Personality disorder

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5276 (Published 10 September 2013)
Cite this as: BMJ 2013;347:f5276

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  1. Linda Gask, professor of primary care psychiatry1,
  2. Mark Evans, consultant psychiatrist in psychotherapy2,
  3. David Kessler, senior lecturer3
  1. 1Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
  2. 2Gaskell House, Manchester Mental Health and Social Care NHS Trust, Manchester, UK
  3. 3School of Social and Community Medicine, University of Bristol, UK
  1. Correspondence to: L Gask Linda.Gask{at}manchester.ac.uk

Summary points

  • People with personality disorder have a persistent pervasive abnormality in social relationships and functioning

  • Personality disorder is associated with high service use and excess medical morbidity and mortality

  • Diagnosis of personality disorder along a single dimension of severity is a major change from traditional categorical approaches

  • Depression, anxiety, substance use, suicidal behaviour, and suicide are all more common in these patients; comorbid mental health problems are more difficult to treat and have poorer outcomes

  • General principles of management include consistency, reliability, encouraging autonomy, and the sensitive management of change

  • Specialist treatments with evidence of effectiveness in borderline personality disorder include dialectical behaviour therapy, mentalisation based treatment, transference focused therapy, cognitive analytic therapy, and schema focused therapy

Most non-psychiatrists are aware of the diagnosis of personality disorder but rarely make it with confidence. In the past, this diagnosis came with a tacit admission that not much can be done, but there is now increasing evidence that treatment can be effective. Epidemiological studies show that 4-12% of the adult population have a formal diagnosis of personality disorder; if milder degrees of personality difficulty are taken into account this is much higher.1 People carry the label of personality disorder with them, and this can influence their care when they come into contact with services, including mental health providers. GPs also carry the clinical responsibility for their patients with personality disorder, and this can be challenging over the long term. This article aims to review the current evidence for the diagnosis and treatment of personality disorder.

Sources and selection criteria

We searched Medline, the Cochrane Database of Systematic Reviews, Clinical Evidence, and the database of the Centre for Reviews and Dissemination using the search term “personality disorder”. We focused mainly on systematic reviews, meta-analyses, high quality observational studies, and randomised controlled trials published in the past five …

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