This was a packed and lively meeting, with forty people attending, with lots of opportunities for participants to discuss the issues arising for therapists and practitioners. Claire Gately is a Clinical Psychologist, working at the Edenfield Forensic Unit, Prestwich and at HM Prison, Manchester. She provided a detailed outline of the main features of personality disorder as a clinical diagnosis, but was open to discussing the limitations of this label and also the stigma which can surround its use. She suggested that personality disorder “needs a good PR campaign”, perhaps along the lines of recent campaigns, aimed at increasing public awareness of other mental health conditions, such as schizophrenia and depression.
She defined personality disorder as consisting of extreme personality traits, which can be expressed in a person having severe difficulties in maintaining relationships with others, or just in getting on with other people, or in keeping out of trouble ( e.g. with the law), and in managing their powerful and rapidly-changing emotions. Claire compared the diagnostic criteria from current psychiatric models, e.g. DSM-5, ICD-10, relating mainly to the US and Europe respectively. She suggested that the notion of ‘clusters’ of symptoms was useful to her in her own work. There seems to be a move currently towards thinking of personality disorder more as a continuum, rather than as a somewhat rigid and fixed emotional state.
Partly because of the stigma attached to personality disorder, and because of the potential for continuing developmental change on the part of teenagers and young adults, mental health services are often reluctant to apply the label to people aged under 25. Personality disorder requires symptoms and behaviour to be persistent, i.e. longstanding, pervasive, i.e. applying in a broad range of situations, and problematic, i.e. causing significant distress to the individual, or to others closely connected with them. Mental health policy has shifted since 2003, with the publication of a Department of Health Report, Personality Disorder: No Longer a Diagnosis of Exclusion, replacing earlier pessimism about the value of therapy for clients and patients with this condition or diagnosis.
The group looked at a brief case study and then worked in small groups, to explore personal and professional experiences of relating to someone with traits of personality disorder. There was some discussion in the group about whether the alternative term of ‘Emotional Intensity Disorder’ might be a less stigmatising and, in some ways, more accurate a term?
In terms of therapy, Claire covered the limited value of medication for personality disorder and the broad range of therapeutic approaches used with this client and patient group, such as Cognitive Behaviour therapy, Cognitive Analytic Therapy, Schema Therapy, Mentalisation Based Therapy, Dialectical Behaviour Therapy and Arts Therapies, which all seemed to have roughly the same outcomes and effectiveness. For therapists, her suggested guidelines included the advice to ‘expect the unexpected’, to monitor our own personal responses, to maintain clear and consistent boundaries and to use self-reflection, particularly in supervision, to support our therapeutic work.
Emergence, Meeting the Challenge, Making a Difference from: www.emergenceplus.org.uk
Ministry of Justice (2011) Working with Personality Disordered Offenders:
A Practition-er’s Guide from https://www.justice.gov.uk/downloads/offenders/mentally-disordered-offenders/working-with-personality-disordered-offenders.pdf