An Overview of “Personality Disorder”
This is a little collection I put together for the people I was training with the other week. I’m sure there are loads of gaps so if you think something essential is missing do let me know. Hope you find it useful.
Keir provides Training, Consultancy and Therapy around complex mental health problems via www.beamconsultancy.co.uk
What do services look like in England? services in the UK. Dale O et al (2017)
Essential Reading
The idea that people who were labelled as having a personality disorder were part of the core work of mental health services first gained traction in 2003 with the publication of the seminal No Longer A Diagnosis of Exclusion (2003)
The Personality disorder Capabilities Framework describes the skills required for staff to work effectively in this area. It is rarely used. (2003)
The review of the 11 pilot sites of ‘personality disorder’ services (2007) Crawford et al describes useful features of effective services.
Stigma
There are some dodgy attitudes towards people who get the diagnosis out there. This is a mix of papers that identify problematic attitudes and ways of challenging them.
The patients psychiatrists dislike (1988)
Jay Watts talking about how having a BPD diagnosis means you don’t get listened to Testimonial Injustice 2018
This is a critique of all diagnosis thats tells us what we all know – people who get this label have lived through awful experiences. (2019)
This is a way of challenging some of the stigma Why Are People With Personality Disorder So Manipulative?
This brilliantly encapsulates how once we have a picture of what someone is like in our mind, everything they do can be twisted to fit that picture: How Not To Get A Diagnosis of Personality Disorder by Recovery in the Bin
The Not So Nice Guidelines for Borderline Personality Disorder. – This is a way of reading the NICE Guidelines for BPD but with a commentary about what services are really like. By recovery in the bin again, specifically Lara Quinn and Erik
How to work with people who get/could get this diagnosis
This is the Ministry of Justice Guide to working with people with ‘Personality Disorder’. Lots of stats, facts and figures (2015)
Meeting the Challenge, Making a Difference – This is the Guide to working with people diagnosed with personality disorder, written by people who identify with personality disorder. (2014)
This talks about Trauma Informed Care and why ‘what we usually do’ often isn’t helpful.
This is the consensus statement on Personality disorder. A paper by a mix of professionals and people with lived experience outlining their vision for the future.
There’s a BBC report on it here
Specific Guidance
Most recently the Royal College of Psychiatrists Position Paper on Personality Disorder makes some very clear recommendations. The reference list from this is a good contemporary guide to useful papers.
NICE Guidelines Self Harm - soon to be updated
NICE Borderline Personality Disorder – The personal accounts of people who have been through services are really interesting. Also gives an overview of different interventions.
NICE Antisocial Personality Disorder
What help is out there?
Theres lots of therapies with an evidence based in this area. These include….
Dialectical Behaviour Therapy (DBT) from the Mind website
Mentalisation Based Therapy (MBT)
Therapeutic Communities – My favourite way of working with people
STEPPS – Systems Training for Emotional Predicability and Problem Solving
Structured Clinical Management (SCM). It is hard to find a good link on this. The book it’s based on is this one
Cognitive Analytic Therapy (CAT)
Someone will tell you one is better than another. The evidence is fairly similar. It’s all about the quality of your relationship.
This gives an overview of MBT, DBT, TFT and GPM. GPM is interesting (something similar over here known as “Structured Clinical Management”) as it is delivered by generic workers rather than specialists.
What makes the work hard?
The Ailment by Tom Maine This isn’t the best copy but this is an excellent article that describes the impact complexity can have on staff. This is the best article you can read if you work in this area!!!
With research suggesting up to 78% of people in prison could be diagnosed with personality disorder, here’s some relevant things to read –
The Working With Offenders booklet again.
The Bradley Report – This looks at mental health problems and learning disability within the criminal justice system
The Corston Report – Specifically about Women in criminal justice
Women and Girls at Risk – A heartbreaking read about the disadvantage women face throughout their lives.
Suicide
Safer Care for Patients With Personality Disorder is both a collection of statistics around people with the diagnosis who killed themselves, and a survey of peoples experience of living with the diagnosis. Best/Worst statistic – Not one of the people who died by suicide was receiving NICE recommended care.
