The DSM-IV describes a personality disorder as 'an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment'. Although this definition is clear in describing a personality disorder it is very 'wordy' and to a sufferer to receive such a diagnosis may be very daunting. 'A diagnosis is only as useful as the support that comes with it'.
There are three clusters of personality disorders:
- Cluster A - Odd/Eccentric including Paranoid, Schizoid and Schizotypal personality disorders. An individual may be emotionally and socially withdrawn, suspicious and difficult to engage
- Cluster B - Dramatic/Erratic including Borderline, Anti-Social, Histrionic and Narcissistic personality disorders. An individual may be emotionally labile and chaotic, have frequent contact with services, lack of empathy and poor impulse control
- Cluster C - Anxious/Fearful including Avoidant, Dependent and Obsessive-compulsive personality disorders. An individual may be perfectionist, over-reliant, passive or fearful of rejection.
I then learnt more in detail about these types of disorders and made many links with my previous knowledge (which I won't detail here but feel free to ask me about it). When reading about the traits of each personality disorder it is simple to identify some of your own personality traits. However, the difference between having traits of personality disorders and actually having the personality disorder is that a PD is persistent, pervasive (affects all of life) and problematic. Note: obsessive compulsive personality disorder is different from OCD.
There are many challenges associated with a personality disorder diagnosis, including likelihood of experiencing adverse life effects e.g. childhood trauma, vulnerability to other psychiatric conditions e.g. depression, high prevalence of PD in the prison population, specialist areas evoke varied and sometimes conflicting professional responses, need for persistence despite set backs and that professionals may feel unskilled and ineffectual.
We also discussed the nature/nurture debate in terms of personality disorders. It appears that the jury is out on the true cause, however, although a lot of personality disorders are associated with experience (for example, childhood abuse/neglect) it is suggested that some people have a genetic predisposition. Why doesn't every person abused as a child develop a personality disorder and why do those with no adverse experiences develop them?
In order for someone with a personality disorder to be referred and accepted to a service they must meet criteria such as 'risk of harm to self or others' or 'burden/distress on family and agencies'. But this means that many people who need help but aren't 'a nuisance' do not receive it and it leads to sufferers exaggerating their behaviours in order to receive support.
Treatment for PD is less medical and more psychologically based i.e. less drugs are given and more therapy is used. CBT can be used along with other methods. One method is Dialectical Behavioural Therapy (DBT) which was developed specifically for individuals with Borderline PD who self-harmed. It is a combination of behavioural therapy and Zen philosophy and aims to help people learn how to tolerate feelings and 'work with' what they experience in a more positive way. "Accepting life as it is, not as it should be - and accepting the need for change despite that reality and because of it".
"I hate you, don't ever leave me" was a very interesting quote from a video we watched; I think it details what its like in the mind of someone suffering conflict as a result of a personality disorder very well.
During the training we also did some work on boundary management and recovery in the context of working with those with PD. Personally, I'm yet to experience working with a sufferer but I now feel better informed if I was faced with such a challenge.
In the work I'm doing, boundaries are very important. "Boundaries are guidelines, rules or limits that a person creates to identify for themselves what are reasonable, safe and permissible ways for other people to behave around them and how they will respond when someone steps outside those limits". People with PD may "struggle to set limits about what they might do and therefore do risky, damaging or dangerous things, but equally they find it difficult to accept other people setting limits in relationships". I found the Boundary Seesaw Model (Hamilton, 2009) very interesting.
Finally I wanted to share this quote about recovery: "not a sprint, but a long-distance race".
I really got a lot out of this training and I appreciate being able to attend such events.
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