Epidemiology, public health and the problem of personality disorder

The public health problem-solving paradigm is a comprehensive method not previously applied to preventive interventions for personality disorder.

To present an overview for clinical psychiatrists.

Review of epidemiological research into DSM-IV Axis Il disorders and application to the paradigm.

Personality disorder affects a substantial proportion of the population. Burdens on health care, social and criminal justice agencies have yet to be accurately quantified. Debates continue over case definition, but there is increasing information on prevalence using 'broad' definitions and aetiology. A conceptual framework, based on development, suggests preventive interventions should be targeted in childhood. The public health approach also requires monitoring of risk factors operating at the population level.

Services in England and Wales for persons with personality disorder are currently inadequate. The problem-solving paradigm suggests new preventive interventions. Psychiatrists should renegotiate their relationship with policy-makers and reconsider their preventive role.