsych, Imperial College London, London, UK steve.pearce@oxfordhealth.nhs.uk.
² Steve Pearce, MRCPsych, Lisle Scott, MSc, MBChB, Gillian Attwood, RMN, Oxford Health NHS Foundation Trust, Oxford, UK; Kate Saunders, DPhil, MRCPsych, University of Oxford, Oxford; Madeleine Dean, MSc, School of Health and Human Sciences, University of Essex, Colchester, UK; Ritz De Ridder, MRCPsych, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK; David Galea, MRCPsych, Seksjon for psykosebehandling, Oslo Universitetssykehus HF, Oslo, Norway; Haroula Konstantinidou, MRCPsych, Francis Dixon Lodge, Leicester; Mike Crawford, MD, FRCPsych, Imperial College London, London, UK.

PMID: 27908900
DOI: 10.1192/bjp.bp.116.184366

Abstract

Background: Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High-quality evidence from randomised controlled trials (RCTs) is absent.

Aims: To test whether DTC treatment reduces use of in-patient services and improves the mental health of people with personality disorder.

Method: An RCT of 70 people meeting DSM-IV criteria for personality disorder (trial registration: ISRCTN57363317). The intervention was DTC and the control condition was crisis planning plus treatment as usual (TAU). The primary outcome was days of in-patient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomisation.

Results: Number of in-patient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self- and other directed aggression and satisfaction with care were significantly improved in the DTC compared with the TAU group.

Conclusions: DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Female
Follow-Up Studies
Humans
Length of Stay / statistics & numerical data*
Male
Mental Health Services / statistics & numerical data*
Outcome Assessment, Health Care*
Personality Disorders / therapy*
Therapeutic Community*

Associated data

ISRCTN/ISRCTN57363317