Prognosis and duration

Personality disorders (PD) are lifelong conditions so no major change is likely. Some disorders, especially of emotional control, can improve with age and maturation. This is less so for obsessive compulsive, schizoid and paranoid types. Normal individuals tend to become less emotional and impulsive and more cautious and careful with age; a person with a personality disorder less so. People with antisocial personality disorder are usually most destructive in their early life. They are diagnosed most frequently between the ages of 30 and 35 and can “burn out” later in life, becoming less antisocial. Domestic disturbances, child abuse and alcohol abuse may persist.

There is also a higher incidence of death by violence and suicide. Between 30 and 60% of completed suicides retrospectively show evidence of a personality disorder.

People with obsessional personality disorders are at a high risk of progression to Obsessive Compulsive Disorder (OCD) or to depressive illness. People with OCD can be severely functionally restricted and people with obsessive compulsive PD, although they are less anxious than those with OCD, may be equally functionally restricted.

People with paranoid and schizotypal PD may progress to schizophrenia, but those with schizoid PD do not.

Borderline PD carries a relatively favourable prognosis with clinical recovery in over 50% at 10 to 25 year follow up.

The prognosis for personality disorders is improved if the person establishes a stable relationship with another person.

Specialised treatment results in substantial improvement in 1/3 to 2/3 of patients. Specialised treatment may take up to 4 years to achieve full effect. People who do not receive specialised treatment are unlikely to improve in the long term.

Therefore the following awards should be considered:

For people who are receiving specialised treatment:

First award period – award for 5 years.

Thereafter an indefinite award may be appropriate. However, in some cases there is potential for improvement in the condition in the longer term.

For people who are not receiving specialised treatment:

An indefinite award, However, in some cases there is potential for improvement in the condition in the longer term especially if they receive specialist treatment.

All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.

Amended June 2008