Personality disorders and treatment drop out in the homeless

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Personality disorders and treatment drop out in the homeless

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Author(s): Carlos Salavera ¹ , José M Tricás ² , Orosia Lucha ²

Publication date (Electronic): 22 March 2013

Journal: Neuropsychiatric Disease and Treatment

Publisher: Dove Medical Press

Keywords: MCMI-II, abandonment, personality disorder, homeless

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Abstract

The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist — homelessness and personality disorders — the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89) was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR) was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II). Cluster B personality disorders (antisocial, borderline, and narcissistic) avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment.

Most cited references 104

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Social exclusion decreases prosocial behavior.

Jean Twenge, Roy Baumeister, C Dewall … (2007)

In 7 experiments, the authors manipulated social exclusion by telling people that they would end up alone later in life or that other participants had rejected them. Social exclusion caused a substantial reduction in prosocial behavior. Socially excluded people donated less money to a student fund, were unwilling to volunteer for further lab experiments, were less helpful after a mishap, and cooperated less in a mixed-motive game with another student. The results did not vary by cost to the self or by recipient of the help, and results remained significant when the experimenter was unaware of condition. The effect was mediated by feelings of empathy for another person but was not mediated by mood, state self-esteem, belongingness, trust, control, or self-awareness. The implication is that rejection temporarily interferes with emotional responses, thereby impairing the capacity for empathic understanding of others, and as a result, any inclination to help or cooperate with them is undermined. 2007 APA, all rights reserved

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Interpersonal rejection as a determinant of anger and aggression.

M Leary, Jean Twenge, E Byrd Quinlivan (2005)

This article reviews the literature on the relationship between interpersonal rejection and aggression. Four bodies of research are summarized: laboratory experiments that manipulate rejection, rejection among adults in everyday life, rejection in childhood, and individual differences that may moderate the relationship. The theoretical mechanisms behind the effect are then explored. Possible explanations for why rejection leads to anger and aggression include: rejection as a source of pain, rejection as a source of frustration, rejection as a threat to self-esteem, mood improvement following aggression, aggression as social influence, aggression as a means of reestablishing control, retribution, disinhibition, and loss of self-control.

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Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system.

David P. Folsom, William Hawthorne, Laurie Lindamer … (2005)

The authors examined the prevalence of and risk factors for homelessness among all patients treated for serious mental illnesses in a large public mental health system in a 1-year period. The use of public mental health services among homeless persons was also examined. The study included 10,340 persons treated for schizophrenia, bipolar disorder, or major depression in the San Diego County Adult Mental Health Services over a 1-year period (1999-2000). Analytic methods that adjusted for potentially confounding variables were used. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness, including age, gender, ethnicity, substance use disorder, Medicaid insurance, psychiatric diagnosis, and level of functioning. Similarly, odds ratios were computed for utilization of mental health services by homeless versus not-homeless patients. The prevalence of homelessness was 15%. Homelessness was associated with male gender, African American ethnicity, presence of a substance use disorder, lack of Medicaid, a diagnosis of schizophrenia or bipolar disorder, and poorer functioning. Latinos and Asian Americans were less likely to be homeless. Homeless patients used more inpatient and emergency-type services and fewer outpatient-type services. Homelessness is a serious problem among patients with severe mental illness. Interventions focusing on potentially modifiable factors such as substance use disorders and a lack of Medicaid need to be studied in this population.

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Author and article information

Journal

Journal ID (nlm-ta): Neuropsychiatr Dis Treat

Journal ID (iso-abbrev): Neuropsychiatr Dis Treat

Journal ID (publisher-id): Neuropsychiatric Disease and Treatment

Title: Neuropsychiatric Disease and Treatment

Publisher: Dove Medical Press

ISSN (Print): 1176-6328

ISSN (Electronic): 1178-2021

Publication date Collection: 2013

Publication date (Print): 2013

Publication date (Electronic): 22 March 2013

Volume: 9

Pages: 379-387

Affiliations

[1 ]Faculty of Education, University of Zaragoza, Zaragoza, Spain

[2 ]Physiotherapy Research Unit, University of Zaragoza, Zaragoza, Spain

Author notes

Correspondence: Carlos Salavera Facultad de Educación, Universidad de Zaragoza, San Juan Bosco, 7, 50009 Zaragoza, España Email salavera@ 123456unizar.es

Article

Publisher ID: ndt-9-379

DOI: 10.2147/NDT.S38677

PMC ID: 3615841

PubMed ID: 23569378

SO-VID: bbe76b82-1f2b-43ca-ba4f-92b8ee536cbb

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This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

Neuropsychiatric Disease and Treatment (submit here)

Personality disorders and treatment drop out in the homeless

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Abstract

Most cited references 104

Social exclusion decreases prosocial behavior.

Interpersonal rejection as a determinant of anger and aggression.

Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system.

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