Rep36 Understanding Personality Disorder

4.8
Attitudes to individuals with
personality disorder
Many individuals with personality disorder have
faced hostility and disbelief from mental health
service professionals. There has been a tendency
to deny these individuals access to services as
they were deemed untreatable. A very negative
approach to individuals with personality disorder
has developed form these attitudes. As a
consequence, people with personality disorder
tend to be wary and distrusting of health
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Users Perspectives
The contribution of service users is vital to the development a modern health service and is
consistent with current clinical governance frameworks. However, the views of individuals suffering
from a mental disorder have not been sought with the same vigour. In particular, individuals who
have a diagnosis of personality disorder have been almost excluded from discussions and
developments relating to their care and treatment. Only very recent attempts to include service
user perspectives in the debate about services for personality disorders have provided important
contributions to positive change in this area. 
For example, attempts have been made to include the perspectives of service users in the
development of the Policy Implementation Guidance for Services for People with a Personality
Disorder (e.g. National Institute for Mental Health in England, 2003). Focus groups of service users,
and discussions with organisations representing service users and carers were set up to contribute to
the policy guidance (Haigh, 2002). This process indicated that the diagnosis of personality disorder
carries a greater stigma than any other mental disorder, and that individuals may feel judged by both
professionals and society. It was generally felt by users and carers that many professionals did not
understand the diagnosis, and service users were left feeling that their difficulties were untreatable.
Focus groups were asked to identify aspects of mental health services they found helpful. The
following provision was described as helpful: early interventions, before crisis point; specialist
services that were not part of mainstream mental health services; being able to make choices from
a range of treatment options; the presence of therapeutic optimism and expectations of positive
change; care that is tailored to individual needs; skill acquisition as a key care task; the
encouragement of creativity; clear and negotiated treatment contracts; accepting, reliable, and
consistent care; care that focuses on education and personal development; a good link between
assessment and treatment; supportive peer networks; a care team that listens to feedback; a shared
understanding of boundaries; appropriate follow up and continuing care; an atmosphere of truth
and trust; and an attitude of acceptance and sympathy.

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services. In order to engage these people in
services it will be necessary to foster an attitude
of respect for their suffering and an approach
that recognises their dignity as fellow human
beings. Others may find the thinking, behaviour
and emotions of individuals with a diagnosis of
personality disorder difficult to comprehend and
they may feel angry, frightened or dismissive at
their actions. However, individuals with
personality disorder can respond to treatment
and if treated with dignity and respect, can come
to trust and work with professional staff. It is
important for professionals to provide a
personalised package of care designed to offer
the person an informed choice of possible
actions and encouragement to engage in a
process of change. This will not always be
successful and professionals may be challenged
by people who attempt to hurt or reject them in
order to maintain their emotional equilibrium.
The danger in this situation is that professionals
resort to stereotyping of the individual as
incapable of change, which can result in the
individual’s exclusion from services.