Medication
Olanzapine is as good as placebo
Local Pictures (From the UK but happy to add more)
England Has the RCP position statement. Scroll up
Wales – This link doesn’t work because Wales has nothing to say on this subject, to our great shame.
And just some other interesting stuff…
Personality disorder on the BBC
I read this blog a lot! *shameless self publicity warning
https://themainoffenderblog.wordpress.com/ A very articulate account of what it’s like living with BPD by @hoppypelican
Online resources:
http://www.dbtselfhelp.com/ – Lots of stuff to work through – All DBT flavour
Sunday night chats on twitter #BPDChat – Also with a DBT flavour
For people who have just been given a diagnosis
This personal account is a good start. Lots of resources in there. By the excellent Sue Sibbald @BPDFFS
Keir Harding provides Training, Consultancy and Therapy around complex mental health problems via www.beamconsultancy.co.uk
Below is a way of talking about complex emotional difficulties without talking labelling them Personality Disorder.
An important area of mental health that is getting increasingly recognised is the way people express various forms of emotional distress. It can cause various behaviours:
People harm themselves, for example by cutting their arms
Drinking unsafe amounts of alcohol
Taking illegal drugs regularly, excessively or irresponsibly
Misusing prescribed medications (or those available over-the-counter at pharmacies)
By impulsive and reckless actions that could have have serious consequences, like driving too fast or having unsafe sex
Chaotic eating patterns – such as bingeing, vomiting, abusing laxatives or continuously eating too much.
In addition, people with these problems often have repeated difficulties in relationships in ways like this:
Never keep friends very long
Cannot hold down a job
Isolated and lonely
Violence in intimate relationships
Over-sensitivity to criticism
Argumentative with people in authority
Feeling very abandoned when left alone or people leave
Unable to cope with making any decisions without help
Often switching between loving and hating family members.
Many people will experience these things at some time during their lives, perhaps in response to stress, but some are severely troubled by many of them for most of their lives. These could be called ‘long-standing emotional problems’, and they often go right back to childhood. In mental health services they are sometimes known by diagnoses like ‘complex needs’, ‘personality disorder’, ‘borderline’ or ‘severe and enduring non-psychotic disorder’.
Although it is not always the case, people with these types of difficulties have usually had difficult childhoods, with adversities like repeated trauma, or physical, emotional or sexual abuse, or neglect and deprivation, or several severe losses and bereavements. On the other hand, some people who suffer very harsh childhoods seem to be somehow ‘protected’ from the long-term psychological damage it can do. Unfortunately, there is no easy way of finding out who will have more problems and who will have less – although research is always being done to help us understand these matters better.
People who suffer in these ways often do so silently, without getting any help and often feeling guilty or ashamed of how they ‘are’. They often do not even know that they have a problem that others have too – and can become very isolated and lonely with it. In fact, these problems are very common, and increasingly recognised. The reason people behave the way they do, and have the difficult relationships they do, is usually to deal with their feelings, and to try and cope with them. But their actions often do not help enough, and they can make matters worse.
Very commonly, the behaviours can be confusing and upsetting, and this is as true for the people themselves as for those around them. This is because there is a lack of information and understanding about how these things arise, unwillingness to think and talk about them, and little knowledge about what can be done to support someone in this sort of emotional turmoil.
Although it is often the easiest route, there is recent research and NICE guidelines which suggest that medication is not usually the best way to deal with these problems. In the NHS, psychological treatment often helps, and this may take different forms. However, short-term ‘quick fix’ treatments and therapies are rarely very much help. Some psychiatric services are good at helping people with these problems, but because the number of people affected has only recently been recognised, many mental health staff do not yet have good training to deal with it.
In this situation, one of the things that can be very helpful is to help people to feel less alone and ‘odd’ – and for this, other people who have suffered similar feelings are usually better than professionals at understanding what it is like.
(This was taken from the Emergence website)
And those are some things that might help you understand whatever personality disorder means and what might help. Again, if something is missing let me know.
Keir
Keir Harding provides Training, Consultancy and Therapy around complex mental health problems via www.beamconsultancy.co.uk