Personality pathology and mental health treatment seeking in a community sample of older adults.

Sampling issues are extremely important in studies of psychopathology, especially with regard to the investigation of personality disorders (PDs). Many studies rely on clinical samples whereas others have focused on representative samples of community residents. Do people who qualify for a PD diagnosis seek and receive mental health services with greater (or possibly reduced) frequency compared with others in the community? Do community-based studies of PDs include people who have been treated? Analyses presented here examine connections between personality pathology and various aspects of treatment seeking in a representative sample of 1 630 middle-aged adults who completed a semi-structured diagnostic interview (Structured Interview for DSM-IV Personality). Results demonstrate a disorder-specific effect. Antisocial, borderline, avoidant and dependent PDs are associated with increased levels of seeking treatment. Four PDs are associated with greater length of treatment. After accounting for lifetime presence of major depression and alcohol dependence, borderline, avoidant and dependent pathology remained associated with increased treatment seeking. These findings point to several conclusions, including (1) community samples do include a substantial proportion of people who have received various kinds of mental health services; (2) the association between personality pathology and mental health treatment seeking is not fully explained by comorbid depression and alcohol dependence.