Psychological distress, depressive symptomatology, coping and DSM-III-R/ICD-10 personality disorders A study among primary mental health care patients

The association between psychological distress, coping and personality disorders (PDs) was studied among a group of 230 primary mental health care patients by means of Principal Component Analysis (PCA) and stepwise multiple regression analyses. The PCAs revealed that those who suffer from personality pathology tend to use passive coping and to be hostile and interpersonal sensitive. Those who show schizoid, schizotypal, dissocial and avoidant traits tend not to seek social support. Those who show dependent and anxious traits tend to avoid difficult situations and not to express their (anger) feelings. The multiple regression analyses provided a more fine-grained analysis: hostility and interpersonal sensitivity appeared to be the strongest independent predictor of personality pathology. More particularly, hostility was high among those scoring high on mainly the dramatic (B) cluster disorders, whereas interpersonal sensitivity appeared to be characteristic of patients from the eccentric (A), the dramatic (B) and the fearful (C) clusters. In addition, PDs were characterised by the inability to handle stress situations in an active way (mainly observed among disorders from the dramatic (B) and the fearful (C) clusters), an inability to use interpersonal relations in order to receive social support (mainly observed among disorders from the eccentric (A) and the dramatic (B) clusters), and the use of passive coping, which was observed among disorders from all three clusters. It is concluded that the assessment of symptomatology and coping may provide the primary mental health care worker with cues concerning the possible presence of personality pathology, which could then subsequently be investigated. This may have important implications for treatment; in cases of personality pathology, referral to secondary mental health care might be appropriate.