Authors' reply to Pearce.

Wewelcome Steve Pearce’s news that a randomised controlled trial of therapeutic communities in the treatment of personality disorder is under way and look forward to hearing the results. 2 We acknowledge that therapeutic communities in the UK are now almost all day programmes, and we perhaps should have more accurately cited the most recent National Institute for Health and Care Excellence (NICE) guidance that “there is as yet no evidence on their effectiveness.” There is indeed a considerable amount of non-trial evidence, which was also analysed at length by the NICE clinical guideline group in drawing its conclusions. The absence of a randomised controlled trial remains problematic when such evidence is now available for other approaches to treatment. Our aims in this review were to highlight the research progress that has been made in recent years, to improve understanding of personality disorder, and help to promote a more positive view of the potential for treatment. Pearce is inaccurate in stating that there is no trial evidence for nidotherapy.We found one (albeit relatively small) randomised controlled trial in people with comorbid personality disorder and severe mental illness, which was included in a systematic review. We included the Service User Network, despite the absence of trial evidence, because of its potential for improving access to help for a large number of people with personality disorder in the broader community. This is important for those of us who work outside specialist services.