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Influence of apparently negative personality characteristics on the long‐term outcome of health anxiety: Secondary analysis of a randomized controlled trial

Tyrer, Peter, Wang, Duolao ORCID:, Tyrer, Helen, Crawford, Mike, Loebenberg, Gemma, Cooper, Sylvia, Barrett, Barbara and Sanatinia, Rahil (2020) 'Influence of apparently negative personality characteristics on the long‐term outcome of health anxiety: Secondary analysis of a randomized controlled trial'. Personality and Mental Health. (In Press)

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Background – It is known that personality has an influence on the outcome of mental state disorders, but detailed
studies on its long‐term impact are few. We examined the influence of personality status on the 8‐year
outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled
Aims – This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional
measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated
with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments
covered the period of 8 years after randomization. An additional aim is to examine the costs of different
levels of personality dysfunction in each treatment group.
Method – Personality dysfunction, using both ICD‐10 and ICD‐11 classifications of severity, was assessed at
baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence
using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred
forty‐four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive
behaviour therapy for health anxiety (CBT‐HA) or standard care. Total costs over follow‐up were calculated
from hospital data and compared by personality group.
Results – At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality
difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion
was found with regard to dependent personality. Using the ICD‐10 classification, 153 patients (34.6%)
had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%)
having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those
with personality disorder adhered more closely to CBT‐HA, and after 8 years, they had a significantly better
outcome than those with personality difficulty and no personality disorder (p < 0.002). Similar results were
found in those scoring high on the Dependent Personality Questionnaire. All these differences increased over
the follow‐up period. Costs were similar in all groups but were somewhat higher in the CBT‐HA one; this finding
is hypothesised to be due to fuller hospital treatment once health anxiety is discounted.
Conclusion – Personality disorder in people with health anxiety, particularly in those who have anxious and
dependent traits, reinforces the benefits of cognitive behaviour therapy, particularly in the longer term.
© 2020 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd

Item Type: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WM Psychiatry > WM 100 General works
WM Psychiatry > WM 140 Mental disorders (General)
WM Psychiatry > WM 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Rachael O'Donoghue
Date Deposited: 13 Nov 2020 15:10
Last Modified: 14 Dec 2020 12:17


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