Re-conceiving personality disorders: Adaptations on a dimension?

Abstract

The diagnosis, treatment and professional response to personality disorders have long been recognised as a challenging area for clinical practice. Clients and therapists alike have reported that this diagnosis can be derogatory and result in discrimination. There still exits a belief amongst some mental health professionals that individuals with personality disorder are ‘untreatable’. This article attempts to reconsider the concept of personality disorder and suggests alternative interpretations that may help to challenge some of this stigma and present formulations more familiar and encouraging to therapeutic interventions. A brief demographic background will be presented followed by an exploration of problems in the assessment of personality disorders. Conceptual difficulties will then be presented together with a review of alternative perspectives and their potential impact on therapeutic interventions, including Tyrer's Personality Diathesis Model [Tyrer, P. (2007). Personality diatheses: A superior explanation than disorder. Psychological Medicine, 37, 1521–1525], dimensional conceptions (Livesley, W.J. (2007). An integrated approach to the treatment of personality disorder. Journal of Mental Health, 16, 131–148), and qualities of Resilience. A particular approach co-developed by the author, Adaptation-Based Process Therapy, is briefly explored within this context.

Keywords:

• personality disorder
• diathesis model
• dimensional conceptions
• adaptation-based process therapy
• resilience
• psychological mindedness

Notes

1. In a review of articles in the British Journal of Psychiatry in 2005, Tyrer et al. (2007) found that personality assessment was formally measured in 3.3% of studies and only partly mentioned in 8.6%.