Intended for healthcare professionals

Practice Clinical Update

Personality disorder

BMJ 2023; 382 doi: (Published 04 September 2023) Cite this as: BMJ 2023;382:e050290
  1. Orestis Kanter Bax, consultant psychiatrist in medical psychotherapy1 2,
  2. Dimitrios Chartonas, consultant psychiatrist2 3,
  3. Jennie Parker, independent lived experience researcher, KUF development lead25,
  4. Spyridon Symniakou, GP partner6,
  5. Tennyson Lee, consultant psychiatrist in medical psychotherapy, psychoanalyst, honorary senior lecturer2 476 8
  1. 1Basildon Complex Needs Psychotherapy and Personality Disorder Service, Essex Partnership University NHS Foundation Trust, UK
  2. 2Centre for Understanding Personality (CUSP), London
  3. 3Camden and Islington Personality Disorder Service, Camden and Islington NHS Foundation Trust
  4. 4Deancross Personality Disorder Service, East London NHS Foundation Trust
  5. 5Berkshire Healthcare NHS Foundation Trust
  6. 6Blithdale Health Centre, Clinical Director East End Health Network
  7. 7Institute of Psychoanalysis, British Psychoanalytical Society
  8. 8Wolfson Institute, Queen Mary University of London
  1. Correspondence to O Kanter Bax orestis.kanter-bax{at}

What you need to know

  • Personality disorders are a set of complex emotional difficulties. They are common, often unrecognised, and are associated with mental and physical health comorbidities and reduced life expectancy

  • Personality disorders are perceived as stigmatising diagnoses. Alternative terms have been proposed. New classification systems help in moving away from rigid use of categorical diagnoses

  • Assessment and management in primary care require a non-judgmental approach that builds trust through attentiveness, validation, openness, and consistency

  • Holistic care for people with personality disorders can be improved with reflective practice structures, staff training, collaboration, and team working

Sources and selection criteria

We searched Pubmed, Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, AMED, British Nursing Index, HMIC, and Health Business Elite using the term “personality disorder”. Findings from randomised controlled trials (RCTs), systematic reviews, and meta-analyses were ranked as high in quality (see table 1) and we also used our own reference archives, books, and expert contacts to supplement the structured search.

Personality disorders describe a set of long standing complex emotional difficulties, which are common, highly stigmatised, and potentially disabling. They are frequently under-recognised and may run a long course when people lack access to appropriate treatment. Recent developments in evidence, guidelines, and policy have placed an emphasis on public awareness, de-stigmatisation, training professionals in generalist settings, improving access to specialist care, and improving physical health outcomes.12 This article provides an overview of the latest information on the assessment and management of personality disorders in primary care, with an emphasis on borderline personality disorder (also referred to as emotionally unstable personality disorder).

What are personality disorders?

Personality disorders are pervasive and enduring, affecting the emotional, cognitive, and behavioural functioning of a person, expressed in relation to their self (eg, identity, self-evaluation, affect regulation, direction) and others (eg, intimacy, boundaries, sense of security in relationships). People with personality disorders may face difficulties with …

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