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Feature Article

Personality disorders: treat or retreat?

Gordon Parker

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Abstract

Assessments of personality style and personality disorder are important as they will shape the clinical assessment and management of the patient. ‘Treatment’, however, is difficult, the principal reasons being that a personality disorder is relatively ingrained and therefore difficult to modify, and that most affected individuals are not motivated to seek change.

Key Points

  • Personality disorders are probably best viewed as being able to be categorised in terms of prototypic styles, but best modelled dimensionally in terms of severity of style and of disordered functioning.
  • The author argues for a two-tier model that defines style at Tier I and disordered functioning at Tier II.
  • Origins of personality disorders are likely to be a mix of genetic and developmental factors.
  • ‘Treatment’ is difficult, reflecting the constitutional weighting of personality and generally low motivation.
  • Assessments of personality style and personality disorder are nevertheless important because they will shape the clinical assessment and management of the patient.
  • Clinical and practice strategies for handling high-risk scenarios presented by explosive and borderline personality disorder patients are noted.
  • Never tell a patient – or anyone else – that they have a personality disorder, as it is psychiatric shorthand for saying ‘I do not like you’.

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