Rep36 Understanding Personality Disorder

particularly strong; Tyrer 
et al
., 1997), and
between the somatoform and anxiety disorders
and the Cluster C personality disorders. Beyond
these conclusions, however, there is little
evidence for specific relationships between
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31
disorders (Dolan-Sewell 
et al
., 2001). That is,
anxiety disorders are noted to occur at
significant rates not only with Cluster C
personality disorders but also with the Cluster B
disorders. In general, personality disorder is a
sensitive indicator of proneness to Axis I
disorders (including psychosis), although Cluster
A personality disorders reflect a more specific
proneness to psychosis (Dolan-Sewell 
et al
.,
2001). In order to maximise awareness about
possibly co-occurring conditions, professionals
are recommended to conduct comprehensive
assessments of clinical syndromes before making
diagnoses of personality disorder; the extent to
which Axis I symptomatology may influence
opinions related to personality disorder requires
clarification in many cases (Hart, 2001). 
3.1.5 Practitioners should focus on needs
formulation not simply diagnosis
The provision of effective treatment for
individuals with personality disorder requires the
ability to place their experiences in a contextual
and explanatory framework that can help to
Assessing personality disorder in clients with learning disability
Only a small number of studies have been carried out into the assessment and diagnosis of
personality disorder in individuals who have learning disabilities. Studies of prevalence suggest
that using structured forms of assessment, estimates approximately match those reported for
individuals without learning disabilities (e.g. Goldberg, Gitta, & Puddephatt, 1995; Khan, Cowan &
Roy, 1997; Niak, Gangadharan, & Alexander, 2002). However, a number of researchers have
questioned the usefulness of diagnostic systems with clients with learning disabilities, especially
those whose impairment is severe. Gostasson (1987) and Reid and Ballinger (1987), for example,
commented that the diagnostic criteria for personality disorder did not really apply to people with
severe learning disability and suggested instead that a typology based on developmental concepts
might be more useful. Similarly, Alexander and Cooray (2003) complained about the lack of
diagnostic instruments validated for use with clients with learning disabilities, problems with
agreement about the definition of personality disorder in this population, and the difficulty of
distinguishing personality disorders from other problems integral to intellectual impairment (e.g.
problems with communication or sensory perception). Consequently, Alexander and Coorey
(2003) recommended the development of more coherent and sensitive diagnostic criteria, and
encouraged the use of behavioural observations and informant information to supplement that
obtained in interview. 
The Royal College of Psychiatrists takes a more cautious view (Royal College of Psychiatrists,
2001). In a review of diagnostic criteria, the Royal College recommends that a diagnosis of
personality disorder should not be made in a person with severe and profound learning disability
and made only with caution in clients with less severe disabilities. Instead, discussion should focus
around personality presentation and the impact of personality traits on functioning. In general,
the use of multiple sources of information (e.g. information from structured interview, responses
to self-report questionnaires, interviews with carers and care providers, and behavioural
observations over time) are likely to offer the best opportunities to determine consistencies in
personality traits and dysfunction in clients with learning disabilities, with the level of reliance on
other sources apart from the client increasing proportionate to the level of disability.