The British Journal of Developmental Disabilities

Vol. 48, Part 2, JULY 2002, No. 95, pp. 95-100

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Summary

The diagnosis of personality disorders in learning disability is often contentious. Some studies showing exceptionally high prevalence rates for these disorders have raised questions about its clinical useful-ness in learning disability. This study aims to estimate the prevalence of a clinical di-agnosis of personality disorder among those with learning disability and mental health or behavioural problems and de-scribe their characteristics. People with a clinical diagnosis of personality disorder were identified by screening the psychiat-ric casenotes of patients from two areas of Leicestershire. ICD-10 DCR (WHO, 1993) criteria were then used to identify the type of personality disorder. Socio-demographic and clinical details were collected using a semi-structured proforma. Twenty nine out of the 430 patients seen by two consultant psychiatrists had a clinical diagnosis of per-sonality disorder, thus giving a prevalence of 7%. The vast majority had either mild or borderline learning disability. Only 34% had a co-morbid mental illness, but the vast majority were on psychotropic medi-cation. Fifty nine had an history of hospital admissions and 59% needed active support from an outreach team. Some recent stud-ies in learning disability have suggested prevalence figures up to 90% for personal-ity disorders. The prevalence figure of 7% from this survey suggests that in routine clinical practice, the diagnosis is limited to those with mild learning disability and sig-nificant behavioural disruption. Those diagnosed in this manner also satisfy the rigorous ICD 10-DCR criteria (WHO, 1993). To diagnose personality disorders across the whole range of learning disability, diag-nostic criteria that are specific for different developmental levels are needed. In the absence of such norms, the current clinical practice of limiting the diagnosis of person-ality disorders to a tightly defined group may make more sense, as it identifies a group of people with specific care needs and resource implications.

Consultant Psychiatrist, Leicester Frith Hospital, Leicester LE3 9QF UK

Lecturer in the Psychiatry of Learning Disability, Greenwood Institute, Westcotes House,

Westcotes Drive, Leicester LE3 0QU UK

Fax: +44 (0)116 225881 E-mail: skg6@le.ac.uk

Consultant Psychiatrist, Leicester Frith Hospital, Leicester LE3 9QF

* For Correspondence