BACKGROUND: The relative burden and risk of readmission for people with personality disorders in hospital settings is unknown. AIMS: To compare hospital use of people with personality disorder with that of people with other mental health diagnoses, such as psychoses and affective disorders. METHOD: Naturalistic study of hospital presentations for mental health in a large community catchment. Mixed-effects Cox regression and survival curves were generated to examine risk of readmission for each group. RESULTS: Of 2894 people presenting to hospital, patients with personality disorder represented 20.5% of emergency and 26.6% of in-patients. Patients with personality disorder or psychoses were 2.3 times (95% CI 1.79–2.99) more likely than others to re-present within 28 days. Personality disorder diagnosis increases rate of readmission by a factor of 8.7 (s.e. = 0.31), marginally lower than psychotic disorders (10.02, s.e. = 0.31). CONCLUSIONS: Personality disorders place significant demands on in-patient and emergency departments, similar to that of psychoses in terms of presentation and risk of readmission. DECLARATION OF INTEREST: None.