Defining severity of personality disorder using electronic health records: short report

Jonathan Monk-Cunliffe, Giouliana Kadra-Scalzo, Chloe Finamore, Oliver Dale, Mizanur Khondoker, Barbara Barrett, Hitesh Shetty, Richard D. Hayes, Paul Moran

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
3 Downloads (Pure)


Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66–4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.
Original languageEnglish
Article numbere137
JournalBJPsych Open
Issue number5
Early online date1 Aug 2023
Publication statusPublished - Sep 2023


  • Economics
  • epidemiology
  • personality disorders
  • physical health
  • rating scales

Cite this