Only 19.3% of Dutch forensic outpatients had a personality disorder diagnosis

Across 15 institutions and 10,560 people in Dutch outpatient forensic mental health, 19.3% carried a personality disorder diagnosis -- below rates in general psychiatric outpatient and detention settings. Of specific diagnoses, 71.2% were "other specified" or unspecified.

In forensic mental health, a personality disorder diagnosis is not a label for its own sake: it shapes risk assessment, what treatment is offered, and how recidivism is managed. Researchers led by Barbera E. Van Reijswoud collected, from fifteen Dutch outpatient forensic institutions, diagnoses for everyone treated in 2023, a total of 10,560 people, to establish how often personality pathology is actually recorded. It was recorded for 19.3%, or 2,033 individuals: 12% with a personality disorder as their primary diagnosis and 7.3% carrying one only as an additional diagnosis. The authors read that as too low rather than reassuring, since systematic reviews put rates in general psychiatric outpatient and detention populations considerably higher, and they conclude personality pathology is under-recognised in this setting. A second pattern supports the interpretation. Among those given a specific diagnosis, 71.2% were coded as "other specified" or unspecified personality disorder -- a placeholder rather than a description -- with borderline (12.4%) and antisocial (11.5%) the only named categories above 2%. Over half of the people whose primary diagnosis was a personality disorder were coded with nothing more precise than the general category. Diagnoses were more common among women, middle-aged patients, those in voluntary rather than mandated treatment, and those involved in more serious violent offences. The measurement caveat is large and the authors state it. The fifteen institutions supplied data of differing completeness: six provided only primary diagnoses, and four -- accounting for 61% of all individuals -- reported only broad DSM categories rather than specific ones. Nothing was recorded about how any diagnosis was reached, so structured assessment cannot be distinguished from clinical impression. This is a study of what gets written down, which is precisely the point, but it means the 19.3% is a floor on prevalence, not a measurement of it.