What is Personality Disorder?
Our personality is the collection of thoughts, feelings and behaviours that make each of us the individuals we are.
As well as the positive things about our personality, we all have less helpful and more difficult parts. These often show themselves at times of stress, but for some people they are there more often in their daily lives. These difficulties may include:
- Having an inconsistent and/or inaccurate sense of self;
- Difficulties identifying and managing emotions;
- Problems getting on with other people;
- Difficulties coping with stressful situations;
- Regular/harmful use of problematic coping strategies (e.g. self-harm, substances, aggressive behaviour);
- Difficulties achieving general life goals.
Diagnosis
People may be given a diagnosis of ‘personality disorder’ if their difficulties carry on for a long time; occur in many or all parts of their life; and are not just caused by substances or another medical condition.
Diagnosis of ‘personality disorder’ is made by a psychiatrist or a psychologist. It is based on a detailed assessment of the person against a set of clinical criteria.
Some people see this diagnosis as unhelpful or stigmatising. Others find that it helps them to name and understand their experiences, and to find the right treatment and support.
What treatments are on offer?
Medication
There is no medication specifically licensed or recommended for the treatment of personality disorder. However, medication may be prescribed to treat problems linked with a personality disorder (e.g. depression, anxiety, short-term episodes of psychosis). These medicines may include anti-depressants, anti- psychotics and mood stabilisers.
Psychological interventions
Personality disorders are usually treated with psychological treatments or talking therapies, such as:
- Dialectical Behavioural Therapy (DBT)
- Mentalisation Based Therapy (MBT)
- Cognitive Behavioural Therapy for Personality Disorder (CBTPD)
- Cognitive Analytical Therapy (CAT)
- Psychodynamic Therapy
- Therapeutic Communities
Ideally, treatment should:
- Take place in the least restrictive environment possible;
- Be voluntary;
- Be part of a wider approach based on a good understanding of the person, clear expectations and goals and plans to keep them safe and well.
Where does treatment happen?
Community Services
Treatment in the community can be accessed by:
- Self-referral or GP-referral to primary care psychology services.
- GPs can also refer people to community mental health services. They will assess the person’s mental health needs and provide or advise on the best support.
- There are also intensive/crisis support services for people in acute distress.
Hospital / Secure hospital
In most cases, treating people with a main or sole diagnosis of personality disorder in hospital is not the best option. However, some people with personality disorder may need a brief time in hospital to help manage an emotional crisis.
When people have a mental illness (such as schizophrenia) alongside their personality disorder, they may sometimes need longer-term hospital treatment. If they are at risk of causing harm to others, admission to a secure hospital may be required.
Prison and Probation Services
People in prison or under probation may be able to access care under the Offender Personality Disorder Pathway. This includes:
- care managed by specially-trained probation staff in the community, with access to psychotherapeutic sessions.
- specially-designed services in prison with specially-trained staff and psychotherapeutic courses.
Support for families and carers
Supporting a relative with personality disorder can be challenging. It is important to know about support available to you and to look after your own well-being.
Identify personal support - e.g. family/friends, personal counselling, AWP Carers’ Network, Personality Disorder support organisations
AWP Family, Friends, and Carers Charter - Our commitment to family friends and carers and your rights as a carer. For more information visit www.awp.nhs.uk/patients-and-carers/ information-carers
Family Connections - This is a 12-week on-line course for anyone who has a close relationship with someone who has Emotionally Unstable Personality Disorder or another PD diagnosis with difficulties managing their emotions. For more information, contact 01722 820121.
Take time to fully understand forensic mental health services with this useful online guide: www.institutemh.org.uk/images/research/7778_Secure_Hospital_Care_Brochure_A5_V5_O nline.pdf
You may be entitled to a Carers Assessment. to assess your needs and identify support suitable for you. Assessments may be offered by the Trust, or by a partner organisation.
Services often vary by area. Please ask your loved ones’ care coordinator about how to access support in your local area.
Contact
This leaflet was written by the AWP Forensic Personality Disorder Service.
This service supports decision-making about the need for secure hospital admission for people with personality disorder, and provides support to care teams working with people with personality disorder.
BSL Video Relay
https://connect.interpreterslive.co.uk/vrs?ilc=AvonWiltshireMHT and ask for our number; or for switchboard 01225 731731 to connect you.
For information on Trust services visit www.awp.nhs.uk
PALS
To make a comment, raise a concern or make a complaint, please contact the Trust’s, ‘Patient Advise and Liaison Service (PALS)
Tel: 01225 362900
Freephone: 0800 073 1778
Email: awp
Other languages and formats
Please ask if you need this leaflet in another language or format such as large print, audio.
AWP Forensic Personality Disorder Service
Leaflet code 055 AWP
Approved March 23
Review due March 26