Personality Disorders

Recently Mark Easton, a journalist and the BBC's home editor, made a reasonable stab at an article on Personaility Disorders. The article has lots of little flaws but it is a large and detailed article that for a brief spell brought a wider audience into the discussions of what constitutes a disorder in something as nebulous a 'personality' and what we we do with those that do seem to be difficult ot manage, or worse, whose daily experiences and interactions with the world are actually distressing to them.

In this case however, probably more valuable than the article itself are the numerous comments made in response that you will find at the bottom of the page. The comments range from the ill-informed, to those with direct personal experience, to those who see 'the state' as conniving and manipulative actors in this field, and thankfully to a number of professionals that chip in to make it a fairly holistic and ultimately informative discussion.

One of the simplest and most informed points of view comes form a clinical psychologist who points out quite rightly:

Rather than ask "does this person have disorder X?", I believe we should instead be asking "should we offer this person help?"

In answering this last question we need to consider 6 things;

1. Level of current subjective distress and suffering.
2. Risk of future distress and suffering if not offered help.
3. Whether their capacity to make consequential decisions is impaired.
4. Whether they are at high risk of losing capacity to make consequential decisions if not offered help.
5. Available resources.
6. Whether we can help.

I find this invetory extremely helpful and will bear it in mind in my negotiations with mental health services who sometimes shy away from offering support to even their own recognised patients because their psychiatic problems are deemd to be psychological and intractable. On the Assertive Engagement Website I have an article on working with dual diagnosis, a rather simple top tips piece but similar to working with personality disorders I hold it as deeply important that no psychiatric worker, even at psychiatrist level should ever be able to say in your presence (not without a fight) that someone's problems are intractable and cannot be changed. There is sufficient evidence out there that improvements in quality of life will have a bottom-up effect on emotional processing, and reduction in daily distress. The goal is always to move someone from personality disordered thinking to personality 'style' thinking, recognising that core traits may never be changed but the damaging effect of those traits can, with work, be minimised. The answer to point six of this inventory is always yes and it is sometimes lone workers that have to fight for recognition of this in each individual case.

The article is at: Mark Easton Article on PD

Keep fighting the good fight.