Challenge the myth that personality disorder can't be treated, urge psychiatrists

Online news
09 January 2020

The myth that people with personality disorder cannot be treated is damaging and untrue, says the Royal College of Psychiatrists (RCPsych) in its first-ever position statement on the disorder and its treatment in England.

Having a personality disorder means the development of someone’s personality has been so severely disrupted that they find it difficult to function in society and live with other people or even themselves.

One in 10 people with a personality disorder will die by suicide. Failure to treat a personality disorder can therefore be fatal.

Psychiatrists and sufferers alike believe there is a pervasive myth in society, including amongst some health professionals, that a personality disorder cannot be treated.

The position statement makes clear this is false and that the myth means sufferers are too often turned away from services that could otherwise help them.

There is also huge national variation in the provision of services. Of those who died by suicide, only 24% had ever been referred to a specialist service for personality disorder.

It is not considered best practice to prescribe medication for personality disorder unless that person is also suffering from a mental illness which can be treated with medication.

And yet 90% of people are prescribed medication often because there is a lack of specialist multi-disciplinary care. Although this is no single therapy that helps everybody, looking at the brain, body and background of the person is vital.

Dr Oliver Dale, co-editor of the Royal College of Psychiatrists’ position statement, said: “For too long, personality disorder has been seen as too complex to tackle.

“This paper demonstrates there is much we can do to change people’s lives. Through publishing this statement, the college is echoing the call for leadership and investment.

“It is hoped the statement will support the efforts of the NHS Long term plan amongst others to address the social injustice that a continued lack of service delivery perpetuates.”

Treating people with personality disorder is considered a significant challenge for health professionals. This is because that while generally with a mental illness there is a previously healthy state to return the person to through treatment, this is more complex for people with a personality disorder. Clinicians talk instead about ‘discovery’ of being able to live more happily, as opposed to recovery.

Dr Julia Blazdell, who has lived experience of personality disorder, and is the Co-President of British & Irish Group for the Study of Personality Disorder, said: “The personality disorder diagnosis has been marred by stigma. Too often the diagnosis is given not as a means to understand the impact of past trauma, neglect and adversity that has shaped a person’s way of being-in-the-world, nor to signpost to a therapeutic avenue of treatment.

“Instead, the diagnosis is sometimes misused as a punishment for unruly behaviour or as a dustbin diagnosis when a more fitting formulation needed to be found. As a result, people receiving this diagnosis in this manner are left feeling ‘doubly-damned’.

“The diagnosis continues to be highly contested. In many ways this position statement is a helpful attempt to attend to this dilemma: how to use a diagnosis that is deeply flawed in a way that is both therapeutic and useful?”

To address these difficulties, RCPsych want to see all psychiatrists trained in the assessment and diagnosis of personality disorder.

The College also wants to see the end of patients with personality disorder being denied mainstream services based on diagnosis alone and ensure that NICE guidance is finally adhered to.

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