Outcome measures

The choice of outcome measures is a problem in the assessment of all psychiatric disorders, but difficulty is particularly great in studies of personality disorders. These disorders affect both the individual and society, and a range of outcomes can be measured to cover these possibilities. Forensic psychiatrists and the general public usually consider that the outcome of mentally disordered offenders is best measured by the frequency of reoffending. This is an easily measured and reliable statistic, but it does not necessarily record symptomatic or personality change, and may be distorted by a range of other factors (e.g. patients who spend a long time in hospital or prison are not likely to reoffend). Changes in symptoms also have limited use since they may be a consequence of changes in mental state disorders quite independent of personality. Repeated measures of personality status also have disadvantages since, as noted earlier, they may be affected by changes with concurrent mental state disorder. Personality also changes with ageing without treatment. (13>

Because of these difficulties, global outcome measures are often used to determine the degree of improvement in personality disorders in long-term follow-up studies, although a battery of measurements is normally used in short-term treatment studies. Unfortunately, there is no standardized set of measures of global outcome. It is reasonable to take into account symptomatic change, social functioning, quality of life, incidents of societal conflict (e.g. police contacts), and reports from informants. Even these may not correctly reflect change in personality status. Thus a person whose personality disorder does not change in any basic way may find an environmental niche in which the personality disturbance does not manifest itself as conflict. Such a person would show improvement on all the items listed above, but the improvement would be a consequence of environmental change, not of personality alteration.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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