This weeks #Otalk is on the topic of Personality Disorder and will be hosted by Keir Harding (@Keirwales).
We all have personality traits that can cause problems for us or other people. When these traits are problematic, pervasive and persistent we could label these traits as a personality disorder. Personality Disorder is prevalent in around 5 to 13 per cent of the population (Coid et al 2006). In mental health this figure increases depending upon the specialist nature of the service with up to 30 per cent in primary care, up to 50 per cent in secondary care, up to 70 per cent in drug and alcohol and eating disorder services and up to 78 per cent in prison (Moran 2003) . In physical health there is a similar trend with, for example 30% in the field of chronic pain (Sansone & Sansone 2015) while “the presence of borderline personality disorder was significantly associated with arteriosclerosis or hypertension, hepatic disease, cardiovascular disease, gastrointestinal disease, arthritis… and ‘any assessed medical condition’” (El-Gabalawy R et al 2010)
My point is that if you are working with people, you are working with personality disorder. There is widespread acceptance that within the already stigmatised area of mental health, Personality Disorder comes with an extra level of negative attitudes towards those who experience it. No Longer A Diagnosis of Exclusion was published in 2003 to try to address this. Still A Diagnosis of Exclusion (2009) suggests that it didn’t. It’s true that services for people living with Personality Disorder have improved over the past years but anecdotally people still struggle to get help with their difficulties, there are large inequalities as to what is available in different areas and staff often feel very deskilled when working in this area.
The area of Personality Disorder can be hugely challenging to clinicians. This can be due to high levels of self harm and suicidality that we might feel responsible for. It can be due to people dropping out of treatment or not seeming to engage with what’s on offer. It could be due significant difficulties in the relationship between client and clinician. My preparation for these challenges in university was non existent. One of my first lessons in how to work with this client group was a staff nurse pointing out a service user and telling me “He’s a PD. There’s nothing we can do for him”.
This chat aims to explore OTs views on the experience of working with people with personality disorder. Some points to consider consider:
-What preparation/training have you had for working with Personality Disorder? Was it enough?
-What are the challenges you experience/anticipate when working with Personality Disorder?
-How do you understand/formulate the difficulties people with PD present with?
-How relevant is OT in the area of Personality Disorder? Can we make a difference?
-How do we look after ourselves and colleagues when working in this area?
El-Gabalawy R1, Katz LY, Sareen J (2010) Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosom Med. 2010 Sep;72(7):641-7. doi: 10.1097/PSY.0b013e3181e10c7b. Epub 2010 May 27.
Kalira, V., Treisman, G.J. & Clark, M.R. (2013)Borderline Personality Disorder and Chronic Pain: A Practical Approach to Evaluation and Treatment Curr Pain Headache Rep (2013) 17: 350. doi:10.1007/s11916-013-0350-y
Sansone R, & Sansone L (2015) Borderline Personality in the Medical Setting Prim Care Companion CNS Disord. 2015 May 28;17(3). doi: 10.4088/PCC.14r01743. eCollection 2015.
Coid, J., Yang, M., Tyrer, P., Roberts, A. & Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry188 (5), 423–431.
Moran, P. (2003). The Epidemiology of Personality Disorders. http://www.dh.gov.uk (last accessed: 5.2.2016).
National Institute for Mental Health for England (2003). Personality Disorder: no Longer a Diagnosis of Exclusion. Policy Implementation Guidance for the Development of Services for People with Personality Disorder, Gateway Reference 1055. London: NIMH(E).
Raven C (2009) Borderline personality disorder: still a diagnosis of exclusion? Ment Health Today. 2009 Jun:26-31.
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