Personality disorders

Until recently there has been little systematic evidence of the efficacy of therapeutic communities for treating personality disorders, and disagreement over whether those who did benefit were really suffering from psychopathic or personality disorder in the first place. While efficacy in this area is still questioned (see Chapter. 4J2.7), the picture has recently changed with the publication of the first systematic review of therapeutic community treatment for people with personality disorders/.2::.' The authors carried out a full search of therapeutic community publications and grey literature, collecting over 8000 references from 38 countries. These were reduced to 29 research studies that met the criteria of randomized controlled trial design (eight studies) or comparative or controlled studies that reported raw data and used conservative outcome criteria (e.g. reconviction rates rather than psychological improvement). A meta-analysis found that 19 studies showed a positive effect within the 95% level of confidence while the remaining 10 straddled the neutral score. The authors conclude that there is strong evidence for the effectiveness of therapeutic communities. Other studies have demonstrated that patients with severe personality disorder, usually of the borderline or antisocial type, have reduced levels of re-conviction and readmission following treatment in a therapeutic community. (24>

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