Personality disorder

Updated: 16/01/18

Shining lights in dark corners of people’s lives
Excerpt from the Consensus Statement for People with Complex Mental Health Difficulties who are diagnosed with a Personality Disorder

Today, increasing numbers of young people are demonstrating signs of distress. Studies reveal that less than half of adults experiencing mental health difficulties in childhood were offered appropriate interventions at the time. Current estimates suggest that 1-5% of adolescents in the UK could meet the diagnostic criteria for borderline personality disorder (BPD).

There is now evidence of a causal and proportionate relationship between Adverse Childhood Experiences (ACEs) (such as parental loss, exposure to domestic violence, physical, emotional or sexual abuse) and poor physical health, mental health and social problems in adult life. Work in Philadelphia, USA highlighted that 45% of children experience 4 or more ACE`s and when they were identified in schools, suitable interventions were offered early on to stop difficulties developing later. In a recent survey of adverse childhood experiences in England, 47% of the population reported experiencing at least one experience and 9% disclosed 4 or more.

Failing to recognise and address early warning signs in children and adolescents not only enable personality difficulties to perpetuate causing significant distress to the young person in the present, it also has considerable impact on long-term personal and societal outcomes. These young people can face:

– Increasing risk of depression and suicidality .
– Decreased psychosocial functioning
– Increased risk of criminality and substance misuse
– Poor educational and employment potential

The critical importance of childhood and adolescence in setting the course for a healthy adult life make it essential that early signs are recognised and effectively addressed.

The good news is that if we ask people routinely about adverse childhood experiences as part of an assessment or care review process, people tell us about their childhood experiences and then start to make sense of their current difficulties in the context of their childhood adversity.  A history of trauma is so common that we have placed special emphasis on it, but it is important to recognise that some people may have similar difficulties without this.

Current thinking suggests that when devising a specific early intervention programme, it is vital to recognise that need for treatment may not be dependent on diagnosis. In other words, better outcomes may result if we stop waiting for people to get bad enough to receive a diagnosis, before we offer them any help.

Early Intervention Programmes for younger people should follow a clinical staging model, i.e. a model which provides a level of intervention appropriate to the distress at the time. In this model, at risk individuals who are showing signs of distress should receive generic trauma informed psychosocial interventions, such as mental health literacy, psychoeducation and supportive counselling. However, if two or more clinical indicators are observed, specific evidence-based programmes such as Helping Young People Early (HYPE) must be prioritised. If severity increases, case management, family psychoeducation, and more intensive psychosocial interventions such as Dialectical Behavioural Therapy (DBT) or Mentalization Based Treatment (MBT) may need to be added to the intervention.

 

If you are supporting a young person with a personality disorder, it is likely that mental health services are already involved. Good inter-agency working can make a really positive contribution to good outcomes for young people.

 

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