A randomized controlled trial of democratic therapeutic community treatment for personality disorder.

Abstract

Background: Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High quality evidence from randomized controlled trials is absent. Aims: The aim of this study was to test whether DTC treatment reduces use of inpatient services and improves mental health of people with personality disorder. Method: A randomized controlled trial of 70 subjects meeting DSM-IV criteria for personality disorder. The intervention was DTC and the control condition was crisis planning plus treatment as usual. The primary outcome was days of inpatient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomization. Results: Among 35 allocated to DTC, 28 (80%) attended at least one treatment session. Number of inpatient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self and other directed aggression and satisfaction with care were significantly improved in those allocated to DTC treatment compared to those receiving TAU. No adverse reactions were detected. Conclusion: DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.